If you have recurring cases of tonsillitis, strep throat, sleep apnea, or other breathing problems, your doctor may recommend you have a tonsillectomy. When planning for surgery, you may be considering recovery time and post-op care, but it’s also important to budget for the cost of the surgery itself.
Amino found that the median network rate for a tonsillectomy is $3,585. Keep in mind—this is an estimate for what you and your health insurance company might pay together (combined) for the surgery.
Read on to learn more about what a tonsillectomy is and who might need to have it done.
What is a tonsillectomy?
A tonsillectomy is a surgery used to remove your tonsils, two small glands located in the back of your throat. It’s usually performed by an ENT under general anesthesia.
The most common types of tonsillectomy are cold knife steel dissection and cauterization. During a cold knife steel dissection, your surgeon will remove your tonsils with a scalpel. With the cauterization method, the tonsils are burned away using an electrocautery. Though the latter method can prevent excessive bleeding, it may also result in more discomfort post-surgery.
Most tonsillectomies that are done to treat chronic infection can be done as outpatient procedures, so you should be able to go home the same day. For cases of sleep apnea or other breathing problems, you may have to stay in the hospital a few days so that your blood oxygen levels can be monitored.
Recovery time for a tonsillectomy is usually about two weeks, and your doctor will prescribe pain medication, as well as antibiotics, for you to take during that time. It’s usually recommended that patients don’t eat solid food during recovery time, so the scabs from surgery have time to heal properly.
Who needs a tonsillectomy?
According to the American Academy of Otolaryngology, about 20% of tonsillectomies are done because of chronic infection, while 80% are done to correct obstructive sleep apnea (OSA). These are the two most common reasons for a tonsillectomy:
Frequent, recurrent cases of tonsillitis or strep throat. As part of your immune system, your tonsils act as a barrier between your airways and bacteria or viruses. When an infection is present, the white blood cells in your tonsils fight it off. However, constant exposure to bacteria and viruses can make your tonsils susceptible to infection themselves. Except for severe cases, getting strep throat or tonsillitis once isn’t usually cause for a tonsillectomy. One case of tonsillitis or strep throat is usually not enough to warrant a tonsillectomy. Professional guidelines dictate that a tonsillectomy may be necessary if you have seven cases of tonsillitis or strep throat within one year, or five cases or more over each of the last two years. It’s still possible to get strep throat after a tonsillectomy, though most people won’t. Those who do continue to get infections will likely experience them with less frequency and severity.
Sleep apnea due to enlarged tonsils. Sleep apnea is a common, yet potentially serious disorder which causes pauses or shallow breathing during sleep. In children, this is often caused by enlarged tonsils that obstruct airflow. A tonsillectomy to correct sleep apnea is more common in children than in adults. Though there are risks involved, the efficacy rate is between 75 and 100%, and most children will experience a lower chance of future infection, better sleep, and an improvement in behavioral issues like hyperactivity.
About 500,000 tonsillectomies are performed on children each year, making it the second most common pediatric surgery. Due to the fact that their immune systems are still developing, children are more susceptible to throat infections like tonsillitis and strep throat. However, it’s more common for children to have a tonsillectomy to correct obstructive sleep apnea than chronic infection.
Due to the health and development problems sleep apnea can cause children, doctors may be more liberal in recommending a tonsillectomy for children.
Are there alternatives to a tonsillectomy?
Tonsillectomies are typically very effective at treating cases of chronic infection and sleep apnea in both children and adults. However, they aren’t generally recommended as the first course of treatment.
For infections like strep throat and tonsillitis, your doctor will likely prescribe antibiotics first. If you continue to get frequent infections, a tonsillectomy may be recommended. The procedure is highly beneficial and can decrease the frequency and severity of infections, though it doesn’t completely eliminate the risk of infection.
Less invasive treatments for sleep apnea may also be offered. These can include continuous positive airway pressure devices (CPAP), lifestyle changes like weight loss, or the use of devices that reposition the lower jaw and tongue. If the main cause of sleep apnea is enlarged tonsils, a tonsillectomy is often the most effective treatment.
Like any other surgical procedure, a tonsillectomy comes with a set of potential risks, including additional infection, bleeding, and swelling. If you’re unsure whether a tonsillectomy is the best option for you or your child, it’s best to have a conversation with your doctor or get a second opinion from an ENT.
What determines the cost of a tonsillectomy?
Amino found that the median network rate for a tonsillectomy is $3,585. Costs range across the US from $2,088 to $4,932—a significant difference. Here are some factors that could impact how much your tonsillectomy 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.
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 (and whether your anesthesiologist is in-network or out-of-network), can impact your cost. Although unlikely, if an emergency arises during your 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 your tonsillectomy could cost, let’s explore insurance coverage and how to get the most care for your money.
Will health insurance cover your tonsillectomy?
Most insurers cover a tonsillectomy as long as it’s medically necessary, which may require proof of recurring tonsillitis, strep throat, or swollen tonsils that affect your breathing. Medicare and Medicaid will usually cover a portion of a medically necessary tonsillectomy, too.
If you don’t have insurance, you may have to pay the full cost of the surgery 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 tonsillectomy, you’ll likely pay a portion of the total 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 your tonsillectomy yourself. Some doctors will offer a discount or an interest-free payment plan if they know you’re shouldering the cost on your own.