Will insurance pay for spine surgery?


Quick Answer

While some insurance companies will completely cover the costs of spine surgeries, many insurance companies will also deny payment for spine surgery if they deem the surgery an unnecessary procedure. Different insurance companies cover different surgeries based on the severity of the condition, the cost of the surgery, and the patient's medical history.

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Full Answer

Different insurance companies have different policies on which types of surgeries they cover and refuse to cover. If the surgery is necessary for the health of the patient and the doctor goes through the proper paperwork, then often times the surgery will be covered. However, some of the reasons why an insurance company would refuse to cover a spine surgery would be that the company thinks the surgery is experimental with new equipment, that the patient has exceeded their benefit level, or simply that the surgery is not covered within the terms of the patient's policy.

The Affordable Care Act in 2010 required insurance companies to have an appeals process in place. This means that individuals who have been denied coverage for a spine surgery are able to appeal in hopes of being covered. A strong appeal case involves both the patient and the doctor providing evidence that the surgery is necessary to the health and well-being of the patient.

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