How much does back surgery cost with insurance?

Seeking Advice
1

I’ve been told I might need back surgery, and I’m trying to figure out how much it’ll cost with insurance. I know there are things like deductibles and co-insurance, but it’s all a bit confusing. Can anyone break it down in simple terms?

2

Sure!.So, first off, you’ll have to pay your deductible before insurance starts covering costs. If you’ve met your deductible, then insurance will start paying a percentage, like 80%, and you’ll pay the remaining 20%.

3

@Phoenix
Got it. And what’s this co-insurance thing I keep hearing about?

4

Murphy said:
@Phoenix
Got it. And what’s this co-insurance thing I keep hearing about?

Co-insurance is the amount you pay after meeting your deductible but before hitting your out-of-pocket max. So, if your deductible is $5k and your max is $7k, the $2k difference is your co-insurance.

5

FYI, make sure your surgeon is in-network with your insurance. If they’re out-of-network, your deductible and out-of-pocket max will be higher, and you’ll end up paying more.

6

Adi said:
FYI, make sure your surgeon is in-network with your insurance. If they’re out-of-network, your deductible and out-of-pocket max will be higher, and you’ll end up paying more.

Yeah, I learned that the hard way. Ended up paying way more because my provider wasn’t in-network. Always double-check!

7

Also, some insurance plans require you to try conservative treatments first, like physical therapy or pain management, before they’ll approve surgery. It’s a good idea to ask about that.

8

Payton said:
Also, some insurance plans require you to try conservative treatments first, like physical therapy or pain management, before they’ll approve surgery. It’s a good idea to ask about that.

Yup! My insurance made me do six months of physical therapy before they would approve my surgery.

9

Don’t forget about the pre-authorization. Your doctor’s office should handle it, but it’s a good idea to call your insurance to make sure everything’s squared away before the surgery.

10

Colby said:
Don’t forget about the pre-authorization. Your doctor’s office should handle it, but it’s a good idea to call your insurance to make sure everything’s squared away before the surgery.

Thanks! I’ll definitely call and confirm that before moving forward.

11

In the end, once you’ve hit your out-of-pocket max for the year, your insurance should cover 100% of the costs. It’s just getting to that point that can be pricey.