Our patient liaisons are here to help guide you through the authorization process for surgery with Twin Cities Spine Center (TC Spine) by:
- Assisting you in gathering the requirements needed per your insurance plan.
- Obtaining prior authorization for your procedure.
- Helping you get answers to your health insurance questions.
Simply call TC Spine and ask to be directed to a patient liaison.
How the patient liaison assists you
Our patient liaison will determine your insurance carrier's requirements for surgery and share that information with you. These requirements could include physical therapy, injections, radiology and medical records from other providers.
Once we receive your medical records, we will submit all necessary information to your insurance carrier for surgical authorization. This process may take up to four weeks, depending on how quickly records are forwarded to us from other providers.
Your health insurer will review the submission and notify us if you've met their requirements for the proposed surgery.
Note: If you call your insurance to check the status of your request, you may not be given the most up-to-date information, because the customer service call center is separate from the medical review department.
What should I ask my insurance company?
While our patient liaison is here to help, you are ultimately responsible. Here are some tips on what to ask your insurance company before your surgery.
Before calling your insurance company, be sure to know the specific name of your surgery, billing code(s), and whether the procedure is inpatient or outpatient. Our patient liaison can provide this information.
- How do I find out if my physician is a member of my network?
- Is there a pre-existing clause on my policy?
- What is the cost difference between inpatient stays vs. outpatient procedures?
- What is my lifetime maximum for my insurance plan?
- Why is it important for Medicaid patients to maintain paperwork with the state?
Auto accident/workers' comp:
- I was in an auto accident. Does this change anything with my insurance?
- Why do you need to know about my work injury?
- Why do you need a denial from my workers' compensation company before my surgery can be prior authorized?
- Will my surgery/hospital stay need prior authorization?
- How is prior authorization obtained?
- How am I notified whether or not my surgery/hospital stay is prior authorized?
If Medicare is your primary insurance (not a Medicare replacement plan), you must contact a patient advocate prior to scheduling your surgery.
How much will my surgery cost?
Knowing the cost of your surgery is important. Unfortunately, there are many variables to each insurance plan or contract that can make this information difficult to understand.
A good place to start is to read your personal health plan summary. You can find this information on your health plan's website, or you can call the Member Services phone number generally located on the back of your insurance card.
Your plan summary will list costs that are covered or excluded and detail your out-of-pocket costs—in addition to your monthly premium—that you may need to pay, such as:
Co-payment: A flat fee you will have to pay each time you visit a provider; this amount varies by provider type.
Deductible: An amount you will have to pay toward your medical expenses (usually annually) before the insurance company begins to pay claims.
Co-insurance: The percentage of your medical costs you will have to pay after you reach any deductibles that apply; not a part of all plans.
Additional costs associated with surgical care may include:
- Hospital stay charges.
- Co-surgeons or surgical assistants who help in the operating room.
- Imaging and/or other diagnostic lab tests.
- Blood, plasma or other biological support you may need.
It may take a few phone calls, but be diligent, and you should have a fairly clear idea of your out-of-pocket costs before your surgery.