What is Neuromonitoring?
Neuromonitoring allows the real-time monitoring of your nervous system during surgery. This is an important part of the surgical tool set as it allows the surgeon to perform the surgery in the safest way possible. Although there are some surgeons who don’t utilize neuromonitoring, we have decided to utilize this safety tool in ALL surgeries in which there is risk to the nervous system to decrease the chance of a neurologic injury. To ensure consistency and safety, we have contracted with Velocity Neurocare and several neurologists to provide this service for our patients. Most insurance companies pay for this service as they see it as an essential part of the surgery. If your insurance company does not cover this service, you will be responsible for the out-of-network cost of this service. This can usually be negotiated and current market price for this service is $950.
Out-of-network charges can be intimidating and difficult to understand. We encourage you to call your insurance plan so that you may better understand the coverage your plan provides. Often, our services will be delayed for processing, due to the out of network designation for our services. If services are denied, our billing company will appeal these determinations and will provide medical justification to support the need for monitoring throughout your surgical care.
As a rough guide, we have included some guidelines that insurance companies have provided. Please call you insurance company so that you may better understand whether this is a covered benefit or not. If your insurance plan is not listed, please contact them to avoid any surprises. You may be responsible for payment applied to the deductible and/or co-insurance.
United Health Care
Usually, a covered benefit if you have out-of-network benefits. Depending on your deductible or co-insurance you might have a portion of patient responsibility. United Healthcare defines payment as according to the patient’s plan. Most UHC claims are being reimbursed according to the Colorado All-Payer Claims Database or the 60th percentile of the in-network rate of the Fair Health database. FAIR Health provides health care consumers with an estimate of how much out-of-network services will cost them. Health care consumers can access FAIR Health’s Consumer Price Lookup at http://fairhealthconsumer.org/.
Anthem / Blue Cross Blue Shield
Usually, a covered benefit if you have out-of-network benefits. Defines payment as according to the patient’s plan. Some Anthem BCBS plans are in network with the neuromonitoring providers we use. For out of state Anthem BCBS plans, the patient might receive the check, we ask that you please contact our office to receive directions on how to submit that payment to our office.
Cigna
Uses a multiplier of Medicare to establish allowed amount for reimbursement. That multiplier is specific to the patient’s plans. Cigna considers neuromonitoring for Lumbar surgery experimental and investigational. We will exhaust all efforts to bill and collect payment, however if our attempts are unsuccessful, you the patient will have a cost incurred to them for the patient’s responsibility. Cervical surgeries are usually covered by this plan.
Aetna
Considers neuromonitoring for Lumbar surgery experimental and investigational. However, if the patient has certain symptoms or Diagnosis, Aetna will consider coverage for lumbar cases. We will exhaust all efforts to bill and collect payment, however if our attempts are unsuccessful, you the patient will have a cost incurred to them for the patient’s responsibility. Cervical surgeries are usually covered by this plan.
Worker’s Compensation and Medicare Replacement Plans
Are both covered plans. There is Colorado State workers comp fee schedule for reimbursement. Medicare replacement plans are reimbursed typically at 100% of Medicare.
Medicare
The neuromonitoring company is reimbursed through the hospital or outpatient facility. The patient will not be responsible for any other payments or balance billing.
