Why Does It Take So Long To Get My Spine Procedure?

Why Does It Take So Long To Get My Spine Procedure?

Why Does It Take So Long To Get My Spine Procedure?

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Why Is It Taking So Long to Get In for My Procedure?

Many patients voice frustration over the time it takes to get services approved. I wanted to take a minute to explain the process that occurs, just to ensure that proper payment of your claim takes place.

Specifically with HMO insurances it can be quite timely. Prior to initial visit, we often must request a referral from the Primary Care Physician. Although most are very efficient at getting right back to us, occasionally it can take a few days to get this referral. As you may understand, the PCP has hundreds of referrals to process and they must contact the insurance and give permission for the patient to be seen by us, “the Specialist”.

Once we receive the referral we are able to see the patient. The doctor evaluates the patient and decides the course of treatment and orders testing or procedures to be done. The staff will then have to check with the insurance company to verify what the benefits are on that procedure. There is no standard when it comes to benefits. Each insurance has several different plans and until we check directly with them, we will not know the benefits and cost to the patient, or whether it requires authorization. Once benefits are verified, we then must initiate an authorization with the authorization department of the insurance company. Occasionally this can be done on-line. Usually it requires filling out additional forms and sending medical records and imaging along with the forms in order for insurance to review the validity of the procedure. It is then time to wait again. It can take 7-14 days to hear back regarding an authorization. At Shim Spine, we are very diligent about following up on these authorization requests, checking on updates every couple of days. Once we hear back from the insurance company, we will call the patient to arrange a date for the procedure.

It can seem sometimes that patients sometimes wait an inordinate amount of time to get their procedures or tests scheduled. As you can see, it is often frustrating to staff as well, as we would like to get you in as soon as possible. If these steps are not followed and we were to schedule a procedure or test without the proper authorization, insurance will deny payment and financial responsibility will fall to the patient. This would not make patients very happy. The next time you have a test or procedure ordered and are wondering why is it taking so long, please know that it is our desire to process this paperwork and get the patients scheduled as soon as possible.

 

 This blog is the opinion of Dr. J Shim based on over 20 years as an orthopaedic spine surgeon.

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As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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