Disc replacement surgery

Disc replacement surgery is a type of spinal surgery where surgeons replace a damaged intervertebral disc with an artificial one. Most major US health insurers, including UnitedHealthcare and Aetna, cover lumbar disc replacement only for single-level procedures in adults aged 18-60 after failed conservative treatments.

Medicare covers cervical disc replacement if FDA-approved devices are used and strict criteria are met. Insurers typically require documentation of chronic pain lasting at least six months despite physical therapy and medications before approving coverage.

Out-of-pocket costs for insured patients often range from $2,000 to $5,000 due to deductibles and coinsurance requirements. Common exclusions by insurers include multi-level disc replacements or prior spinal fusion at the same site, according to a report from YourInsurance.info.

Preauthorization is mandatory with all major carriers such as Blue Cross Blue Shield, Cigna, and Humana for both inpatient and outpatient settings. Denials frequently occur when imaging does not show clear degenerative disc disease or when alternative diagnoses like osteoporosis exist.

Appeals succeed most often when physicians provide detailed surgical necessity letters citing failed non-surgical interventions and radiological evidence matching insurer policy language.