How Much Does a Spinal Cord Stimulator Cost?

If you’re thinking about getting a spinal cord stimulator, you’re probably asking yourself “How much does a spinal cord stimulator cost?” and “Is spinal cord stimulation covered by my insurance?”

The answer is the cost depends but by having a better understanding of what factors determine cost and coverage, you can have a better idea about your insurance coverage for spinal cord stimulation.

So how much does a spinal cord stimulator cost?

Spinal cord stimulation was approved by the U.S. Food and Drug Administration in 1984. And the good news is since spinal cord stimulation is a well-established therapy it’s covered by most major insurance plans.

The cost for a spinal cord stimulator is much like any medical procedure or surgery, costs vary from person to person. However, learning about the important factors that influence cost can help answer this question.

In-network vs. out-of-network providers

One of the biggest factors affecting the cost of getting a spinal cord stimulator is whether or not the pain management physician you’re working with is “in-network”- meaning that the physician is in your insurance provider or payer’s specific coverage network. Choosing an in-network pain management physician can significantly minimize any potential costs.

Coverage provided by individual insurance plans

Your cost will be dependent on the specific details of your insurance plan. For example, the options and benefits provided by a Health Maintenance Organization (HMO) plan are different from a Preferred Provider Organization (PPO) plan.

Most insurance plans include a maximum cap on the yearly out-of-pocket expenses that you are required to pay. Depending on your plan, these expenses may include your deductible and copayments (or copays). The amount you will pay comes down to your specific co-pay, co-insurance, and deductible plan you selected and how much you’ve already paid against it over the course of the year.

For example, if you have a high deductible plan but have already been to the doctor a few times this year, you’ll pay less out-of-pocket costs for your spinal cord stimulation procedure. If you have a low deductible, you’ll pay even less.

Inpatient vs. outpatient procedures

Like any medical procedure, the cost of an outpatient procedure is much less than the cost of an inpatient procedure. Fortunately, since spinal cord stimulation is a minimally invasive procedure so it’s almost always an outpatient procedure – significantly lowering potential costs.

The type of spinal cord stimulator battery

There are two types of spinal cord stimulator batteries: rechargeable and non-rechargeable.

It’s possible to see lower costs with rechargeable spinal cord stimulators over the course of several years, like Nevro HFX^TM, because rechargeable batteries have a significantly longer battery life so fewer additional surgeries and insurance requests for battery replacements are needed^1,2. HFX’s rechargeable battery is designed for 10+ years without programming restrictions, compared to 2-5 years for most non-rechargeable devices^1,2*.

You experienced a successful spinal cord stimulator trial

Unlike other chronic pain treatment options or surgery, with spinal cord stimulation, you can try a temporary system first and see if it helps relieve your pain before you decide to move forward with an implant.

The trial is not only great for you to see if spinal cord stimulation relieves your pain, but it also lets the insurance companies confirm that spinal cord stimulation is the right option for you. If you have a successful trial, meaning you experience at least 50% pain relief, your insurance plan will most often agree you should move forward with the implant and will want to cover your treatment.

Spinal cord stimulator trial cost 

A spinal cord stimulator trial, even though it’s temporary, is covered by nearly all major insurance plans for appropriate candidates. The trial is a simple, outpatient procedure. Find out more about a spinal cord stimulator trial.

Who is a good candidate for spinal cord stimulation?

Your insurance provider will most likely cover spinal cord stimulation if your plan agrees with your physician that you’re an appropriate candidate for spinal cord stimulation. So who is a good candidate for spinal cord stimulation?

Spinal cord stimulation is proven to be very successful for people with nerve pain who have tried other treatments and still aren’t getting long-term pain relief.

