How Much Does It Cost to Get Your Tonsils Removed with Insurance?

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There is no question that medical care is expensive. Surgeries, especially those requiring lengthy hospital stays, are at the top of the price structure. However, these surgeries are often necessary for healthy living. They may even be life saving.

What is a Tonsillectomy?
A tonsillectomy is a procedure in which a surgeon removes both tonsils. Most often, the reason for removing tonsils is a repeat infection that is often referred to as tonsillitis. If a patient experiences six or more cases of tonsillitis or strep throat per year, an Ear Nose and Throat specialist may recommend having the tonsils removed. Tonsillectomies may often take place if swollen tonsils make breathing or swallowing difficult. They must also be removed if cancer is detected in one or both tonsils.

How Long is the Hospital Stay?
Tonsils are usually removed as an outpatient surgery under general anesthesia. In most cases, patients are released from the hospital once they awaken and show no signs of complications. Very young children, elderly individuals and those with other severe diseases may be kept overnight or longer. It is possible that the hospital stay is extended should any complications arise, though these are rare.

How Much Does a Tonsillectomy Cost?
The cost of any procedure varies from patient to patient. Costs associated with a tonsillectomy depend upon the age of the patient, any other health concerns, the length of the hospital stay and the reason for the tonsil removal. In the United States, most recent reports show that the cost for a tonsillectomy can range from about $3200 to about $8500.

What Will Insurance Cover?
Insurance policies vary. An excellent insurance policy may cover as much as 85 percent of the procedure. High deductible insurance policies may leave patients paying most or even all of the final cost. Even very good policies may cover little if the tonsillectomy is viewed as an elective procedure. Unfortunately, tonsillectomies are largely regarded as elective by insurance companies.

What Can the Patient Do?
Unless it is an emergency tonsillectomy, the patient should take the time to consult with the physician, hospital and insurance provider prior to the surgery. The patient should be provided with a complete breakdown of the costs, including anesthesia, hospital stay, operating room and physician services. The patient should also ask for a breakdown of additional costs, such as possible extended stays and prescription pain medication. In many cases, the insurance agency will require that the patient ask for pre-approval of the surgery before it can be filed as a claim. It may be necessary for the patient and the caregiver to contact the insurance agency. Insurance companies may take up to six weeks to approve a surgery. If the procedure needs to take place quickly, the hospital staff may need to contact the insurance company to prove need.

What is the Final Cost for the Patient?
The final cost may be as low as $300 or as high as $7500 or more. The only true way to learn the final cost is for the patient to thoroughly study the insurance plan, receive a pre-printed breakdown of costs and verify all information with the insurance provider.