Kenneth Pettine, MD, a fellowship-trained spine surgeon and co-owner of the Loveland (Colo.) Surgery Center, lists five ways cash payments for spine surgery can help the patient and the ASC.
1. The patient gets coverage. It is very difficult to obtain insurance authorization for a patient who wants to have cervical or lumbar artificial disc replacement (ADR). For example, UnitedHealthcare and Blue Cross Blue Shield of Colorado do not cover these innovative procedures even after an exhaustive appeals process. "This situation is extremely frustrating to patients," Dr. Pettine says. After an insurance denial, the alternative of a cash payment is discussed with the patient in the surgeon's office. The offering "provides a needed alternative for motivated patients who want an alternative to fusion," he says.
2. An alternative to medical tourism. "We were noticing many patients were considering going to Germany or India where they could pay cash for an ADR," Dr. Pettine says. "We felt we could offer these patients a cash price similar to what they would pay overseas but allow them to have their surgery close to home by a surgeon they know and trust," he says. "Follow up is easier and more efficacious." By offering cash payments at a lower price, the center is providing patients "an alternative to obtain quality spine care otherwise denied by their insurance and avoid a trip overseas," he says.
3. The price is affordable for many patients. A cervical or lumbar ADR often costs around $50,000 if performed in the inpatient hospital setting. "Loveland has set cash prices for these surgeries that represent a 60 percent reduction from the hospital charges," Dr. Pettine says. The cash price includes the implants, surgeon, facility and anesthesiologist fees. "All this can be provided to patients at an affordable rate, still allowing ample profit margins," he says.
4. It may lead to insurance coverage. Following the procedure, Loveland Surgery Center bills all cash-paid surgeries to the insurance company. In a few cases, insurers have paid for the surgery even though they initially denied it, in which case the surgery center then reimburses the patient. "Once the precedent has been set, our experience is insurance companies continue to pay for the procedure even after an initial denial," Dr. Pettine says.
5. The ASC gets more volume. "Offering cash payments for all types of spine surgery helps the ASC by increasing volume and providing immediate and definitive payment," Dr. Pettine says. Although information on cash payments for surgery is not on the center's website, numerous patients have said they learned about this alternative on other websites or on Facebook. Nowadays people learn about offers like this not by "word of mouth" but by "word of the web," he says.
Learn more about Loveland Surgery Center.
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Surgery Center Best Practice: Clearly Communicate and Confirm Patient Financial Responsibility Prior to Day of Surgery
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1. The patient gets coverage. It is very difficult to obtain insurance authorization for a patient who wants to have cervical or lumbar artificial disc replacement (ADR). For example, UnitedHealthcare and Blue Cross Blue Shield of Colorado do not cover these innovative procedures even after an exhaustive appeals process. "This situation is extremely frustrating to patients," Dr. Pettine says. After an insurance denial, the alternative of a cash payment is discussed with the patient in the surgeon's office. The offering "provides a needed alternative for motivated patients who want an alternative to fusion," he says.
2. An alternative to medical tourism. "We were noticing many patients were considering going to Germany or India where they could pay cash for an ADR," Dr. Pettine says. "We felt we could offer these patients a cash price similar to what they would pay overseas but allow them to have their surgery close to home by a surgeon they know and trust," he says. "Follow up is easier and more efficacious." By offering cash payments at a lower price, the center is providing patients "an alternative to obtain quality spine care otherwise denied by their insurance and avoid a trip overseas," he says.
3. The price is affordable for many patients. A cervical or lumbar ADR often costs around $50,000 if performed in the inpatient hospital setting. "Loveland has set cash prices for these surgeries that represent a 60 percent reduction from the hospital charges," Dr. Pettine says. The cash price includes the implants, surgeon, facility and anesthesiologist fees. "All this can be provided to patients at an affordable rate, still allowing ample profit margins," he says.
4. It may lead to insurance coverage. Following the procedure, Loveland Surgery Center bills all cash-paid surgeries to the insurance company. In a few cases, insurers have paid for the surgery even though they initially denied it, in which case the surgery center then reimburses the patient. "Once the precedent has been set, our experience is insurance companies continue to pay for the procedure even after an initial denial," Dr. Pettine says.
5. The ASC gets more volume. "Offering cash payments for all types of spine surgery helps the ASC by increasing volume and providing immediate and definitive payment," Dr. Pettine says. Although information on cash payments for surgery is not on the center's website, numerous patients have said they learned about this alternative on other websites or on Facebook. Nowadays people learn about offers like this not by "word of mouth" but by "word of the web," he says.
Learn more about Loveland Surgery Center.
Related articles on cash payments from patients:
Surgery Center Best Practice: Clearly Communicate and Confirm Patient Financial Responsibility Prior to Day of Surgery
Surgery Center Best Practice: Send a Letter Prior to Service
7 Ways to Ensure Payment Without Damaging Patient Relationships