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How do I find customary cost for laminotomy/discectomy?

I'm going in for surgery next Thursday for a lumbar laminotomy/discectomy at Mount Sinai Hospital in New York, NY. I am using an out-of-network surgeon. My insurance, CIGNA, is supposed to pay 60% of what is "usual and customary" for out-of-network. They are saying they will pay $3K (coincidentally, the same amount as my deductible.) I am going to fight them to cover more, for I can't imagine that there are any decent spine surgeons in NYC taking $3K for this type of surgery. Does anyone know where I can find data on what is usual and customary in a particular geography? Thanks!


  • dilaurodilauro ConnecticutPosts: 9,875
    by the Insurance company.
    I know with my insurance, I can find approximate costs for any type of procedure. It also allows you to select varioius areas.
    Again, its only an estimate.

    But CIGNA has those details. There is medical billing codes for every office visit, procedure, surgery, etc
    Generally, those costs are submitted to the Insurance company, then the Insurance company indentifes what their
    accepted and negotiated rate would be and then finally you co-pay

    Example - ESI Procedure

    Hospital Cost - $ 2,000
    Insurance rate: $ 1,200
    Your Co-pay $ 240 (assuming your pay 20%)

    I would call back your insurance company to get the details. You might need to know exactly what the surgical procedure is and the billing code. The doctor's office can provide you with the exact code. There is a nation wide accepted manual that lists all the various medical codes
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Vvv03, how did your surgery go? Who was your doctor? Did you find out the cost?
    I am choosing a doctor now for my surgery and most likely he will be out of network.
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