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

Written by James Hirby and Fact Checked by The Law Dictionary Staff  

For many young people, tonsil removal is a rite of passage. A necessary outcome of repeated strep throat infections, the procedure can prevent potentially catastrophic complications as these infections become more severe with age. Unfortunately, tonsil removal can be painful and often comes with a surprisingly long recovery period. Common side effects include painful or difficult swallowing and persistent throat pain. Fortunately, the risk of serious side effects like secondary infections and loss of speech are exceedingly rare.

Since tonsil removal is a common procedure for children and young adults, it's covered by most health insurance plans. Unfortunately, it's usually considered to be an elective procedure. This dramatically increases its out-of-pocket costs and may significantly reduce its perceived benefits.

Tonsil removal was not always judged to be an elective procedure. As recently as 20 years ago, doctors would remove kids' tonsils once they experienced a handful of strep throat infections or secondary bouts of tonsillitis. However, an emerging medical consensus suggests that the tonsils are an important part of the body's immune system and may actually serve to quarantine infections that might otherwise devastate other parts of the body. As such, kids are rarely subjected to tonsil removal without exhibiting serious signs of weakness. The procedure is now more common in adults who experience recurring periods of tonsillitis.

If you do elect to have your tonsils removed, you'll want to find a doctor who can perform the surgery as an outpatient procedure. Since tonsil surgery is not a particularly invasive procedure, most doctors will do this without difficulty. You should expect to pay your doctor about $400 for the initial consultation.

Depending upon the policies of your insurance company, you'll be on the hook for 50 to 70 percent of the total cost of your surgery. If you have an excellent health insurance plan, you may need to pay just 15 to 30 percent of the procedure's costs. On the other hand, a bare-bones insurance policy may force you to pay as much as 90 percent of the procedure's costs.

Since your tonsil surgery will require some form of anesthesia, it will cost at least $2,000. If you elect to have your surgery performed in a hospital's operating room, it could cost upwards of $6,000. After your insurer's payment, you'll be looking at a final cost of between $1,000 and $5,000. To ensure that you actually need to have your tonsils removed, you may wish to see an ear, nose and throat doctor to get a second opinion.

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