Insurance, Authorizations, and Costs

Before your first visit

When you book, the office checks your insurance benefits and tells you whether your plan needs a referral from your primary doctor, what your copay for a specialist visit is, and whether Dr. Wey is in your plan's network. Please have your insurance card ready when you call, and bring it to the visit. If something changes, such as a new plan at the start of the year, let us know before the visit.

Prior authorization

Many spine tests and treatments need approval from your insurance plan before they are done. The office handles the requests; your part is to know that they take time.

• MRI and CT scans: most plans require authorization. It usually takes a few days.
• Physical therapy: some plans limit the number of visits or need a referral.
• Injections: usually authorized, often with a requirement that therapy was tried first.
• Surgery: most plans require prior authorization. Plans typically ask for proof of a course of non-surgical care, recent imaging, and the exam findings. Disc replacement and endoscopic surgery are sometimes reviewed more closely than fusion, and a denial can often be overturned on appeal with the right documentation. Dr. Wey's team prepares those appeals, and his careful notes from your visits are what make them succeed.

This is one reason the first visit asks so much about what you have already tried: the record of your non-surgical care is also the record your insurance will want.

A few plan-specific points

• Medicare covers most spine surgery, including cervical disc replacement. Lumbar disc replacement is not covered by Medicare for people over 60, so other options are discussed.
• Injured at work or in a car accident? Workers' compensation and auto insurance claims have their own rules. Tell the office when you book so the right claim is set up from the start.
• Out-of-network plans: ask the office for an estimate before scheduling. Hospital charges, anesthesia, and imaging are billed separately from the surgeon's fee.

What a bill looks like

A surgery generates several bills: the surgeon, the hospital or surgery center, anesthesia, and sometimes an assistant surgeon or a nerve-monitoring service. Each is submitted to your insurance. Your share is your deductible, copays, and coinsurance under your plan. The office can give you an estimate of the surgeon's fee in advance, and the hospital's financial office can estimate its charges. Ask; it is a normal question.

Paperwork the office handles

• Work and school notes, and return-to-work letters with restrictions.
• Disability and family leave forms (FMLA and short-term disability).
• Handicap placard applications.
• Letters of medical necessity for equipment, braces, and appeals.
• Records requests from other doctors, with your permission.

Allow a few business days. Forms are not completed during the visit.

Questions

Call the office with any billing question. If a bill does not look right, we would rather hear about it early.

Learn more

My frequently asked questions and your first visit.

This page is general information. Coverage depends on your plan, and the office will tell you what applies to you before anything is scheduled.