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Question: I have a herniated disk C5-6 and need a cervical fusion. My insurance does not want to pay due to a pre-existing neck sprain, even though this is different. If insurance wont pay, is the surgeon required to perform the surgery anyway? Or do they want money up front? Answer: Dear Celeste,
The surgeon is not obligated to do surgery on this non-emergent problem. Personally the cost for this surgery is almost prohibitive to be done as a self-pay procedure. Most insurances will try to deny payment however going over your particular policy would be the most prudent thing to do to see how long the pre-existing clause is in effect.
Robert E. Abraham, MD
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