Before purchasing implants, “The idea is to get an accurate picture of all the costs from the most expensive option to the least expensive option because people’s anatomies are different, and a different implant may be needed at the time of surgery. You’ll want to have all this information before you negotiate coverage with insurance companies,” he says.
Dr. Dooley adds that insurance companies frequently agree to cover costs of certain equipment, such as implants and total knee or hip replacements, but may suddenly decide to stop coverage if they experience spikes in the number of claims. “We started doing total knee and total hip replacements. After six months and doing a couple hundred of those procedures, our payor decided it wasn’t going to pay for them anymore, so we had to stop those procedures for two or three months while we renegotiated our contracts,” he says. “My advice to other ASCs is to discuss these things up front and ahead of time with companies, even though you may not see any obvious reason why they wouldn’t pay for certain services.”
