I'm confused... I thought all surgery was elective unless it's considered an emergency (ie - cauda equina, car accident, fall, etc).

So does that mean your insurance will not cover even if a surgeon says you are a candidate?

Any help would be great... Dave!

To me elective surgery is if you are getting a face lift or something like that. If you have a medical problem and the dr. says you need surgery, it is not elective. Elective is something you don't need but choose to have. I had gastric bypass that some consider elective. I considered life saving since I had high blood pressure and diabetes etc. All gone since having the surgery. These days most insurance companies make the surgeon get pre-approval before any surgery is done.

Thanks Hessie... let me clarify... the 1st neurosurgeon I saw said he would like me to wait but that if I continued to have flares-ups & I asked him to do the surgery, he would do it. From everything I've read on these boards this is usually the case for back surgery (ie that the patient decides when to have surgery & not the Doc unless an emergency).

However, the 2nd neurosurgeon's PA whom I just saw for a prelim exam to get an updated MRI, stated that the only way he would do surgery (and my insurance would pay for it) is if I had a flare up & upon examination they dertermined newly damaged nerves, then they would do emergency surgery.

Obviously, I will meet with the Doc after the updated MRI & see what he says but the PA's position just seems different then most peoples Doc's on these boards.

Take care... Dave!

Hi: I had lumbar fusion surgery and it was considered elective. I was told it becomes non-elective once it's an emergency/life threatening. My surgery was canceled several times by the hospital because it's a level 2 trauma center, and when they have emergencies all elective surgeries are on the list for cancelation. I had a PLIF with rods and screws, repair of stenosis and lamina with facet joint procedure (can't remember the name). My insurance covered it, but there are some elective procedures they don't, like plastic surgery, so it may depend on your insurance, or how they word it.

That makes sense... thanks Desert!

Glad I could help... Are you worried about the insurance covering the surgery or the date/timing of the surgery?

To add to what I already said, I was in a situation where I was going to loose 4 units of blood when the hospital canceled my surgery, so I asked the Dr if there was any way to prevent the cancelation so I wouldn't loose all the blood I donated, and he said no, because the emergency surgery that canceled mine was a large transit accident, and my situation didn't compare. He also added, yes you need this surgery asap and it's an inconvenience for you and me, but you won't die tomorrow if you don't have it, you'll just loose all the blood you banked. He sounds really callous, but he really isn't, he just tells it the way it is. With this particular hospital it happens often where surgeries that are considered elective are canceled. I talked to a patient that this happened to that was having by-pass surgery, and they made him wait too because his particular situation wasn't *immediately* life threatening, same thing with a cancer patient that had to have a malignant growth removed from her spine.

Once my insurance approved the surgery the first time, I didn't have to get reapproval because of the 2 cancelations.

My insurance considers any elective surgery as non-emergency surgery, and then there are elective procedures that they don't cover at all.:wave:

Hey Dave,

Hope you are having a pain-free day. Maybe you should call your ins. and ask them about your concerns? It wouldn't hurt to ask and it might help you feel less nervous about it. Just adding my 2 cents. Take it easy.

Angie :wave:

My insurance company considered my spine surgery as elective as well, because my condition was not life threatening; however, they did cover it100%.

[QUOTE=crookedback
So does that mean your insurance will not cover even if a surgeon says you are a candidate?
[/QUOTE]

I'm not sure I understand your question or answered it very well, but if you have a surgery that is mechanically/medically necessary to dimish pain, improve quality of life, help you return to work, prevent further injury or nerve damage, then it should always be covered unless you have a very unusual insurance coverage. Calling your insurance with your concerns is a good idea like the op said. I can't think of a reason why it wouldn't be covered, if your dr say's you need it for the above reasons. In my case as well they paid for the hospital bill 130,000. which did not include the many pre-op tests and post-op treatment/scans, that was necessary, like follow up appts. PT, medical aids, etc. All of my pre-op, post-op and hospital bill was paid 100%. I had to have over 7 expensive imaging tests pre-op and a couple post op and they paid for all of it. I also went to PT for over a year and a half and that added up real fast but was covered, until my insurance put a cap on it.

Good Luck...

Another thing to be aware of is that insurance companies will use every trick they can to get out of paying for the surgery. That is why you need pre-approval for this type of surgery. Their preference is drugs. Percocet or the like is much less expensive than a $100K+ surgery. Once you get pre-approval, your costs should be limited to co-pays.

I have heard of insurance companies requiring info sent to their doctor for review as well.

I had a heck of a time getting approval for the IDET I had last year. It to all summer to get the approval.

Thanks all... so if I'm hearin ya'll correct if the Doc says ur a "candidate" for surgery then the insurance will usually cover even though the Doc will not recommend surgery unless bowell/blader are involved or u can't walk... hence the "elective" position?

Take care... Dave!

Well I think when insurance companys are not paying for elective surgery it is like gastric by pass, cosmetic surgery.

For example, my back surgery I had a choice to stay disabled, or try to have surgery to correct it. Maybe that is elective, but not like having a boob job elective!

Thanks all... I think form waht everyone is saying here that the key word is if the doc says ur a candidate, the insurance will pay & I will definitely call my insurance to confirm... I was just thrown off by the 2nd surgeon's PAs stance that the insurance will not cover unless considered an emergency...

Take care... Dave!

Another thing to be aware of is that insurance companies will use every trick they can to get out of paying for the surgery. That is why you need pre-approval for this type of surgery. Their preference is drugs. Percocet or the like is much less expensive than a $100K+ surgery. Once you get pre-approval, your costs should be limited to co-pays.

I have heard of insurance companies requiring info sent to their doctor for review as well.

I had a heck of a time getting approval for the IDET I had last year. It to all summer to get the approval.

That is the truth. My surgery was pre-approved. The surgeon almost got 100 percent even though I was out of network. I got a bill from them for $15,000.00. They also said they would accept what every the insurance paid and I would not be responsible. So I call the dr. office. They tell me I need to call the ins. co. I call them and they say the dr. needs to call them. Such a run around. Even with prior approval you have to be careful. I am not paying a penny. Let them fight it out. It is 7 months already.

Yah Dave.. that is the best way to sum it up. Some docs know insurance groups very well and some wont approve anything unless you are on your deathbed practically.

ELECTIVE surgery for most insurance groups (speaking as an Ex HR Director) means that it's an procedure that you choose to have, but is not truly medically necessary to be well persay. Such as an implant, etc. You may want it, but healthwise.. it's not medically necessary.

Unless you are in an emergency state and incoherent/incapacitated to not be able to verbalize your authorization to have a surgery.. you are always given a choice to have surgery or not. This is not considered "elective".

Take care.:wave:

Well I think when insurance companys are not paying for elective surgery it is like gastric by pass, cosmetic surgery.

For example, my back surgery I had a choice to stay disabled, or try to have surgery to correct it. Maybe that is elective, but not like having a boob job elective!

I actually had gastric bypass surgery and had no problem being approved. I had alot of medical problems so no problem. I thought in the beginning it was elective but really it was life saving. I had the surgery in 2002. If I didn't have it, I may not be around now. I'm only 42. I had to have it fixed due to a complication. They didn't want to pay for that. Had to appeal almost a year before they did. At least with my insurance, they will pay for anything if they think it is medically necessary. They decided to throw me out of back therapy since I was not getting better fast enough. It is crazy to make someone wait until it is an emergency. Just think of the extra damage that can cause.

Thanks Gang... man the "medical game" is so much fun!

Take care & thanks for the input... thanks!