Nerve Block Costs: Epidural Steroid Injection Costs – Medical Bill Survival Guide
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Nicholas Newsad, MHSA is a senior analyst at a national healthcare management company. He holds a master's degree in hospital and health service administration from Xavier University. He lives in Westminster, Colorado.He has served as a senior healthcare analyst for six years and has also served as an interim surgery center administrator. He has been quoted and interviewed in the L.A. Times, NY Daily News, MSN Money, and Smart Money, as well as numerous other magazines, newspapers, and radio shows.

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Nerve Block Costs: Epidural Steroid Injection Costs

0 Comments - Posted by Nick Newsad on August 17, 2012 at 3:18 am

Minimize spinal nerve injection costs and epidural steroid injection costs by being pro-active consumers.

1) INSURANCE COVERAGE:

Auto insurance and worker’s compensation are frequently the primary insurance coverage for pain management. If nerve blocks are administered to manage pain caused by a car accident injury, your health insurance provider will not cover your treatment if there is an auto insurance medical policy in place. Similarly, if your nerve block injection is part of a pain management program to treat a work-related injury, then your health insurance will likely decline coverage because your state worker’s compensation fund should cover the injury.

Providers, like physicians and surgery centers, generally love auto insurance medical coverage because they pay providers very high rates. Auto insurance companies are generally not very astute healthcare purchasers.

2) SITE OF SERVICE:

Nerve block costs to the patient can vary widely depending on where they are performed. There are three different places you can have a nerve block.

The most cost-effective place to have a nerve block administered is in the office of a pain management physician specialist. Having a nerve block administered in an ambulatory surgery center or hospital is more expensive than getting a nerve block in a physician’s office. There are three major reasons that a physician may want to perform a nerve block in a more expensive setting like an ambulatory surgery center or hospital.

      a) The first reason is physician convenience. Many nerve blocks are administered by anesthesiologists who traditionally “hang out” in surgery environments all day long like ASCs and hospitals. These types of anesthesiologists primarily focus on anesthesia for surgery and may not even have a traditional office for patient appointments. It is convenient for these anesthesiologists’ schedules to have you come to them at the place where they perform most of their surgery-based work.
      b) The second reason is related to equipment. Sometimes a type of portable x-ray machine called a “C-arm” is used during spinal injections so the physician can see inside your body when he or she is performing a spinal injection. Brand new C-arms cost around $100,000 and not many physicians can afford to own them, so these physicians will take their patients to surgical facilities that let them use their C-arms.
      The need for use of a C-arms during a nerve block largely depends on the physician’s comfort giving the injection and the type of injection.
      Generally, surgery centers do not like buying C-arms because insurance companies know that most nerve blocks don’t require them, and refuse to pay anything extra to offset the cost of the C-arms. Whether a C-arm is used on a nerve block or not, the insurance company generally pays the provider the same thing.
      c) The third reason has to do with money. The patient’s cost of having a nerve block administered in an ASC, includes the anesthesiologist and the ASC. However the patient’s cost of having a nerve block administered in a physician’s office only includes the physician. Over 50% of the ASCs in the United States are at least partially owned by physicians. If your anesthesiologist is an owner in an ASC, he or she will indirectly be paid more because the “extra payment” to the ASC helps to support their investment.
      Insurance companies knows this, and try to disincentivize physicians from taking patients to ASCs by paying physicians more for nerve blocks that are performed in physicians’ offices. A physician that is paid $83 for a nerve block performed in an ASC, would be paid $183 for performing the same nerve block in his or her office. Paying more to the physician actually saves the insurance company and patient money because the ASC would have been paid an additional $300-$650 on top of what the physicians had been paid.
    Below you can see that the Medicare program and Medicare patients save about 50% on nerve block costs when they are performed in a physician office. Recall that Medicare patients have to pay a 20% coinsurance on the cost of their care. This table only shows the cost difference for the first injection too. Nerve block costs can increase when multiple injections or “levels” are given during one visit. I would expect 2-3 injections per visit.

 

Medicare Nerve Block Cost Difference for 1st Procedure
Procedure MD@Office MD@ASC +ASC Fee =Total Coins Diff
 Epidural Nerve Block (62310)  $247  $107  $301  $408  $32
 Lumbar/Sacral, Steroid Injct (64483)  $242  $112  $301  $413  $24
 Paravertebral Pain Injection (64493)  $181  $93  $301  $394  $43

3) PHYSICIAN SPECIALISTS:

It is my opinion that patients can save money by seeing an anesthesiologist or physiatrist that is a “pain management specialist” as opposed to a surgery-focused anesthesiologist that performs pain management “on the side”. Pain management specialists are more likely to have real, office-based clinics where they can perform you nerve block instead directing you to a hospital or surgery center, which would bill you in addition to the physician’s fee.

4) HIGH-DEDUCTIBLES:

Nerve block costs can grow significantly when they are performed over a series of visits. When this happens, a patient may return to the physician several times to receive additional injections over the course of several weeks or months.

If I had a high-deductible and was trying to keep nerve block costs down, I would avoid surgery centers like the plague and find myself a pain management physiatrist that would agree to take a fee of no more than $450 for each visit, not each procedure. Expect 2-3 “procedures” each visit. I would not pay more than $450 for a single visit if I had a high-deductible.

5) TREATMENT COST–ALMOST NOTHING:

The real cost of a nerve block is about $60 in supplies. In the grand scheme of things, nerve blocks are one of the cheapest outpatient procedures to perform next to colonoscopy. What you are really paying for is the technical expertise of the physician. If you ever find yourself with a high-deductible and a $1,000 facility fee for the first of three nerve block, you are probably in a pretty good position to barter.

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