Tonsil removal surgery cost without insurance

Q: Is tonsil surgery covered?

Most insurers cover a tonsillectomy as long as its 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.

**Dr. Jefferson cannot book patients to public hospital operating lists from his private rooms**

Table of Contents Show

Self-Fund
Join a Health Fund
Compassionate Release of Superannuation
How much will it cost to remove my tonsils?
Is tonsil surgery covered?
Is Getting tonsils removed worth it?

There are many Ear Nose and Throat conditions that do not require surgery. These problems can be assessed and managed in our private rooms without an operation.

If surgery is recommended and you are not covered by health insurance you have 3 options:

Pay for the operation yourself (self-fund) through the private hospital system
Join a Health Fund *RECOMMENDED*
Apply for Compassionate Release of Superannuation

Self-Fund

Many of our patients choose to “self-fund” their procedure. This allows you to have the operation performed by the surgeon of your choice, at a private hospital on a date that is convenient for you.

There are 3 fees associated with an operation at a private hospital: 1. The surgeon’s fee 2. The anaesthetist’s fee 3. The hospital fee

Our surgeon’s fees:

Item Number	Description	Cost @ Ear Nose Throat Newcastle	Medicare Rebate
41632 x 2	Bilateral Grommets (grommets in both ears)	$ 930.00	$ 277.05
41789	Tonsillectomy (child less than 12 years of age)	$ 800.00	$ 225.35
41793	Tonsillectomy (person over 12 years of age)	$ 1000.00	$ 287.35
41671, 41692 x2, 41764	Septoplasty/Turbinoplasty (blocked nose operation)	$ 1732.50	$500.85

* Please note: These fees are current as of July 2021 and are subject to change at any time

Join a Health Fund

In most cases, it is more cost-effective to take out private health cover now and have surgery in 12 months time. Most health funds require a 12-month waiting period for surgeries on pre-existing conditions. Private health will cover most, or all of the hospital fees, depending on your excess. The hospital fee is typically the most expensive part of having surgery in the private system. Private health funds will also cover most of Dr Jefferson’s fees as well as the majority of the anaesthetist’s fees. If you choose to take out health insurance, please let us know the date you joined. We will schedule in a phone consult with our Practice Nurse in 12 month’s time to determine whether surgery is still required. If your condition has changed, we may book you in for a review with Dr Jefferson prior to considering a surgery date.
To compare health funds here: Compare Private Health

Compassionate Release of Superannuation

The Australian Government may allow you to access your superannuation for medical treatment if you meet certain requirements. You can find a list of the requirements and the process for applying here: Eligibility for Compassionate Release of Super

How much will it cost to remove my tonsils?

For a common procedure such as a tonsillectomy, the total price can range from $8,000 to $10,000 even with a cash discount offered by most hospitals.

Is tonsil surgery covered?

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.

Is Getting tonsils removed worth it?

“The good news is, having your tonsils removed has proven to significantly reduce the rate of infection for chronic sufferers. And you don't need your tonsils, so there are no long-term consequences for having them removed,” Dr. Ingley says.