If you develop appendicitis, you’ll need prompt medical attention and, most likely, surgery. Since appendectomies are usually unexpected, you might be wondering how much it will cost.
Amino found that the median network rate for an appendectomy is $13,199. Keep in mind—this is an estimate for what you and your health insurance company might pay together (combined) for the surgery, not necessarily what you’ll pay out-of-pocket.
Read on to learn more about what an appendectomy is and who might need to have it done.
What is an appendectomy?
An appendectomy is a relatively common surgery done to remove the appendix, a small tube-shaped pouch on the right side of your abdomen. Removal is necessary if you develop appendicitis, when your appendix becomes infected and inflamed.
Appendicitis can cause abdominal pain, swelling, low-grade fever, nausea, vomiting, and diarrhea. If you experience any of these symptoms, it’s important to seek treatment right away. Though the appendix isn’t considered a vital organ, it can spread life-threatening bacteria into the abdominal cavity if it ruptures. If you have appendicitis, your doctor may want to do an appendectomy right away.
There are two types of appendectomies: open and laparoscopic. Your doctor will decide which type is right for you, based on the severity of your appendicitis and your medical history. Both are usually done by general surgeons, and you will be put under general anesthesia for the procedure.
During an open appendectomy, your surgeon will remove your appendix through a small incision in your lower right abdomen. This type of appendectomy has more risks involved and requires a longer recovery period but is often necessary if your appendix has burst.
If you get a laparoscopic appendectomy, your surgeon will make several small incisions in your abdomen and use a small, narrow tube (called a cannula) to inflate your abdomen with carbon dioxide gas. This allows them to see your appendix more clearly. Then, they will insert a laparoscope—a long, thin tube with a camera a the end—to help guide the surgery. Your appendix will be tied off with stitches and removed. This type of appendectomy is usually recommended for older people and people who are overweight. There are fewer risks and a quicker recovery time associated with a laparoscopic appendectomy.
Most patients will be able to go home the same day as surgery, but full recovery can take 4 to 6 weeks. Appendectomies have a high success rate and most people have no complications.
Who needs an appendectomy?
Both children and adults can get appendicitis and need an appendectomy. If you have any symptoms of appendicitis described above, seek out medical care immediately. Though having appendicitis doesn’t necessarily mean your appendix has or will burst, the life-threatening nature of that possibility makes it important to seek emergency care. Pregnant women with appendicitis may feel the pain in the upper right section of the abdomen since the appendix is higher during pregnancy.
Are there alternatives to an appendectomy?
Traditionally, an appendectomy has been considered the most effective way to treat appendicitis and avoid major complications. However, recent research has found that milder cases can effectively be treated with antibiotics. A study published in the Journal of the American Medical Association found that “appendectomies were 99.6 percent successful. Among patients treated with antibiotics and followed for a year, 73 percent did not need surgery. However, 27 percent of the patients treated with antibiotics had to have their appendix removed within a year after treatment. But there were no major complications associated with delaying surgery.”
Still, if you have symptoms of appendicitis, you need to see a doctor right away. Your doctor may recommend a CT scan, which can help them determine if you need an appendectomy or if treatment with antibiotics is sufficient.
What determines the cost of an appendectomy?
Amino found that the median network rate for an appendectomy is $13,199. Costs range across the US from $9,884 to $18,585—a huge difference. Here are some factors that could impact how much an appendectomy costs:
Where you live often affects how much your surgery costs, especially since it determines which hospitals and doctors are available to you. For example, if you live in an urban area, you may have more options to choose from.
If you need to ride in an ambulance to the emergency room, you probably won’t have time to make sure the ambulance is in-network. Consumer Reports says, “if the ambulance company that transports you to the emergency room doesn’t take your insurance, your out-of-network costs could be over $2,000, depending on factors such as where you live and the level of care you receive before you get to the hospital.” Though you may not have a choice in which ambulance company responds to your emergency, you should call around before an emergency comes up, to get an idea of the options available to you.
The network rate, which is what our estimates are based on, is negotiated between your health insurance company and doctor or hospital—so your insurance company and whatever provider you choose will play a large role in determining cost.
Your health insurance plan affects the cost of your surgery for a few reasons. Whether your surgeon is in-network or out-of-network can impact the overall cost. Your co-insurance and co-pay, as well as how much of your deductible you have left, can also make a difference in how much you pay out-of-pocket.
What happens during the procedure, such as what kind of anesthesia you get, whether your anesthesiologist is in-network or out-of-network, and what type of appendectomy you get, can impact your cost. If complications occur during surgery, you might have additional unexpected costs.
Your personal health also plays a role in how much your surgery costs. If you go into surgery with preexisting health problems, there could be additional expenses.
Now that you know how much an appendectomy could cost, let’s explore insurance coverage and how to get the most care for your money.
Will health insurance cover your appendectomy?
Most insurers cover an appendectomy as long as it’s medically necessary, which may require proof that you have a serious case of appendicitis that could cause your appendix to rupture. Medicare and Medicaid usually cover a portion of a necessary appendectomy, too. However, if you have an appendectomy for a more mild case of appendicitis that could have been treated with antibiotics, your insurance may not cover the procedure.
If you don’t have insurance, you may have to pay the full cost out-of-pocket. Where you get care (which doctor and facility you go to) can have a big impact on your total cost.
How to get the most for your money
Even if your insurance does cover some or most of your appendectomy, you’ll likely pay some of the cost out-of-pocket. To make sure you’re getting the most (and best) care for your money:
Ask your insurance company about your costs, like co-insurance, copays, and deductibles.
Utilize your Health Savings Account (HSA), Flexible Spending Account (FSA), and Health Reimbursement Account (HRA) to cover out-of-pocket expenses.
Use Amino to compare prices for different doctors.
Look into outpatient centers—they often have more affordable surgery options.
Have a conversation with your doctor. This is especially important if you don’t have insurance and are paying for the surgery yourself. Some doctors will offer a discount or an interest-free payment plan if they know that you’re shouldering the cost on your own.