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Does Medicare Pay For Laser Spine Surgery

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Medicare Coverage For Surgical Procedures

Does Medicare Cover Cataract Surgery?

Medicare generally doesnt cover the costs associated with laser spine surgery. However, Medicare benefits will cover inpatient and outpatient surgery when deemed medically necessary by your healthcare provider.

Work with your doctor in advance to confirm whether or not your specific surgical procedure is covered. Once you verify Medicare benefits will apply, refer to Part A if you will be formally admitted into a hospital or Part B if you are having outpatient surgery.

TIP: Get to know Medicare better with our introduction to coverage options and plans.

How To Know If Your Laser Back Surgery Cost Is Covered By Insurance

Since laser back surgery is newer and less well-known than more traditional forms of back surgery, many people who could benefit from the procedure worry that their insurance will not cover it. This is a deterrent, as laser back surgery cost – like the cost of any surgery – can be quite high without insurance coverage. For the most part, laser back surgery is covered by insurance for patients who need it. Below, we’ll explore the factors involved in determining whether the surgery is covered.

Finding a Provider

It is essential to find a provider who accepts your health insurance in order to get coverage and keep your laser back surgery cost to a minimum. Most providers list this on their websites you can also call to find out. Your insurance provider may also furnish a list of local surgeons who accept your plan. If you have a PPO plan, you will also need to be careful to ensure that the doctor you choose is in-network.

How Much is Covered?

Although most people will find that laser back surgery is covered by their insurance, each individual’s laser back surgery cost may vary based on:

  • Size of their deductible
  • Size of their limit on out-of-pocket expenses
  • How much of the deductible and out-of-pocket limit has been used so far this year
  • Percentage of procedures and medication covered by their insurance
  • For some plans , how much the insurance will reimburse for the type of procedure
  • How extensive the surgery is

Will My Insurance Company Cover My Laser Back Surgery Cost

Laser back surgery is an extremely cutting-edge procedure. During this type of surgery, a surgeon uses a fiber optic camera and a laser probe to treat common spine conditions, like herniated discs, without actually opening up the spine. It is highly effective and safe, with a short recovery time and a low risk of side effects. Because the procedure is so cutting-edge, many people worry that the laser back surgery cost may be out of their price range, and that it may not be covered by insurance. Fortunately, most people are able to get insurance coverage and manage their laser back surgery cost without any issues.

Your Portion of the Costs

If your doctor determines that you need laser back surgery to treat your chronic back pain, your insurance should cover the procedure as long as it is performed by a doctor who accepts your insurance. However, insurance coverage varies widely from person to person. Some insurance plans offer comprehensive coverage, with no deductible or out-of-pocket costs. Other insurance plans have a high deductible and out-of-pocket costs, with patients shouldering a large portion of the cost burden until a certain amount is reached. Most insurance plans fall somewhere in between these two extremes.

To understand what to expect for your portion of the cost of laser back surgery, you need to have a strong understanding of your insurance coverage. For example, how big is your deductible, and how much of it have you used so far this year?

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What Does Medicare Pay For Vision Care

Original Medicare coverage excludes routine eye exams. The only coverage you will receive for vision though Medicare is to treat conditions like glaucoma, detached retinas, and cataracts.

Glaucoma is an eye disease that affects your optic nerve, resulting in vision loss. A detachment of a retina happens when the retina tears away from the underlying tissue.Certain health conditions or some form of trauma can lead to this severe injury. If a detached retina is not corrected with surgery, it can ultimately lead to permanent vision loss.

Cataracts cause a cloudy lens over your eye that can cause blurry eyesight. Certain chronic conditions like cataracts require surgery to repair the eye. In a situation like this, Original Medicare will extend coverage to the lens replacement surgery. The doctor will remove the existing cataract and replace it with a manufactured lens.

Medicare covers a pair of eyeglasses or contact lenses when you have replacement surgery. In this case, Medicare will also cover exams to diagnose vision issues you may be experiencing due to an eye ailment.

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Medicare will provide coverage if you have diabetes or if you are at a high risk for glaucoma. But, if you are not high-risk, paying out-of-pocket could be a requirement.

Does Medicare Cover Medical Devices

Spinal Cord Stimulator Treatment for Failed Back Surgery

Medicare Part B helps cover the cost of medically necessary durable medical equipment if your doctor prescribes it for use in your home. Your copays and deductibles will still apply.

There is a long list of items covered, including:

  • Continuous Glucose Monitors examples include Dexcom and Libre
  • Insulin pumps and supplies
  • Before renting or purchasing any medical equipment, be sure to ask if the retailer or supplier participates in Medicare. Medicare will only provide coverage through suppliers who participate in the Medicare program.10

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    Why Choose Minimally Invasive And Endoscopic Spine Surgery At Vanderbilt

    • Recognized care

      BlueCross BlueShield named us a Blue Distinction Center for high quality spine surgery care. And Beckers Healthcare included us on its list of 100 hospitals with great neurosurgery and spine programs.

