Health insurance and migraine surgery costs

As you might expect, one of the most common questions that we get at Migraine Surgery Specialty Center is regarding the issues surrounding health insurance and costs for the procedure.  On social media, this is also one of the most questioned aspects of our care, and it is not unusual to get a comment such as, “since I don’t have insurance I’m sure you would not take care of me.”  Shaming us, even if it is not warranted, doesn’t feel very good to read.

I think it is important for patients to understand that the cost of health care, especially surgery, is not high for ambiguous reasons.  When patients are quoted the cost of the procedure, I want to make sure that they understand that it costs us a lot to care for you.

In order to take a migraine patient from beginning to end, here is an incomplete list of the things we have to pay for:

Costs of getting the word out that our procedure can help patients… time, software, advertising costs
Time for my patient coordinator to review each patient’s situation and arrange for the initial consultation
Time for the process of seeing patients and evaluating patients,
Time for preparing for surgery (ordering labs, reviewing medical notes, arranging staff, etc..)
Time for performing surgery,
Time for managing recovery,
Costs of paying for medical staff,
Costs of paying for the operating room staff
Costs of paying for office staff
Costs of paying for billing staff who manage the insurance claims
Costs of paying for the office mortgage
Costs of paying for the operating room mortgage
Costs of paying for the operating room supplies
Costs of paying for the operating room technology (anesthesia machines, monitors, etc.)
Costs of paying for anesthesia providers

Costs of paying for all of the extra overhead things such as licensing, permits, inspections, and certifications that we do to ensure that the level of care we give our patients is second to none.

Before any profit is made, expenditures can add up to $7000 – $10,000 depending on markets and even drug availability.

For patients who feel it is unfair for doctors such as myself to charge so much for their services, I don’t think there is an understanding of the costs of simply providing the basic services.  If you add the costs associated with over 15 years of surgical training, expertise and judgement, and then understand that there is a necessity to make some profit in order to keep food on the table for my family and make my mortgage payments at home, you can begin to understand why migraine surgery is not inexpensive.

Unfortunately, insurance providers play by their own rules.  Some providers pay a lot for migraine surgery and some do not pay at all.  Some say they will pay before the surgery, and then minimize payments following the surgery.  In a large hospital setting, the hospital plays the law of averages by negotiating with insurance providers, wielding a bigger stick than an independent physician such as myself can do.  They have offices filled with people who negotiate and argue with insurance companies all day long, and they can do so because they are treating, in some way or another, hundreds of inpatients every day.

In the world of an independent physician providing outpatient surgical services, this is simply not possible.  If I were to employ all the necessary back office staff to deal with all of the insurance plans we are faced with, overhead costs would skyrocket and certainly make providing care impossible.  It is for this reason that we cannot rely solely on insurance to pay for migraine surgery.

You can be certain that our staff will work with each patient to make certain that insurance does reimburse them for as much as possible, and sometimes these payments do cover the entirety of the surgery and surgery center costs.  If we relied on these insurance companies as the means for payment, however, there would be no way that we could keep the doors open to provide migraine relief to anyone.  While I would love to provide this amazing surgery to everyone regardless of payment, the reality is that with the current state of health care and health insurance in this country, that is simply not  possible.  I sincerely hope that patients can understand that, and understand that we do what we can to control costs and fees in order to help as many migraine sufferers as possible.

One of the things we do is to offer financing for patients. This can allow a debilitated patient, for example, to get back to work and normalize their life for a minimal up-front cost. By returning such patients to the work force and allowing them to have an income again, we can create a situation where not only can they afford their surgery, but also can maintain an ongoing income for years following their procedure. Taking financing plans actually costs our practice significant money, but trying to find ways we can help our patients financially is one of our priorities.

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