Does Insurance Cover Scoliosis Surgery and What to Expect

Many people are concerned about the cost of scoliosis surgery, but the good news is that most insurance plans cover it.

Most insurance plans, including Medicare and Medicaid, cover scoliosis surgery as a medically necessary procedure.

The extent of coverage varies depending on the insurance plan and the specifics of the case, but in general, patients can expect to pay a portion of the costs out-of-pocket.

In some cases, insurance may cover the full cost of the surgery, including hospital stays and rehabilitation.

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Insurance coverage for scoliosis surgery can be complex, but most insurance plans cover the diagnostic tests required to confirm scoliosis, such as X-rays or MRI scans.

Commercial insurance plans have varying levels of coverage for scoliosis treatment, with children and adolescents mostly covered, young adults more restrictive, and adults limited or requiring justification.

Medicare covers scoliosis treatment for medically necessary cases, while Medicaid coverage varies by state.

To determine what your insurance will cover, you can call the number on the back of your health insurance card and ask about your coverage for chiropractic and physical therapy services.

You may need to provide a list of CPT codes, which are numerical descriptors used to identify various healthcare services, to your insurance company to determine coverage.

Some treatments for scoliosis may require preauthorization from the insurance provider, which means the treating physician needs to obtain approval from the insurance company before proceeding with certain treatments.

Pre-approval processes might be involved for certain treatments and age groups, and the severity of scoliosis plays a significant role in determining coverage.

Here's a summary of insurance coverage patterns:

It's essential to consult with a doctor and review specific insurance policies to understand individual coverage options.

Most health insurance policies cover back surgery when it's medically necessary, but the cost can be high, exceeding $100,000 for a typical back surgery.

To make insurance coverage work most efficiently, it's crucial to keep your address and contact information updated, check your policy before you arrive, and inform your doctor's office about any lapses in premium coverage.

Government programs like Medicaid and Medicare can cover scoliosis treatment, but the specifics vary.

Medicare typically covers bracing, physical therapy, and surgery for scoliosis deemed medically necessary in individuals aged 65 and older.

For individuals covered by Medicaid, coverage for scoliosis treatment may differ from private insurance plans and have specific guidelines and requirements.

Medicaid coverage for scoliosis treatment varies significantly across states, with some states offering comprehensive coverage and others having stricter eligibility requirements and limitations.

Most states provide coverage for children and adolescents with scoliosis, while coverage for adults might be more restricted.

Here's a summary of the general coverage patterns for different age groups:

The total cost of scoliosis surgery can be a shock to many patients. It's not just the procedure itself, but a multitude of other factors that contribute to the overall cost.

Pre-surgical tests, including bloodwork, imaging studies, and bone density testing, can add up quickly. Your spine surgeon will require these tests before you're cleared for surgery.

The surgical team, including the lead surgeon, anesthesiologist, and support staff, also factor into the cost. The surgical procedure itself is typically billed separately. Surgical supplies, such as disposable instruments and materials, are also factored into the overall cost.

Hospital stay, which typically lasts 4-10 days, is another significant cost. This includes your room, staff care, and food. Physical therapy, which is often considered an integral part of the recovery process, can also add to the overall cost.

Here are the estimated costs of some of the factors that contribute to the overall cost of scoliosis surgery:

Your insurance may cover some or all of these costs, but it's essential to understand what you'll be responsible for paying out of pocket.

When you're dealing with healthcare costs, it's essential to understand the concept of in-network providers. Insurance plans often have a network of preferred providers, and seeking treatment from providers within this network can help minimize out-of-pocket costs.

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If you stick to in-network providers, you can expect lower deductibles and co-payments. This is because your insurance plan has negotiated discounts with these providers.

However, coverage for out-of-network providers may still be available, albeit with higher deductibles or co-payments. This means you'll have to pay more out of pocket if you choose to see a doctor outside of your network.

Here's a breakdown of what you can expect with in-network and out-of-network providers:

Keep in mind that some insurance companies are obligated to provide coverage for out-of-network services at the same level as they cover in-network services, but you'll need to check with your insurance company to confirm this.

Pre-surgical tests can drive up the cost of scoliosis surgery, including bloodwork, imaging studies like CT scans and X-rays, MRIs, and bone density testing.

The surgical team is another factor, with costs adding up for the lead surgeon, anesthesiologist, and support staff like OR nurses and surgical techs.

The surgical procedure itself is typically billed separately, adding to the overall cost.

Surgical supplies, such as disposable items like scalpel blades and suture material, also contribute to the total cost.

Medications, including anesthesia, pain medications, and anti-inflammatories, are another expense to consider.

Surgical implants, like plates, screws, and rods, can be a significant added cost, especially if allograft material is needed for the "fusion" aspect of the surgery.

A hospital stay of 4-10 days after surgery will include costs for the room, staff, and food.

Physical therapy is often required after surgery to strengthen muscles and increase flexibility, and can be a significant additional cost.

Post-surgical bracing, while not always necessary, can be expensive if custom-made, and may not be covered by insurance.

If you're denied coverage for scoliosis surgery, your next step is to appeal the decision of the insurance company.

Your doctor can provide you with a Letter of Medical Necessity explaining why the surgery is necessary.

You'll also need copies of your clinical records to support your appeal.

It's essential to directly address the reasons why the insurance company denied coverage for the surgery.

If the reason is because the treatment is not covered under your plan, it can be challenging to formulate a successful appeal.

By being proactive and working closely with your insurance company, you can navigate the process and find coverage for your scoliosis surgery.

Insurance coverage for scoliosis treatment can vary greatly depending on the type of insurance plan and the specific treatments needed.

Some insurance providers may not cover certain scoliosis treatments, such as the CLEAR Scoliosis Treatment, due to a lack of documentation or proof of its effectiveness. This was a concern raised by Anne Hayness in 2018, who pointed out that Medicare and Mutual of Omaha did not cover the CLEAR txs despite their potential to make changes and corrections.

If you're considering chiropractic services for scoliosis, it's essential to check your insurance coverage and the qualifications of your doctor. Francesca D. Manheim, for example, had to deal with the issue of her doctor only accepting Blue Cross insurance, despite being certified to provide chiropractic services.

Here are some possible insurance options to consider:

Keep in mind that insurance coverage can change, and it's always a good idea to check with your provider for the most up-to-date information.

Medical insurance coverage for scoliosis treatment can vary depending on several factors.

The type of insurance plan you have can affect what treatments are covered. For example, if you have a plan that includes chiropractic services, you may be able to get coverage for chiropractic care.

Anne Hayness, a commenter on a blog post, noted that Medicare and Mutual of Omaha do not cover the CLEAR scoliosis treatment, despite its proven effectiveness.

Francesca D. Manheim, another commenter, had a similar issue with her Affordable Care Act plan covering chiropractic services, but her doctor only accepted Blue Cross insurance.

If you're considering the CLEAR scoliosis treatment, it's essential to check your insurance coverage beforehand. Some clinics may not bill insurance for the treatment, as L Collins discovered.

Here are some possible reasons why insurance may not cover the CLEAR scoliosis treatment:

It's crucial to discuss your insurance coverage and options with your healthcare provider before starting any treatment.

After scoliosis surgery, your child's spine should look significantly straighter, although some curve will still remain.

It takes at least 3 months for the spinal bones to fuse together well.

Fusion is a permanent process that stops growth in the spine, but this is usually not a concern as most growth occurs in the long bones of the body, such as the leg bones.

Children who have this surgery will likely gain height from both leg growth and having a straighter spine.