For patients
An extra layer of protection while you're asleep.
Your surgeon has asked us to monitor your nervous system during your operation. Here's what that means, what to expect and how billing works.
What is IONM?
Your nerves, checked continuously during surgery.
Intraoperative neurophysiological monitoring (IONM) uses small electrodes to send and record tiny electrical signals along your nerves, spinal cord and brain while you are under anesthesia.
A certified technologist watches those signals for the whole operation, with a physician reviewing them in real time. If a signal changes, the surgical team is told right away so they can adjust, often before any lasting injury happens. IONM is used in spine, brain, head and neck, blood vessel, and nerve surgeries.
What to expect
Before, during and after.
Before surgery
Meet your technologist
On the day of surgery a Delta technologist may introduce themselves, explain the monitoring and ask you to sign a consent and assignment-of-benefits form. Ask them anything.
During surgery
Monitoring while you sleep
Electrodes are placed after you are asleep, usually on your scalp, arms and legs. You won't feel the signals. We watch them for the entire operation.
After surgery
Little to notice
The electrodes are removed before you wake up. Some people notice minor redness, bruising or muscle soreness where they were placed, which usually fades within days.
Billing & insurance
How we bill for your care.
We bill your insurance directly, and we work to keep your share of the cost as low as the law and your plan allow.
Commercial insurance
We bill your plan
Delta is generally an out-of-network provider. We submit claims to your insurer on your behalf and, where needed, appeal for fair payment. Federal and New Jersey law protect you from most surprise bills at in-network facilities.
Auto accident
PIP / no-fault
If your surgery is related to a motor vehicle accident, we bill your auto carrier's personal injury protection coverage. Have your claim number and adjuster details ready.
Work injury
Workers' compensation
For work-related injuries, we bill your employer's workers' compensation carrier directly. Please share the claim number and case manager contact.
Include your name, date of surgery and any statement number.
If you are uninsured or not using insurance, you can request a good faith estimate of expected charges.
Notice
Your rights and protections against surprise medical bills
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is balance billing? When you see a provider that isn't in your health plan's network, they may be allowed to bill you for the difference between what your plan pays and the full amount charged. This is called balance billing.
- For certain services at an in-network hospital or ambulatory surgical center, out-of-network providers may not balance bill you, and you are responsible only for your plan's in-network cost-sharing (copayments, coinsurance and deductibles).
- You are never required to give up your protections from balance billing, and you are not required to get care out-of-network.
- Your health plan generally must count any amount you pay for these services toward your in-network deductible and out-of-pocket limit.
- If you are uninsured or self-paying, you have the right to receive a good faith estimate of expected charges.
If you believe you've been wrongly billed, contact the federal No Surprises Help Desk at 1-800-985-3059 or visit cms.gov/nosurprises.
New Jersey law also protects you from certain out-of-network bills, including for services at an in-network hospital or surgery center that you did not knowingly choose to receive out-of-network. For help or to file a complaint, contact the New Jersey Department of Banking and Insurance at 609-292-7272 or the Consumer Hotline at 1-800-446-7467, or visit nj.gov/dobi.
Questions
Frequently asked.
Why did my surgeon order neuromonitoring?
Some operations work close to the spinal cord, brain or important nerves. Monitoring gives your surgeon real-time information about how those structures are doing, so problems can be caught and corrected early.
Is IONM safe?
Yes. The risks are low. You may have minor bleeding, bruising or soreness where small electrodes were placed. When motor pathways are tested, there is a small risk of tongue or lip bites, which the team protects against with a soft bite block.
Will I feel anything?
No. Monitoring happens while you are under anesthesia, and the electrodes are removed before you wake up.
Who is watching my signals?
A CNIM-certified technologist stays with you in the operating room, and a licensed physician reviews the monitoring in real time from a secure connection.
Why did I get a separate bill from Delta?
Neuromonitoring is a separate professional service from your surgeon, anesthesiologist and hospital, so it is billed separately. If you have questions about a statement, call our billing team. We're happy to walk through it.
Do you take my insurance?
We bill commercial insurance plans, auto (PIP / no-fault) carriers and workers' compensation carriers. If you're unsure about your coverage, call us before your surgery and we'll help you check.