Q: Is there still an opportunity to negotiate out-of-network contracts for spine surgery?
Scott Blumenthal, MD, Spine Surgeon, Texas Back Institute, Plano: Yes. We work with each patient individually and help them understand why we are not part of their specific network. Our patients see the benefit of being in control of their own healthcare rather than the insurance company dictating what type of care they can receive. Our unmatched expertise and experience provide patients with the comfort they need and they are able to see the value we offer. We also provide concierge services through our Center for Disc Replacement including a dedicated phone number, designated staff who can help with anything from scheduling appointment to travel arrangements. Our clinical concierge team also serves as a liaison between patients, their families and physicians to enhance communication, comfort and care. Many of our patients have done their research and they know they want a surgeon with the skill and expertise we offer, so they are not opposed to being out of network.
Dennis Crandall, MD, Founder and Medical Director of Sonoran Spine Center, Mesa, Ariz.: It is becoming more difficult with the influx of new spine surgeons who are willing to work for almost any reimbursement, and insurance companies who care most about a "Sale Price" on surgery.
Walter Eckman, MD, Founder, Aurora Spine Center, Tupelu, Miss.: Yes.
J. Brian Gill, MD, Spine Surgeon, Nebraska Spine Center, Omaha: I would say yes and no. Yes we are still able to negotiate out-of-network care but it is quite difficult and the insurance company is unwilling at times to accept our fee schedule. It is just easier to pass the difference on to the patient from the insurance standpoint. For example, if an in-network plan pays 80 percent and the patient pays 20 percent, an out-of-network plan may only cover 70 percent with the patient now paying the remaining 30 percent. Insurance companies are not willing to make exceptions on a case by case basis.
Richard Kube, MD, Founder & CEO, Prairie Spine and Pain Institute, Peoria, Ill.: We do still have the ability to provide out-of-network services to some individuals. There are an increasing number of insurance providers in our region who are dropping or severely limiting the out-of-network benefits patients have.
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