Los Angeles Minimally Invasive Spine Institute Blog

Los Angeles Blue Shield PPO Spine Doctor (Los Angeles Minimally Invasive Spine Institute)

Spine injury can be inflicted by several disorders. In addition to sprains and sore muscles, there are degenerative and congenital diseases, infections, and tumors that can cause serious damage to the soft and bony spinal tissues. Improper body mechanics, aging, structural abnormalities, and trauma can also cause damage to your spine, which may result in back pain and other symptoms like leg pain, weakness or numbness. It takes a team of health professionals to successfully diagnose and treat chronic spine injury and back pain. It is important that you consider getting opinions from a number of experts before resigning yourself to surgery. Investing your time gathering the necessary information is vital in helping you make an informed treatment decision that will best support your desired level of physical activity and lifestyle.

The spine is a compact environment occupied by groups of muscles, tendons, nerves, and ligaments living side by side. This kind of arrangement can be compared to a neighborhood (spinal column) where the houses (vertebrae) have been constructed close to each other. If one catches fire, the next house will likely be affected in some way. Similarly, pain from a compressed nerve will affect the nerve adjacent to it in some way. For this reason, it’s important to treat it before the whole body is affected.

Some patients may not really understand why they are experiencing such pain. When you combine this pain with apprehension, one may end up with feelings of anxiety or fear. It possible that the patient does not know who to turn to for help with their disorder. Also, those who have an idea of what the problem could be are left wondering if they can afford the necessary treatments and surgery. If you have a Blue Shield PPO coverage, worry not, you’ll get state-of-the-art spine surgery at significant discounts.

About Us

At Dr. Rappard’s Los Angeles Minimally Invasive Spine Institute, we are a state of the art center offering high-end spine surgery designed to make your neck pain, back pain, or sciatica go away faster. We only perform ultra-minimally invasive neck surgery and back surgery. Our Blue Shield PPO Spine Surgeon uses only sophisticated high resolutions cameras strategically positioned through the natural openings in the spine, a spine laser and miniaturized surgical instruments, all of which are inserted through a small skin incision. Our spine surgery is done devoid of cutting or disrupting normal bone, muscles, or ligaments. This makes recovery much quicker. Your surgery your body is allowed to focus on healing from your condition as opposed to the traumatic effects of the surgery. Whether you’re seeking state of the art back pain, sciatica, or neck pain treatment, Dr. Rappard Blue Shield PPO Spine Surgeon has specialized techniques that can get you better in the quickest way possible. 

Dr. Rappard’s Expertise

Dr. Rappard’s core specialty is a rare one referred to as neurointerventional surgery. Only about 800 physicians are trained and certified in this specialty throughout the U.S. It takes about 8 years of training after medical school, and generally entails advanced minimally invasive neurological procedures. Dr. Rappard is a rare breed as a spine trained neurointerventional surgeon and among endoscopic surgeons. For this reason, he is uniquely qualified to perform a careful evaluation, expertly interpret patient MRI’s, perform image-guided spinal procedures, and serve as a qualified and knowledgeable endoscopic spine specialist.

Our Approach to Creating a Lasting Doctor-Patient Relationship

At Los Angeles Minimally Invasive Spine Institute, we are committed to the doctor-patient relationship. We spend quality time with each and every patient to clearly understand their general health, job requirement, lifestyle, any underlying medical conditions, and expectations. Our Blue Shield PPO Spine Surgeon makes sure that every visit is comprehensive and thorough. Our initial consultation often involves taking an extensive history and performing a detailed physical examination for the purposes of creating a foundation for making proper diagnosis, which will support any medical decisions.  We’ll explain the situation and details of your diagnosis, discuss your treatments options and help you understand the expected outcomes.

If we recommend additional treatment or further diagnostic studies, we’ll make you understand the reasons behind your plan of care. We understand that each patient’s situation is unique and that’s why we’re prepared to respond to your questions when you visit. With our patient-centered philosophy, we are able to determine the simplest, safest, and most apposite treatment methods needed to realize effective results.

How Blue Shield PPO Spine Surgery Coverage Works

Your Blue Shield PPO plan gives you the freedom to choose any hospitals and physicians within the plan's network and sometimes even outside the network. Your costs will be lower if you select a network provider but if you choose a physician who is not a member of Blue Shield PPO network, your out-of-pocket costs will be higher for each service.

Using your Blue Shield PPO Coverage to Pay for Your Spine Surgery

  • You pay part; Blue Shield PPO pays part. 

Your Blue Shield PPO uses cost-sharing as a way of keeping costs in check. When you see our spine surgeon or undergo your spine surgery in our facility, you pay part of the cost of those services in the form of copayments, deductibles, and coinsurance. The cost-sharing aspect of a PPO plan ensures that you really need the healthcare services you’re getting. If spine surgery is the only way to treat your condition, then your BlueShield PPO has got you covered. Also, the idea of cost-sharing helps you offset the cost of your healthcare. In the past, spine surgery has been an expensive endeavor and those in dire need of it ended up with massive debts, but with PPO discounts, spine surgery doesn’t have to be a total burden.

  • You pay less when you use a PPO’s network of providers

Your PPO limits from where and whom you can receive your spine surgery and other healthcare services. As such, there are strict rules about how you get your healthcare. If you fail to follow the managed care plan’s rules, you’ll be penalized by having to pay a greater portion of the cost of your spine surgery out of your own pocket or the provider won’t pay at all. Also, you can expect to pay more when you choose an out-of-network provider.

Dr. Rappard’s Los Angeles Minimally Invasive Spine Institute is a Preferred Provider Organization (PPO) committed to delivering quality spine-related health services at a discounted cost by offering incentives for members who are registered with the Blue Shield coverage. We also offer services to patients who are not members of PPO network.

