How Much Does Tommy John Surgery Cost?
Tommy John surgery, also known as ulnar collateral ligament reconstruction (UCLR) surgery, is a procedure usually performed to restore the torn ligament in the elbow.
The condition, which is chiefly associated with baseball and tennis players, occurs when excessive force is constantly placed on the elbow, causing it to become injured.
The procedure was named after Tommy John, the baseball player who was the first person to undergo the surgery in 1974.
How much does it cost to have tommy john surgery?
The cost of a non-surgical elbow treatment procedure can be $500 to $5,000 with insurance, but for patients without insurance, the costs can range anywhere from $10,000 to $26,000 or more. The treatment for elbow injuries should usually be covered by insurance, except for the more sophisticated forms of treatment.
If you do have health insurance, check with your provider to see what they are going to cover. If you are looking for a new plan or do not have coverage, consider using services such as eHealthInsurance.com that allow you browse through hundreds of policies.
According to PlacidWay.com, elbow surgery costs up to $50,000, including hospitalization, anesthesia and physical therapy treatment.
According to a Times Free Press report, the cost of Tommy John surgery alone costs more than $15,000 at Georgia Sports Orthopedic Specialists center.
A patient who had undergone Tommy John surgery in Overlake calculated the costs incurred during the day of the procedure. According to his post, when the facility fee, doctor’s fee, doctor’s assistant fee and anesthesia were factored in, the grand total was $15,053.25, but as an insured patient, his total cost added up to only $649.23.
Factors that affect the price
Professional fees
Surgeon’s fees are usually on a case-to-case basis and will differ from one surgeon to another. In general, the rates depend on experience and expertise of the surgeon.
Facility
The cost of elbow ligament reconstruction surgery is specific to the facility where the procedure is conducted. Getting the procedure done as an in-patient in a hospital can add to the overall cost. Most hospitals require their elbow surgery patients to stay overnight after the surgery. However, patients can still get the procedure done in the hospital for a lower fee, but as an outpatient. For patients who want the least expensive method, they can get Tommy John surgery performed on them at a licensed outpatient facility.
Hospital fees
These vary from one hospital to another and include operating room charges, labs, X-rays, medications, and any testing that the doctor orders before and after the surgery.
Insurance coverage
Some surgeons and medical facilities accept standard Medicare insurance. For patients with health insurance, a certain part of the cost will be covered. However, they may be required to pay a co-payment or co-insurance, unless they are enrolled in several insurance companies. They may also need to pay for all services that are not covered.
Tommy john surgery overview
Before undergoing the surgery, the patient will be examined and a comprehensive medical assessment including a number of diagnostic tests will be performed. An s-ray is done to look for bone or fracture irregularities, while an MRI is performed to examine the soft tissues in the elbow. The outcome of the examinations will determine if the surgery is needed.
During the surgery, which usually takes an hour, an incision is made on the inner area of the elbow joint and the damaged ligament is substituted with a tendon collected from another part of the patient’s body, such as the forearm, hamstring, knee or foot. At times, donor tissue is used.
The entire procedure can take up to an hour to perform.
What are the extra costs?
A rehabilitation of at least one year normally begins one or two weeks after the surgery, depending on the patient’s condition. Although there is a typical rehab program, every patient is given one tailored to their condition. Each session, without insurance, can be in the $100 to $150 range. At a bare minimum, the Times Free Press article sourced above said you should expect at least three months of physical therapy sessions.
Patients usually will need to pay a co-pay for every doctor’s visit, for an MRI (if not included in the package) as well as for physical therapy.
Pain medications may also be prescribed after the surgery to help patients cope with the pain as well as antibiotics to prevent infection.
An elbow brace may also be recommended after the surgery to immobilize the joint and help in the healing process.
Tips to know:
Perform research about the medical professional who will be performing the Tommy John surgery. He or she, at a minimum, should be a board-certified surgeon with a specialty in elbow diagnosis and treatment. If you’re unsure where to look talk with a local orthopedic surgeon for a referral.
Tommy John surgery is covered by many medical insurance policies, but be sure to check with your insurer first. If you are paying for the procedure yourself, the costs to be incurred will be explained and may be authenticated in writing.
Ask the hospital or medical facility for a quote beforehand, and make sure that it includes the surgeon’s fee, the anesthesiologist’s fee, and other charges to be incurred.
When choosing surgeons, make sure to base your decision on qualifications and experience and has performed the procedure enough times to be highly skilled with excellent results.
Before you undergo the procedure, make sure to establish what your post-surgery payments will be and plan for any emergency, such as complications, as it may significantly increase the total cost of the care.
Questions to ask your doctor
What do I need to bring to my appointment?
How soon can I get an appointment?
What types of payments do you accept?
Do I need to have private health insurance?
How much will the surgery cost me after insurance pays its share?
What is the maximum on my insurance policy and will the surgery meet that limit?
What equipment and tests will the insurance cover?
Do I have disability insurance?
How much of my prescription costs after the surgery will be required to pay every month?
How can I save money?
Consider the Tommy John surgery done in an outpatient setting. This greatly reduces the cost since there are no hospital room fees and other hospital charges involved.
Tommy John surgery is much less expensive if you have insurance that covers the procedure. Be sure to ask about the details before deciding to undergo the surgery. If you don’t have insurance, ask about a cash discount or see if the hospital works with those who meet income requirements.
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