lfran Posted October 2, 2011 Report Share Posted October 2, 2011 Can anyone tell me how much it tends to cost to have a tonsillectomy (either with or without insurance)? And does blue cross tend to cover it for PANDAS kids? I have the option to switch to BC soon, but not sure that I want to, so wondering how much T&A costs out-of-pocket if I can't get my HMO to approve. Link to comment Share on other sites More sharing options...
911RN Posted October 2, 2011 Report Share Posted October 2, 2011 Can anyone tell me how much it tends to cost to have a tonsillectomy (either with or without insurance)? And does blue cross tend to cover it for PANDAS kids? I have the option to switch to BC soon, but not sure that I want to, so wondering how much T&A costs out-of-pocket if I can't get my HMO to approve. I would not have reason for tonsillectomy given as PANDAS. I don't think PANDAS is even a real code yet?? Surely, the ENT will use a different reason such as hypertrophy of tissue, recurrent Strep or some other commonly "acceptable" malady to justify removing tonsils. IF this is done- I would doubt that insurance would deny coverage. My oldest had adenoidectomy based on night time mouth breathing which was affecting the enamel on his teeth and actually shortening the space between his nares and upper lip. This was all discovered and proven by a DDS/Orthodontist and then we went to ENT who confirmed hugely overgrown adenoids. This was going to cause issues for dental work later. There are many reasons Tonsillectomy could be done so that one never has to even mention a controversial dx like PANDAS- which may or may not give insurance cause to reject or deny surgery. IMHO, I would keep PANDAS out of the equation. ANY other reason should be good enough. Link to comment Share on other sites More sharing options...
thereishope Posted October 2, 2011 Report Share Posted October 2, 2011 I don't think they would code a tonsillectomy under PANDAS. I think they just code it as a tonsillectomy or tonsil and adenoids. I can't remember our full cost as it was 3 years ago. The final cost may have been a few thousand. Maybe between $3K-4K? But the ENT appt leading up to the tonsillectomy is a separate cost. Being a specialist, that may be around $300-400. When anything is billed through any hospital in your county, you can always file for financial assistance pre or post procedures and appointments. I think most would be surprised how high your income can be and still qualify for some type of discount. You may be able to set up payment plans too. This can all be done even if you have insuarnce. Link to comment Share on other sites More sharing options...
matis_mom Posted October 3, 2011 Report Share Posted October 3, 2011 Can anyone tell me how much it tends to cost to have a tonsillectomy (either with or without insurance)? And does blue cross tend to cover it for PANDAS kids? I have the option to switch to BC soon, but not sure that I want to, so wondering how much T&A costs out-of-pocket if I can't get my HMO to approve. I think for us it was about 3k counting hospital and all... and that is with the "negotiated rate"! Link to comment Share on other sites More sharing options...
mk8898 Posted October 11, 2011 Report Share Posted October 11, 2011 Our non PANADAS son had a T&A - we hadn't met our deductible yet, so we had to pay out of pocket. Hospital bill - $4,026 ENT - $800 Anesthesiolgist - $600 Link to comment Share on other sites More sharing options...
lfran Posted October 11, 2011 Author Report Share Posted October 11, 2011 THANK YOU! Our non PANADAS son had a T&A - we hadn't met our deductible yet, so we had to pay out of pocket. Hospital bill - $4,026 ENT - $800 Anesthesiolgist - $600 Link to comment Share on other sites More sharing options...
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