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Did you know that your insurance can deny your back surgery if you smoke? We often have patients ask why we include smoking restrictions in our pre-surgery instructions, so we thought it was time to chat about what we have seen, and why some insurance companies have a “no surgery for smokers” policy.

Let’s take a look at some of the questions we have heard:

Can I get back surgery if I smoke?

Technically, the answer is yes, you can get back surgery if you smoke. But in reality, it’s much more complicated than that. Many back surgeons will not schedule back surgery for a smoker, and many insurance companies won’t pay for the procedure if it is performed.

Though the laws and insurance practices are ever-changing, historically, some insurance claims for back surgery have been denied because the patient smoked tobacco regularly before surgery.

How does smoking affect surgery?

There is ample evidence that smoking impacts the body’s ability to heal from surgery.

  • Wounds take longer to heal due to the excess carbon monoxide in the smoker’s body. The Cleveland Clinic explains “if you don’t quit smoking before surgery, you may be at higher risk for infections since oxygen is the main source for healing wounds.“
  • Decreased lung capacity can make it harder for anesthesiologists to keep smokers breathing during surgery.
  • According to Spine-Health, smoking can be particularly detrimental to spinal fusion surgeries, as smokers see “A significantly decreased rate of successful fusion (called non-union or pseudoarthrosis),” and “Markedly poorer clinical outcomes (i.e. pain reduction) regardless of whether or not a successful fusion in the spine is achieved.”

Because of these complications, and because doctors are avowed to “do no harm” it is both philosophically and ethically defensible for a surgeon to refuse to perform a back surgery for a patient who has not quit smoking.

Do smokers pay more for health insurance

Depending on where you live, a smoker may pay a higher premium on their health insurance than a non-smoker. Under the Affordable Care Act, insurance companies are allowed to charge a “tobacco rating” for smokers. This increase in premium is allowed to be up to 50% higher than the premium paid by non-smokers.

While some states require insurance companies to charge less than 50%, and 7 states don’t permit a tobacco premium at all, the majority of states (including Arizona) allow the insurance company to use the tobacco premium to charge smokers more for insurance.

Depending on where you live, misrepresentation of your smoking habit may be considered insurance fraud, and may even constitute felony charges.

And as we’ve said before, there is ample evidence of insurance companies historically denying back surgery claims for smokers.

How much does back surgery cost without insurance

As with much of this discussion, the cost of back surgery, if you have to pay out of pocket, will depend on many factors.

  • The procedure you need
  • Your overall health
  • Your diagnosis
  • Your age
  • Your location

A laminectomy, for example, might cost between $50,000-$90,000. A spinal fusion may range from $80,000-150,000.

How much does back surgery cost with insurance

With insurance, and assuming your deductible has been met, your back surgery may cost as little as $200 to a few thousand dollars, depending on the factors above and your coverage levels. According to Healthline, a Medicare patient may pay as little as $764 for a spinal fusion.

How long should you stop smoking nicotine before surgery

Continuing with Medicare patients as an example, Smoking within the 6 weeks prior to surgery is grounds for a denial of the claim. This seems to be a workable rule of thumb, and a timeline supported by many doctors and insurance companies.

At the Desert Spine and Scoliosis Center, Dr. Baig recommends that clients stop smoking as quickly as they are able. Most insurance companies now provide coverage for smoking cessation programs and services to help you on your way. We are happy to help where we can along the way and are confident that quitting cigarette smoking will help not just your back surgery and recovery process, but your overall health and well-being.

Book a consultation – Call the experts as Desert Spine and Scoliosis today.