You could be a candidate for spinal cord stimulation if:

• You have nerve-related chronic pain meaning your pain has lasted for more than 3 months
• Your pain is located in your back, trunk, or limbs
• You still have pain even after trying other treatment options like surgery, pain medications, or injections

Because spinal cord stimulation is a minimally invasive procedure, it’s also a great option for people who aren’t surgical candidates or don’t want another surgery. Hear physicians share who they recommend spinal cord stimulation:

Insurance coverage & cost for Nevro HFX spinal cord stimulator 

HFX is FDA approved and has been proven to effectively manage back and leg pain for nearly 80% of people so it’s covered by all major insurance plans³.

Commercial Health Insurance

HFX is covered by all major commercial insurance plans, including Aetna, Humana, United, and Blue Cross Blue Shield.  Just like any medical procedure covered by insurance, it’s typical to pay deductibles, copays, or coinsurance fees defined by your unique plan.

Veterans Affairs (Tricare)

HFX is available for veterans and active-duty military members or their families across the US depending on the availability of physicians experienced with spinal cord stimulation at your nearest VA and military hospitals.

Workers Compensation

Workers comp, in all states except Washington, provides coverage for HFX.

Does Medicare cover spinal cord stimulators? 

HFX is covered by Medicare and most supplemental insurances. If you have supplemental insurance, you can expect to pay even less.

Does Medicaid cover spinal cord stimulators? 

Most states’ Medicaid policies cover HFX however it’s important to check to see if your physician accepts this type of insurance.

Paying for spinal cord stimulation without insurance

Spinal cord stimulation can be paid for out-of-pocket. Many physicians offer out-of-pocket discounts for people who don’t have insurance. It’s best to ask the physician you’re working with to determine what your out-of-pocket costs will be.

It’s important to take some time to review your plan and coverage options with your insurer and pain management physician. Your physician and insurer are the best resource for coverage questions and can provide specific details about your coverage benefits and if you will have any out-of-pocket costs.

How much does an HFX consultation cost? 

In most cases, at the time of your HFX consultation you can expect to pay your regular copay cost for a specialist visit.

Make sure to check with your pain management provider on how they will apply your insurance benefits.

What if I already have a spinal cord stimulator? Is upgrading to Nevro HFX covered?

Yes, replacing your spinal cord stimulator with HFX is covered by most insurance plans though it’s important to always check the specifics with your physician and insurance carrier.

More information about the process to replace your spinal cord stimulator can be found here.

You have support from the Nevro HFX access team

Working with and navigating insurance can seem overwhelming. To make things easier, HFX has a dedicated team of insurance specialists called the HFX Access team who will work with you and your physician throughout the complete insurance approval and coverage process.

As you and your physician work through the insurance process, if you have questions or run into insurance-related issues, the HFX Access team can act on your behalf to help get your procedure covered by your insurance plan.

This team takes the time to fully understand your specific situation and is committed to improving your access to the chronic pain treatments you need.

Find out if you’re a candidate for Nevro HFX

To find out of you’re a candidate for HFX, the first step is to take a short assessment today. At the end, you can request a call from an HFX Coach who will answer any questions you have and help you find an HFX-trained doctor in your area.

Summary 

• Your physician and insurer are the best resource for coverage questions and can provide specific details about your coverage benefits
• Nevro HFX is covered by most major insurance plans including Aetna, Humana, United, etc., and Medicare.
• Spinal cord stimulators with rechargeable batteries are designed to last up to 10 years, while stimulators with non-rechargeable batteries often require a medical procedure to replace the battery as often as every two years

*Other spinal cord stimulation companies with 10-year battery life claims, generally limit your programming options by requiring you to use a narrow set of low-frequency therapy programs to achieve the 10-year battery life.

Sources

1. Van Buyten, JP. International SCS Effectiveness Study: Long Term Outcomes of the Therapy in 956 Implants from 2010 –2013. Presented at NANS 2017.
2. Senza Summary of Safety and Effectiveness Data (SSED). Published May 8 2015.
3. Kapural L, et al. Comparison of 10-kHz High-Frequency and Traditional Low-Frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: 24-month Results from a Multicenter, Randomized, Controlled Pivotal Trial. Neurosurgery. Published 09 2016 [Epub ahead of Print].