How Much Does a Tonsillectomy Cost?
A tonsillectomy is a procedure that involves removing the tonsils, which is usually done when someone experiences recurrent cases of tonsillitis or strep throat. A tonsillectomy is also performed for those who are suffering from disruptive sleep apnea.
A tonsillectomy is common among children, although adults can receive the procedure at times as well. This is especially true when an adult has sleep problems resulting from enlarged tonsils.
How much does a tonsillectomy cost?
On average, a tonsillectomy can cost anywhere from $4,000 to $11,000 without insurance. The cost generally depends on the age of the patient, the location of the hospital or doctor, professional fees charged by the doctor, the facility, anesthesia fees, and insurance. Most tonsillectomy patients are covered by insurance, especially when the surgery is ordered by the physician.
With insurance, the prices of a tonsillectomy are typically between the $200 and $1,300 from the numbers we researched. The Blue Cross Blue Shield estimator, for example, said the procedure could cost anywhere from $460 at an outpatient center to as much as $5,000+ at a hospital with insurance. These were Blue Cross Blue Shield rates based out of North Carolina. Again, your insurance rates will greatly vary as all policies are so much different.
If you do not have health insurance, major companies, such as eHealthInsurance.com, can help you sort through hundreds of policies.
The Northwest ENT Surgery Center, a surgery center located in Georgia, says a common procedure such as this can cost anywhere from $8,000 to $10,000, even with a cash discount at a hospital factored in. However, at their surgery center, no insurance patients can pay $2,800, and this fee would include the surgeon’s and anesthesiologist’s fees, equipment, and laboratory services.
Factors that affect the price
Age
The tonsillectomy procedure for children, on average, is less than for adults. The reason is that pediatric tonsillectomy is considerably easier, is less painful, and has lower odds of complications. The difference in price between tonsillectomy for adults and children is about $500.
Fees
The cost of tonsillectomy includes doctors’ fees ($500-$600), anesthesia fees ($600-$700), and facility fees ($1,500-$4,500).
Facility
Where a tonsillectomy is performed also affects the total cost of the procedure. Undergoing it in a hospital often results in higher fees, but the fees can be lower when having the surgery in a licensed ambulatory surgical center. An ambulatory surgical center generally refers to a freestanding licensed ambulatory diagnostic or surgical facility.
Insurance
Patients with insurance pay significantly less than those who undergo tonsillectomy without insurance. In general, the cost depends on the insurance plan and the insurer. Some insurance companies cover the total cost of the procedure, while others cover about 80 percent of the total cost. On average, insured patients pay around $500 while the uninsured ones are charged around $5,500.
Location
A tonsillectomy performed in states where the cost of living is low is usually cheaper than one performed in a state with a higher cost of living. This can be true with any professional service.
Tonsillectomy overview
Before the procedure is even considered, your doctor will first want to explore your medical history, take a physical examination and order separate tests such as a throat culture /strep test, x-ray and/or blood test.
For children, a general anesthetic is always used; however, for an adult, a local anesthetic will be used to numb the throat. The procedure will almost always be performed at an outpatient center, but in some circumstances, some may need to spend the night at the hospital.
During the procedure, the mouth will be held open using a clamp to allow the surgeon full access to the tonsils. The most common type of tool used during the procedure will be a scalpel; however, some surgeons may also use laser technology to cut the tonsils out. Once the tonsils are removed, the surrounding blood vessels will be closed off using a heat-type method and the patient will then be sent off for recovery.
What are the extra costs?
As mentioned prior, all of your pre-operative tests, such as an x-ray throat culture and/or x-ray, can all be an additional cost to consider.
After the tonsillectomy is completed, the doctor will typically prescribe antibiotics to prevent infections and pain relievers to keep the patient comfortable during recovery.
As noted above, the surgeon fee, anesthesiologist, and facility fees can all be separate, depending on the facility billing policy. Before your surgery starts, ask for an itemized bill to know what your quote will include.
An adult tonsillectomy is often going to cost more than a children’s procedure. This is due to the fact that there are fewer complications involved when the procedure is done on children.
A follow-up visit will be necessary a few weeks after the procedure to make sure everything is healing properly.
Tips to know:
The primary risk is bleeding after the surgery has been performed. Approximately one percent of patients who undergo the procedure will experience bleeding to some extent. Aside from bleeding, other risks include dehydration, pain and/or an infection.
After the surgery, the throat will be sore for several days, and in turn, this soreness may or may not affect the sound and volume of your voice. It can also make it hard for someone to eat. According to Cigna, it could take up to 10 days to see a full recovery.
If you have insurance, always make sure the surgical center/hospital and surgeon is in network to avoid out-of-network costs.
How do you know if you need your tonsils removed?
You have chronic sleep issues that may disrupt your sleep.
You experience recurrent tonsillitis caused by either an infection or strep throat.
You have at least five to seven chronic infections within a year.
How can I save money?
Consider having the procedure done in an outpatient setting. When compared to a hospital, an outpatient center will be much less.
Even if you don’t have a health insurance policy, talk with your doctor or surgical center to see if you can either save by paying cash up front, or in some circumstances, you may be able to have the fees waived if you meet certain income requirements.
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