My insurance does not require a referral. Why do I need one?
Our office requires a referral because we want to ensure that it is medically appropriate for you to see a neurosurgeon. Typically surgery is a last resort, and surgical intervention is sought only when conservative treatments such as massage and physical therapy have failed. Additionally, most insurance companies will not approve certain surgical procedures unless nonsurgical treatments have already failed. Your primary care physician can help you decide when and if you should consult one of our neurosurgeons.
What type of medical imaging studies do the surgeons require?
Typically a CT or MRI scan within the past six months is preferred.
My injury is work related. Do you accept L & I claims?
Yes, we accept L & I, however in addition to a referral, preauthorization from your claims manager is required (as our surgeons are specialists). If you have not obtained preauthorization for your consultation, please contact your referring provider’s office.
If the surgeon recommends surgery, what are the next steps?
You will meet with the surgery scheduler who will review important information about your procedure. The surgery scheduler will contact your insurance company to obtain preauthorization for your procedure. Once authorization is obtained, the surgery scheduler will contact you to schedule your procedure.
How long does it take to obtain preauthorization from my insurance?
All insurance companies are different. Medicare does not require preauthorization and often an appointment can be scheduled after the consultation. Most major medical insurances require three weeks to process preauthorizations. L & I typically require requires a minimum of four weeks to process preauthorizations.
My insurance company denied my procedure. What do I do now?
Depending on the reason for denial, the surgery scheduler will work with your surgeon to determine next steps. In many cases a peer-to-peer call may be scheduled with your surgeon and your insurance company so your surgeon can explain why your procedure is medically necessary.
Why are my post-operative appointments scheduled with the physician assistant and not the surgeon?
Each surgeon in our practice works closely with a neurosurgical physician assistant (PA). Ordinarily, your surgeon’s PA is present during the surgical procedure and provides direct assistance in the operating room. In most cases, you will likely have your first post-operative clinic appointment with your surgeon’s PA. Typically, during this and any subsequent appointment(s) with the PA, your surgeon is also in the office seeing other patients. This allows our PAs the opportunity to consult with the surgeon directly if necessary.