    • Advanced care

      Our experts are among few nationwide with specialized training in endoscopic spine surgery, an advanced form of minimally invasive surgery. Our surgeons can treat cervical, thoracic and lumbar conditions ranging from disc herniation to stenosis and even fusions endoscopically. We tailor treatment techniques to our patients’ needs based on the latest research.

    • Personalized care

      We tailor your treatment plan to meet your unique needs and health goals. And, unlike any other spine center in the region, we carefully track how our surgical patients are doing years after treatment. We use the information we gather to improve how we care for patients every day.

    • Telehealth

      We can offer specialty care through a simple video consultation with your doctor. This means you have access to a Vanderbilt specialist, close to home.

    What Does Medicare Part C Cover

    Medicare Part C is also known as Medicare Advantage. Medicare Advantage plans are provided by private companies with approval from Medicare. These plans include all your Part A and Part B coverage and often provide extra coverage for services not included in Original Medicare. Medicare Advantage plans may offer coverage for vision, hearing, dental and wellness services. Many Medicare Advantage plans also provide prescription drug coverage .5

    Recommended Reading: When Can I Switch From Medicare Advantage To Medigap

    Does Medicare Cover Back Surgery

    • Find out if Medicare covers back surgery and learn what other options might be available to help you pay for out-of-pocket expenses related to your treatment.

    Back surgeries are expensive. According to a study published by Statista, the average spinal fusion surgery cost $110,000, as of 2019. It goes without saying that most Americans are unable to foot the bill upfront themselves. Find out below if Medicare covers back surgery and how much coverage you might be eligible for.

    Cataract Surgery Cost And Coverage With Medicare

    The 2020 CMS payment reduction for cataract surgery. The systemic problem and proposed solutions.

    Medicare covers both types of cataract surgery equally. Your eye doctor will help you determine which is better for you during an eye exam.

    The different plans of Medicare come into play at various points of your cataract surgery journey and provide coverage for different expenses, while working together to help you walk away from your procedure with the lowest cost possible.

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    Cataract Surgery: Is It Medically Necessary

    Medicare will only cover your cataract surgery if it is deemed as being medically necessary. In the majority of instances, procedures like cataract surgery will be deemed medically necessary. However, it will be useful to make sure that this is the case before you proceed with the surgery. Otherwise, if you discover that Medicare will not pay for it after the fact, it could put you in a real financial bind.

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    Estimating Your Costs For Medicare Cataract Surgery

    The services you need can vary, so the costs will depend on your specific circumstances. But you can get an idea of your estimated cost by following these steps:

  • Find out whether youll be inpatient or outpatient for the surgery. This impacts how you will pay.
  • Verify that the doctor and facility youll use accept Medicare.
  • Ask your healthcare provider what you should expect to pay for the surgery.
  • Find out which prescriptions you may need afterward. If you have Medicare Part D, check your formulary for the cost of these drugs.
  • Verify coverage with any additional insurance providers. For example, you might have benefits with Medicaid or a spouses employer.
  • Check your deductibles or out-of-pocket limits. Youll need to meet the deductible before your coverage begins. If you have an out-of-pocket limit, you wont pay anything past that amount.
  • Also Check: Can You Qualify For Medicare Before 65

    What Are The Benefits Of Laser Spine Surgery

    With laser spine surgery, there is less risk of infection, blood loss, and potential injury to your back muscles and soft tissue than with traditional open surgery. Because the procedure is less invasive, your hospital stay and recovery time in general should be shorter. Additionally, surgeons are continually evolving the techniques used for minimally invasive spine surgery to treat patients with more accuracy and fewer complications.

    To find out if your back or neck pain could be treated by laser spine surgery, contact Premier Spine Institute. Dr. Ngu is practiced in using minimally invasive techniques to address a variety of conditions that can cause you discomfort.

    Medicare Advantage Cataract Help

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    A Medicare Advantage plan is a private insurance plan that replaces your Medicare Part A and Part B benefits. Some Medicare Advantage plans offer additional routine vision benefits, but at the very least all of these plans must cover services that are equal to Medicare Parts A and B.

    Your share of the cost will depend on your plan, but your contribution never exceeds your out-of-pocket maximum . Refer to your annual Summary of Benefits and Coverage to see your plans particulars.

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    What Are Cataracts And How Do They Affect Vision

    According to the National Eye Institute, a cataract occurs when the lens of your eye becomes cloudy. The lens is the clear part at the front of the eye that helps you to focus on an image. When functioning normally, light enters your eye through the lens and passes to the retina, which then sends signals to your brain that help you process what you see as a clear image. When the lens is clouded by a cataract, light doesnt pass through your eye to your retina as well, and your brain cant process images clearly, resulting in blurry vision.

    Cataracts can occur in one or both eyes, but they cannot spread from one eye to the other. Your chances of developing cataracts increase significantly with age.

    Some people develop cataracts at a much younger age, such as in their 40s or 50s. However, these cataracts tend to be smaller in size and do not usually affect vision. In general, people dont experience vision problems from cataracts until they reach their 60s.

