The Spine Network of California Launches Patient Advocacy Services

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CEO Trudy Maurer taps her years of experience to help spine surgery patients navigate the complexities of treatment, insurance coverage and claims.

“It’s one thing to discover that you may need spine or neck surgery,” says Trudy Maurer. “But to find the right surgeon for your particular needs, and then navigate the confusing and often frustrating world of insurance claims, coverage and post-operative care can overwhelm anyone, especially when they are in pain.”

Maurer, who is the CEO of the Spine Network of California, says that the best outcomes for virtually any spinal surgery procedure are most likely to occur the first time a patient undergoes that procedure. “It’s more difficult for a surgeon to correct or improve upon results from a previous surgery,” she says. “That’s why it is of utmost importance to seek a spine surgeon who has the right background and surgical experience to treat a person’s individual needs and medical condition.

The Spine Network can facilitate appointments with highly qualified spinal surgeons who practice across California including the San Francisco Bay area, Los Angeles and San Diego, as well as Reno, NV. There is no charge for this service.

However, too often once a person is matched with the right surgeon, the battle begins with the insurance company to confirm coverage for the surgery. “An insurance company might deny a claim based on outdated information, or as a matter of policy, even for procedures that are considered routine “standard of care,” says Maurer.

To assist patients in dealing effectively with their insurance companies, The Spine Network of California has launched a new, optional Patient Advocacy service. “Most people, no matter how good a negotiator they may be, are not experienced in approaching insurance companies and speaking to them in their ‘language’ in order to gain approval for their surgery,” says Maurer. In fact, research shows that it takes an average of 24 to 30 calls for a Patient Advocate to resolve an insurance-coverage issue,” she says. Our patient advocacy services include communication with the insurance company and submission of documents in order to gain approval of procedures and evaluation appointments.”

The Patient Advocacy service is a separate service offered by the Spine Network of California at an hourly rate. Advocacy services are limited to spinal surgery issues and are available regardless of which surgeon ultimately performs a procedure, whether that surgeon is a member of the Spine Network of California or not, says Maurer.

For example, a 36 year-old woman who had suffered two separate injuries while lifting heavy objects at work was diagnosed by her spine surgeon with 2 herniated discs in her lumbar spine (described in medical terms as a “level 2” injury, meaning that 2 discs are affected), and she was in constant pain.

The patient did have one surgical procedure a few years ago to attempt to fix her problem; a discectomy to remove the damaged portions of her discs to relieve pain; the procedure seemed to help for a while but the pain returned and grew much worse over time. Her surgeon explained that arthritis had also formed in the damaged areas, adding to her discomfort and loss of full mobility.

She soon learned another fact; that workman’s comp insurance companies often won’t cover a level 1 artificial disc replacement procedure, and will almost never cover a 2-level procedure, although a 2-level procedure is what most people need. “That’s a real problem”, says Maurer, “since many patients actually have a 2 - level injury. That means that there are many people out there who are not covered to have the best standard of care for their injuries. Patients need to work with their advocates to convince their insurance companies to change this policy”, says Maurer. “In this patient’s case, it took 2 arbitration sessions to finally gain approval to have her procedure covered.”
 
“When a person is diagnosed with a spinal injury or disease and surgery is the recommended course of treatment, it’s critical to receive that treatment as soon as possible”, says Maurer. “If surgery is delayed, further damage may occur, which could diminish the results of a surgery. In these cases, medicine delayed is medicine denied.”

For information on locating a qualified spinal surgeon or to learn more about patient advocacy services at The Spine Network of California, contact Trudy Maurer, CEO via email at trudy@spinenetwork.com or dial 1-888-673-4575 9AM-5PM PST.

Visit the website at http://www.spinenetwork.com

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