If your doctor has recommended surgery to treat your Chiari malformation, chances are you have started to wonder about the details, such as what the surgery will be like, what to expect during recovery and whether the procedure is covered by insurance.
Preparing before your procedure is a great way to help you relax during your recovery period and focus on your health, rather than unexpected surprises. Talk to your surgeon’s benefits specialist or your insurance company to determine if your procedure will be covered by insurance.
About Surgery for Chiari Malformation
Before diving into whether surgery for Chiari malformation is covered by insurance, it may be helpful to understand a little about the surgery itself. There are different procedures used by surgeons to treat Chiari malformation, and your doctor may have recommended one approach or a combination, depending upon the specifics of your condition.
Procedures used to treat Chiari malformation include:
- Traditional Dural Opening Chiari Decompression – The surgeon removes a small section of bone at the base of the skull to relieve the pressure caused by the blockage of cerebrospinal fluid (CSF). The membranes surrounding the brain are opened and a flexible patch is sewn in to expand the area, then suture or staple the soft tissue closed at the surgery site.
- Minimally Invasive Chiari Decompression – This procedure is similar to traditional dural opening Chiari decompression, only the surgeon uses special instruments and microscopic visualization. As a result, the incision is much smaller and no patch is required.
- Non-Dural Opening Chiari Decompression – This procedure involves removal of a small section of bone at the base of the skull without opening the dura (membrane surrounding the brain).
- Cervical Laminectomy – In a cervical laminectomy, the surgeon removes a portion of the vertebrae at the top of your neck. This helps make room around the spinal cord and alleviates the pressure that can cause damage and symptoms.
Regardless of which surgery your doctor has recommended, there are a few things you can expect in general:
- Your hospital stay will be about 2-4 days, allowing your doctors to monitor your recovery.
- You will be put under general anesthesia and will not be awake during your procedure.
- You will likely have a prescription for pain medication after your surgery.
- There will be follow-up visits with your doctor during your recovery.
- You may require physical therapy to assist with pain and mobility during your recovery.
How to Find Out if the Procedure Is Covered by Insurance
Navigating the world of health insurance benefits can be tricky for a layperson. Luckily, you aren’t on your own. There are people specially trained to not only understand insurance but to help explain benefits and coverage to patients.
The first place to check is with your surgeon’s office. Some practices employ a benefits specialist whose job is to help you understand exactly what procedures are covered by your insurance. When you meet with the benefits specialist, be sure to have all your insurance policy information on hand. This will help him or her understand your exact plan.
If you don’t have a benefits specialist available to you, another great resource is your insurance company itself. They can most accurately help you determine what your coverage will be like if you provide them with as much information as possible, including your doctor’s contact information, the procedure codes, your diagnosis and the scheduled date of your surgery. If you don’t have this information, your doctor’s office can provide it to you.
In-Network vs. Out-of-Network Insurance
If insurance wasn’t confusing enough, you also need to consider the element of in-network providers. It’s important to understand exactly what that means. What if you find an out-of-network provider that you would like to visit? Can you still have surgery with that doctor, if that is who you prefer?
Absolutely! An in-network provider is one who has formed a partnership with the insurance company, but you are still covered when you visit an out-of-network provider. Every insurance company handles the situation differently, but you can generally expect to pay more to visit an out-of-network doctor. Depending on the specifics of your financial situation, the extra cost may be worth it if you have found an out of network provider that you are comfortable seeing.
What Is Covered?
To determine exactly what elements of your surgery are covered by insurance, you will need to consult with your insurance company or benefits specialist. Keep in mind there are expenses related to your surgery, other than the procedure itself, including:
- Anesthesia
- Prescription medication
- Hospital stay
- Follow-up doctor visits
- Imaging
- Physical therapy
These costs may not be covered by your insurance. That is why it is important to anticipate the “out of pocket” costs of your care. Again, your benefits specialist or insurance representative can help you make these determinations.
Planning Leads to Peace of Mind
Understanding insurance can take some time, but the extra effort now is going to help you rest easier during your recovery. Meet with your doctor’s benefits specialist, speak with a representative from your insurance company and make sure you have a thorough understanding of your benefits coverage before your procedure. That way, you can spend your time recovering, rather than dealing with financial considerations after your surgery for Chiari malformation.
