Does Medicare cover surgery at Laser Spine Institute?

lsi-logo_social_logoDetermining what procedures and services your medical insurance will cover can be confusing. Coverage seems to be different everywhere you go. At Laser Spine Institute, we are devoted to ensuring our patients receive the best care possible. So when you asked about Medicare coverage, we listened.

We sat down with Clay Grossman, Laser Spine Institute’s Vice President of Patient Financial Services, to help answer your questions.

Q: Is Laser Spine Institute in contract with Medicare?

A: Laser Spine Institute is in contract with Medicare for the professional services provided by the physicians.  However, we are not in contract with Medicare for the facility fee for services provided for the Laser Spine Surgery Center. Medicare does not allow for reimbursement for Ambulatory Surgical Center (ASC) facilities for spine surgery.

Q: Why does Medicare not cover the Laser Spine Institute facility?

A: Medicare does not cover surgery center fees because we perform surgeries in an ASC as opposed to a hospital. Medicare does not allow for reimbursement for ASC facilities. As a result, patients with Medicare are responsible for fees incurred for the facility. Our cutting-edge facilities are equipped with state-of-the-art equipment and amenities. More than 11 percent of patients who visit Laser Spine Institute are patients who use Medicare for insurance coverage.

Q: Will my secondary insurance cover my procedure?

A: Because Laser Spine Institute isn’t in contract with Medicare for the facility fee, the claim will not be denied because a bill will not be submitted. This means that your secondary insurance will not be able to step in to cover the remaining balance.

Q: Will Medicare ever cover Laser Spine Institute’s Ambulatory Surgical Center (ASC) costs?

A: Currently, Medicare does not recognize Laser Spine Institute’s procedures on its ASC list and does not offer reimbursement. Laser Spine Institute’s success rate and high outcomes are helping us to gain recognition. We hope that Medicare will one day reimburse for such procedures in an outpatient setting.

Laser Spine Institute is continually working to educate Medicare and other payers about our minimally invasive spine surgeries. Each time we enter into an agreement with an insurer, it is important that Laser Spine Institute’s costs be covered. Proper reimbursement for our procedures enables Laser Spine Institute to deliver the best quality of care to our patients. Compromising that care is a concession that Laser Spine Institute is not willing to make. Patient care and satisfaction will always be at the forefront of every decision we make.

We are proud of the quality of care that we provide to our patients and are continually working to further improve that standard. We have worked diligently to find other forms of financing for our patients, which include Compass and Care Credit.  There are many financing options available.  Please do not hesitate to contact us to ask for more details.

Q: Why do some doctors not accept Medicare?

A: There is a trend among some medical practices to stray away from Medicare. This is not the case with Laser Spine Institute. We work with many insurance companies and are continually looking for ways to make our procedures more accessible to patients.

What you need to know about Medicare:

  • Because Medicare regularly reduces what it reimburses, physicians earn less for procedures and office visits.
  • Many medical facilities and doctor’s offices are waiting long periods of time to receive reimbursement from Medicare.



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