Tonsillectomy Without Insurance!

Updated on February 08, 2012
S.C. asks from Queen Creek, AZ
8 answers

My six year old's pediatrician has suggested that he might need to have his tonsils removed and referred me to an ENT. I'm all for the procedure, but the problem is that we don't have traditional insurance. We're on a sort of Christian "sharing" plan, which would reimburse us for the operation after it's been completed. At least, I hope it will. I'm not 100% this will qualify, actually.

I'm committed to doing it either way, if it's what my son needs, but I wanted to at least get an idea going into it of what it would cost. When I called the ENT today, I was told the initial visit would be $250 and they would quote me a price for the surgery after he's been evaluated. Apparently there are so many variables in what needs to be done (adenoids, etc) that they really can't give me an accurate price up front. They refused to even give me a ballpark, actually.

And I get that, I really do. But I really need to know if this is going to be something that I simply won't be able to pay for right away. My son has extremely large tonsils (one rests snugly against his uvula, actually) that cause him to snore heavily at night. It affects his voice as well (throat constantly sounds swollen) and when he's even the slightest bit sick he has to breathe heavily through his mouth. The pediatrician and I are concerned about obstructive sleep apnea, though I have never witnessed an episode of this.

So obviously I feel like he needs to be seen no matter what, but I guess I would just feel a little better knowing how much these things normally cost. Have any of you gone through this without insurance? If so, what was the final cost and were they willing to take payments on it after the fact? I understand it's an out-patient procedure now, so I'm hoping that will mean the cost is somewhat affordable but I really have no idea. Any help and advice you could give me would be greatly appreciated.

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answers from Oklahoma City on

My kids do not do without health insurance, ever. I have no health care at all. The ER is my family doc. I have to be so sick that I feel like I am about to die before I can even go get antibiotics.

The kids? They get a state medical card that will cover anything they need. If you cannot afford insurance then go to the state offices and fill out the paperwork, they may qualify.

The "health plan" you have does not sound safe for the kids in this instance. He could choke to death if they swell at all.

2 moms found this helpful


answers from Erie on

If a tonsillectomy "doesn't qualify" under your current "health plan" then that is a red flag you need another plan. Like Gamma G, my dh and I have never had health insurance, none of our employers ever offered it, but our kids were ALWAYS covered by medicaid. If we didn't qualify, I would buy separate policies for them, rather than depend on being reimbursed (or not!) by some sketchy plan that may or may not be beneficial.
I hope the figures quoted to you below are accurate, those prices don't sound too bad. And yes, make sure you tell them you are paying in cash, it really can affect the price (and how screwed up is THAT? 2014 can't come soon enough for me!)

Good luck to you and your little guy. I hope he is on the mend soon :)

1 mom found this helpful


answers from Phoenix on

My 5 yr old just had his tonsils and adnoids removed, as well as tube implants in his ears. So far it has been the best thing for him, but one of the worst expierences! He had fluid built up in his ears due to improper drainage becasue of the size of his tonsils/adnoids. I truly believe since the surgery it's the first time in his life he's been able to breate through his nose! The sleep apnea is real, you would be able to tell if monitoring his oxygen levels during sleep. My son's sleep has improved dramatically since the surgery. The recovery was the worst. I thought he'd be relaxed eating jello, ice cream, and popsicles for a few days and back to his normal rambunctious ways.....NOT SO! He was in so much pain, he refused to eat anything other than water, and even slobbered all the time from not swallowing his own spit. We had to force the pain medication, which made him constipated. He was fully recovered after 10 days, but it was 10 very exhausting days.... In the end it was worth it, I would definatley do it again. I just wish I could have been better prepared on what to expect afterward.

As for insurance we are blessed. We have very good coverage and our total out of pocket cost from initial visit to post op visit has been $140.

I know the providers submit for one amount, and the insurance pays another due to network discounts, so I will give you the full amount submitted so you have a 'ballpark' amount of the absolute full amount.

Initial ENT visit = $486.00/hearing test, determined hearing loss due to fluid build up, suggested tonsil removal.

Follow up visit = $131.00/ fluid still there, scheduled surgery

Surgery/Dr. = $1,553.00

Hospital (Arrowhead outpatient surgery) = $9,160.40

Again these are the full amounts that was billed to the insurance. The Hospital amount includes the anesthesiologist as well.

We are in the west valley and were refered to Dr. J. Altman, he is by far one of the elite and I recommend him to anyone in need of an ENT. I feel I should mention, the initial visit was on referal from the pediatrician due to a failed hearing test at school. This is the reasoning for the follow up visit. I hope this helps!



answers from Phoenix on

Make sure you tell them you are a "cash pay" patient. The cost is always significantly lower and what you have in not "insurance". They inflate prices for insurance because they know they will only get a small % of whatever number they submit. In your case whatever number they give you, you'll pay the full amount.



answers from Atlanta on

First of all -make sure it's outpatient. I know several kids who have had their tonsils out in the past year, and they spent the night in the hospital, which means it's going to cost more.

I second Gamma G's idea of getting the kids on state medical insurance if you can't afford private insurance or get it through an employer. If one of them got injured or had a significant health issue, you would be in a HUGE mess!



answers from Los Angeles on

At ucla it runs 5500 to 7000. It might be that your child must spend the night which increases cost of course. They can't guarantee you it will be out patient even if the OR is an out patient suite. Might you go see an ENT for their opinion with your Childs records and current CT or X-rays? Good luck.



answers from Phoenix on

I agree with applying to AHCCCS first, even if you don't think you will quailify. If you don't qualify, take your rejection letter to the Indigent Care Clinic at Good Samaritan (you can check to see if other hospitals have them). Indigent Care Clinics are for used with hospitals that have Residency Training (for doctors) and receive Medicare funding. They are required to provide Indigent care via Medicaid or sliding fee scales. If you end up or choose to pay out of pocket, go to an ENT that owns their out-patient surgery center. Dr. John Raines has one and he is an outstanding ENT, he did my daughter and husbands surgeries.
Take the time to do your homework and don't be afraid to negotiate prices. Pay up front and make sure that your receipt says "Paid in Full".