Does NYSHIP Cover Spine Surgery?

Herniated discs, degenerative disc disease, and sciatica are some examples of conditions that can cause debilitating back pain. Sometimes, symptoms from these conditions can improve with nonsurgical treatments and therapeutic injections. However, when those kinds of treatments stop working, surgery on the spine may be the only option for relief.
An orthopedic surgeon from NJ Spine & Orthopedic may suggest a spine surgery to relieve you of pain and help you regain mobility. However, not only do the surgery and prosthetics have to be paid for, but you’ll also need physical therapy, home care, medical equipment, medical supplies, and medication for recovery. Does NYSHIP cover the costs related to spine surgery? We can help you answer any potential insurance or treatment questions.

Does NYSHIP Cover Spine Surgery?

Orthopedic specialists only recommend surgery when all treatment methods are exhausted when trying to relieve your pain and give you back the ability to work and enjoy activities. However, a surgeon can perform minimally-invasive spine surgery without admitting you to the hospital. 

NYSHIP does cover most of these outpatient surgery arrangements. However, there are associated copays if you select an in-network surgeon to do the surgery or a coinsurance cost if you select an out-of-network provider. With an in-network surgeon, these are the copays that you will be expected to pay:

  • $20 for the orthopedic surgeon’s fee if the provider bills separately from the facility
  • $20 ambulatory facility fee if you have the surgery done in a medical office
  • $30 facility fee if the surgery is done in a non-hospital outpatient surgical center
  • $60 outpatient facility fee if a surgeon does the surgery in a hospital outpatient surgical center

For patients who select an out-of-network surgeon, coinsurance percentages will have to be paid instead of copays. For example, surgery done in an office setting has a coinsurance cost of 20%, with another 20% for the surgeon if the surgeon bills separately from the facility. However, in a hospital outpatient surgical center, the coinsurance cost is only 10% or $75, whichever is greater.

What Else Does NYSHIP Cover?

If you have conditions like herniated discs or degenerative disc disease and need discs replaced with prosthetic metal and plastic discs, these can be paid for in full through network providers. For rehabilitation and physical therapy needs after the surgery, NYSHIP covers physical therapy and chiropractic services through the Managed Physical Medicine Program.

Medically necessary outpatient rehabilitation services after surgery will only cost you a $20 copay for every visit with an in-network provider. However, visits with an out-of-network provider will result in a 50% coinsurance cost for office visits under the Managed Physical Medicine Program. 

What About Recovery Care and Medications?

Minimally-invasive surgery patients tend to recover faster than open spine surgery because less soft tissue is injured during the process. However, it’s still going to take most individuals about six weeks to be able to walk and return to normal daily care activities. During this recovery time, you may need home care services, medication, medical equipment, and medical supplies to help with the recovery phase.

Home care is essential when recovering at home. Because you won’t be able to assume your normal daily care activities, you’ll need someone to provide food, keep you clean, and tend to your wounds. Even if you don’t live alone, having a home care provider might benefit your care. With NYSHIP, home care services, durable medical equipment, and certain medical supplies are paid in full through the Home Care Advocacy Program (HCAP).

Medical equipment like a cane, walker, heating pads, or back brace will help in the recovery process. In addition, medical supplies and medications such as ice packs, laxatives, and pain medication will be necessary.

Consult With the Spine Specialists at the Nearest NJ Spine and Orthopedic Office and Get Relief for Your Pain Today!

Now that you know that NYSHIP covers spinal surgery, the NJ Spine & Orthopedic surgeons can help relieve your pain and return your mobility with minimally invasive surgery. With NYSHIP, you can get your surgery and the things you need to put you on the path to recovery.

The surgeons and doctors at NJ Spine & Orthopedic specialize in minimally-invasive surgery and pain management. If you are experiencing severe back pain and lack mobility, call us at (866) 553-0612 or complete our contact form to relieve your pain and get you moving again.

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