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    Does Medicare Cover Nursing Homes And Long

    Original Medicare generally doesnt cover the cost of a nursing home, assisted living or long-term care facility. Medicare Part A does cover care provided in a skilled nursing facility .

    If you qualify for it, Medicaid, which is administered by states under federal guidelines, may cover nursing home care. You may need to exhaust your personal resources on medical care before you are eligible.

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    Does Medicare Cover Laser Cataract Surgery

    Cataracts are unfortunately a very common part of getting older. In fact, over half of Americans will develop cataracts, or need cataract surgery by the time theyre 80.

    When they first form, you probably wont even notice them. However, over time, they will start to affect your vision. It may get to the point where they affect your daily activities. If you dont treat cataracts, they can lead to vision loss. So its better to do something about them sooner rather than later.

    The treatment for getting rid of cataracts is surgery. While sometimes a surgeon will use surgical tools for this surgery, using lasers is another option.

    So a common question many people have is, Does Medicare cover Laser Cataract Surgery? In this article, we answer this question in clear, plain English. You will also find the average costs of laser cataract surgery, as well as other helpful info.

    How Much Does Medicare Cataract Surgery Cost With No Extra Coverage

    Medicare Advantage Requiring Prior Authorization for Cataract Surgery?

    According to Healthcare Bluebook, a fair price for cataract surgery would cost $4,366.1

    Medicare Part B covers 80% of standard surgery once you meet your annual deductible.

    For example, say you need cataract surgery on one eye, and it costs $4,366 for the standard procedure. You would need to pay 20% after you meet your deductible. The table below gives a breakdown of the costs:

    Cataract Surgery
    $233 $1,059.60

    The cost of your surgery will depend on several factors including the type of intraocular lens you get, the technology used, and the surgeon who performs it.

    If you undergo laser cataract surgery, you will likely need to pay the added costs yourself. This is also the case if you receive a premium toric IOL for astigmatism or a presbyopia-correcting IOL.

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    Does Medicare Cover Laser Back Surgery

    Good news for seniors who have put off treating neck or back pain because of cost: Physician Partners of America is one of the few healthcare providers that accepts Medicare for minimally invasive laser spine procedures.

    These procedures typically cost patients thousands of dollars without Medicare or insurance coverage.

    With most laser spine surgeries, the surgeon and the surgical facility are billed separately. Physician Partners of America accepts traditional Medicare for both the physician and the facility, allowing the procedure to be become more affordable for Medicare patients.

    No one should be forced to live with excruciating pain because they cant afford surgical intervention, said James St. Louis, D.O., MS, director of PPOAs Minimally Invasive Laser Spine Group. We are pleased to be able to make this life-changing option to our patients very affordable.

    What Is The Biggest Disadvantage Of Medicare Advantage

    Medicare Advantage can become expensive if you’re sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient’s choice. It’s not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.

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    Laser Spine Surgery Performed By Experts

    Dr. St. Louis, the surgical founder of Laser Spine Institute in Tampa, Fla., joined PPOA in January. Phillip Kravetz, M.D., another pioneer in the field, will perform these procedures in Texas.

    Minimally invasive laser spine procedures are fast becoming the gold standard for addressing severe spine-related pain. Minimally invasive refers to the small incision and tiny instruments used to perform a procedure. Narrow dilation tubes are fed through the incision to spread the muscles surrounding the back. In contrast, traditional open back surgery uses a five- to six-inch incision. Through this a surgeon must cut and tear muscles to reach the spine.

    The laser is mainly used for ablations and disc work.

    Laser spine surgery isnt the only way PPOA ensures a good patient outcome. Its surgeons also use intraoperative neuromonitoring to further ensure safety of the patients neural system during the operation. IONM can see what neither the doctor nor the fluoroscopy machine can, and it helps avoid accidental injury.

    The methods used in PPOAs minimally invasive laser spine surgery allow for a totally outpatient procedure. Most patients are able to walk out of the surgery center the same day, and resume activities in days or weeks, as opposed to months with traditional surgery.

    Common Conditions That Can Be Treated Through Laser Spine Surgery

    The Robotic Spine Institute

    Thanks to technological and medical advances, physicians are now able to treat a number of common back and neck conditions with laser spine surgery, which is often less painful and heals more quickly than traditional open spine surgery.

    Laser spine surgery, or minimally invasive spine surgery , is performed without making a long 5- to 6-inch incision on your back, which used to be commonplace in back surgery. The procedure is still generally reserved as a last result, though, when other nonsurgical treatments, such as physical therapy and epidural injections, have not alleviated pain and discomfort in your back or neck, according to the American Academy of Orthopaedic Surgeons.

    If your doctor can pinpoint the precise location or source of your pain, then he or she can use a minimally invasive laser technique to address the issue. During the surgery, your doctor will access your spine by making small incisions using specialized instruments. One of laser spine surgery’s primary benefits is that it can be performed as an outpatient procedure, without a lengthy hospital stay.

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