  • You have to get service pre-authorized by the PPO

Before we take any expensive tests, procedures, or your spine surgery, you’ll be required to obtain a pre-authorization. Failure to get approval from your PPO before any of these are commenced means that the PPO won’t pay. As such,

When we request the PPO for pre-authorization, the PPO will want to know the reason why you need that spine surgery. This is to ensure that you really need that care and there is no alternative that can help achieve the same goals. For instance, when Dr. Rappard asks for pre-authorization for your spine surgery, the PPO might request you to try physical therapy first for your neck pain or back pain. If you try it and it doesn’t fix the problem, then your spine surgery may be authorized.

The good thing about PPO’s is that you don’t have to have a primary care physician. You’re allowed to go to any specialist registered with the plan without a referral from a PCP. But depending on your condition, you may need pre-authorization, so you’ll want to call your PPO providers before scheduling an appointment with us.

Blue Shield PPO recommends conservative nonsurgical therapy for a specified time including:

  • Participation in physical therapy, including active exercise
  • Use of prescription strength analgesics (anti-inflammatory medications included)
  • Evaluation and management of associated behavioral, cognitive, and additional problems when present

Blue Shield PPO Will Provide Coverage for Spine Surgery for Any of the Following Conditions

  1. Spinal repair surgery for tumor, dislocation, or infection (including fungal infection, discitis, osteomyelitis, abscess, or tuberculosis) when debridement is necessary and the extent could help get rid of the infection that could cause the spine to be unstable.
  2. Spinal fracture with neural compression or instability
  3. Spinal stenosis with:
  • Neurogenic claudication that results in significant functional impairment in a patient who has documentation of lateral recess/central/ foramina stenosis on an imaging such as MRI and has failed at least 3 months of conservative care.
  • Associated spondylolisthesis shown on plain x-rays
  • Severe, progressive idiopathic scoliosis
  1. Severe or rapidly progressive symptoms of cauda equina syndrome, neurogenic claudication, and motor loss
  2. Persistent debilitating pain on a daily basis that has a documented effect on the patient’s daily living even with the optimal conservative non-surgical therapy

Some of the Surgical Approaches Used to Access the Spine

Your spine can be accessed from different angles, including:

  • Anterior approach: Spine is accessed from the front of your body, through the abdomen.
  • Lateral approach: The pathway to your spine is made through your side
  • Posterior approach: Spine accessed from the back


Minimally invasive procedures help in reducing hospital stays. Patients undergoing MISS procedures can go home on the same day or in one or two days. This is because the length of time required in the hospital varies from one patient to another. Patients who opt to undergo traditional surgery can stay in the hospital for three to five days. Postoperative pain after minimally invasive spine surgery is less compared to pain experienced by the patient after following a traditional open procedure. Even though one should still expect to feel some uneasiness, thanks to the new advancements in pain control, Blue Shield PPO Spine Surgery doctors can now help manage and relieve your pain easily.

Contingent to the procedure and your general physical condition, your doctor may recommend physical therapy to help you regain strength and even speed up your recovery process. To be strong and be able to resume your normal duties, you will be required to undertake specific exercises. If you underwent a fusion procedure, it may take a couple of months before the bone is solid again. During this restorative period, the fused spine must remain in correct alignment. You will be trained on how to move properly, sit, reposition, walk, and stand.  The period it takes to resume your daily activities following minimally invasive spine surgery is determined by both your individual procedure and condition. After undergoing surgery, your doctor will assess you to make sure that your healing process is progressing as anticipated.

Imaging During Spine Surgery

With the help of computer-assisted image guidance, Blue Shield PPO Spine surgeons are able to view the operative site in a finer clarity compared to traditional visualization techniques. Moreover, implants like screws or rods can be implanted and placed with a greater degree of accuracy than generally attained with conventional techniques. Computer-assisted image guidance helps in yielding real-time views of the anatomical position and even orientation of the operative site while the patient is undergoing the surgical procedure. This is owing to the fact that images taken before (preoperatively) the surgery are merged with those taken while the patient is undergoing surgery. To ensure a high level of precision and safety, Blue Shield PPO Spine surgeons rely on preoperative computed tomography (CT) and intraoperative fluoroscopy (real-time x-ray).

It is important to note that not all patients qualify for minimally invasive spine surgery (MISS) procedures. Before any patient can undergo these procedures, our doctors ensure that there is an assurance that similar or better results can be obtained through minimally invasive spine surgery techniques than with an open surgery.

The Four Pillars of Treating Chronic Spinal Pain

Dr. George Rappard coined the four pillars of spine care and they include:

  • Physical therapy and chiropractic care tailored to your condition
  • Selecting newer and more effective medical therapy
  • pain injections targeting your specific pain source, and when needed,
  • Minimally Invasive surgery that will preserve your natural spine

To maximize your chance to succeed, this care model makes sure that you’ve been maximally treated at one step before the next can be considered.

Contact Us to Learn More

If you’re a Blue Shield PPO subscriber and would like to undergo spine surgery, Los Angeles Minimally Invasive Spine Institute is a Preferred Provider that you can trust. Our Blue Shield Spine Doctor is high-qualified and experienced and only uses state-of-the-art techniques and tools. Contact us today to schedule a consultation.

The 4 Pillars of Treating Chronic Spinal Pain

George Rappard MD discusses the 4 key pillars of spine care. The 4 pillars are physical therapy and chiropractic care tailored to your condition, appropriate selection of medical therapy, pain injections targeting your specific pain source and, as a last result, minimally invasive motion and stability preserving spinal surgery performed as an outpatient procedure. Through effective use of the first 3 pillars only about 5% of our patients need to go on to have back surgery or neck surgery.

How can we help you?

Contact Us to Schedule a Consultation.



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