How come (most) health insurance does not cover spinal fusions?

[dontcallmecass]

I have found that the most common reason for denied coverage is
1. a gap in your coverage. If you were uninsured 30 days in the past year, you may be denied benefits for a whole year after the fact for a preexisting condition.

2. the doctor you are seeing is out of network. If you have an HMO, they won't cover you at all. If you have a PPO, you may have coverage, but at a lower rate (eg 50% instead of 80%).

After graduation, take the COBRA for six months. Otherwise, you may find yourself in category 1. above. Hopefully, you will be gainfully employed within 6 months of graduation and will have your own insurance.

If you want to do the surgery before you graduate, you can do it over a summer semester and still be insured as a student. The 3 months off should give you adequate recovery time.

Also, I have to say I disagree with Debbei. You don't have to rush into this.

I hope this helps. If you or your parent calls Cigna, they should be able to tell you the reasons for denied medical coverage.

Best of luck.

p

thanks for your advice. i do have in fact an hmo

and i wish i didn't have to rush into this, but i'll be graduating in the fall of 2010, so in order to be completely insured, i'll be needing to do it this summer.

[pmsmom]

Thanks for this post.

My dh's carrier was just switched to Cigna.

Maybe it's in the way the doctor writes about the necessity for surgery?

Marian

[asccbodypro]

Thank heavens for our Military coverage and we live near a great military hospital with a great surgeon! It's hard enough to face this surgery let alone having to worry about paying for it. Good luck!

[Mom37]

check Scottish Rite or Shriners Hospitals no cost

I just have a question.

Does anyone know why this type of surgery not covered by most health insurance policy's/physicians. It just baffling to me that such an important surgery is not covered by most insurance policy's.

We went to both Shriner's and Scottish Rite for 2nd and third opinions and they did not charge anything. We did land up doing spinal fusion at Scottish Rite. They were excellent. We went to a second opinion due to rapid progression while braced. We chose Shriner's in Erie, PA as they also used the same Spincore brace as well as Boston hard brace the first doctor wanted us to use. They said no bracing would work and eventually in a couple to few years surgery would be needed. They paid for a hotel room for us in Erie. We went for a 3rd opinion at TSRHC (Scottish Rite). My insurance would cover (still lots of expense to us, but a fraction of the cost),but we were so impressed by Scottish Rite that we continued to go there. They went a step beyond the doctor I paid to see, and Shriners. They did an MRI and my daughter had a spinal cord issue. We were referred to one of the most experienced pediatric neurosurgeons and had surgery. Then had surgery at TSRHC when my daughter was able and needed surgery at no cost for all her orthopedic needs.

[txmarinemom]

Mom37,

She's too old to receive care at Shriners or TSRH. They treat kids under 19 - although I have heard of cases where they treated patients over 19 who were previously treated there when they were age-eligible.

This isn't an option for her.

Regards,
Pam