Will health insurance pay for the removal of tonsils and adenoids? Learn about how this treatment is covered and compare policies.
The removal of your tonsils and adenoid glands is included in most private health insurers’ basic policies. These procedures are included in basic private health insurance plans and you don’t need to pay for extras to be covered for a tonsillectomy or adenoidectomy.
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A tonsillectomy or adenoidectomy can be performed at a public or private hospital. However, the cost, waiting times and extra benefits will differ depending on which system you are treated under.
- Public health system. While you can elect to have the surgery performed at a public hospital where the procedure will be covered by Medicare, waiting times can be as long as years and many patients don’t have the luxury of time.
- Private health system. Using the services of a private ear, nose and throat specialist (ENT) is quicker. However, the out of pocket expenses can run into the thousands of dollars if you’re not insured. Private hospital cover gives you the option of choosing the doctor you want as well as having the surgery performed when you want.
The removal of tonsils and adenoids is a common procedure for children to have done, which makes having private health cover important for families. However, it’s not just children who have their tonsils removed, so it’s something to think about even as you get older.
Surgery to remove the tonsils and adenoid glands is covered by Medicare, but waiting lists can make public cover an unattractive option for children. This is one of the reasons why having private health insurance is so important. Not only can private health insurance help you avoid waiting lists, it also provides you with the opportunity to choose your own doctor.
Tonsils can get infected, which can lead to a condition called tonsillitis. When this happens to your adenoid glands the condition is called adenoiditis. The two conditions are related and adenoiditis can lead to tonsillitis and vice versa. Recurring infections of the tonsils and adenoids need to be treated by a either a tonsillectomy or adenoidectomy.
The symptoms of tonsillitis and adenoiditis can include:
- Bad breath
- Ear infections
- Swelling of the tonsils and adenoids
- Tonsillectomy and adenoidectomy procedures are typically performed by an ENT specialist and take about an hour to complete. Patients are required to stay overnight in hospital.
- You will need to see a general practitioner (GP) to get a referral to an ENT. Your GP may be able to recommend a preferred or trusted specialist, but you can also choose your own.
- Your insurer may be able to provide a list of ENT specialists who have a relationship or agreement with your fund. You can also check the registry of the Australasian College of Surgeons to find a doctor in your area.
The following questions will help you find a ENT specialist and prepare for a tonsillectomy or adenoidectomy procedure.
Questions to ask your insurer
Questions to ask your ENT specialist
- What are the costs for initial consultations, the procedure and follow up consultation(s)? (You will be given a list of the expenses you will incur and you’re required to provide consent to these charges.)
- What’s the best way to prepare for the procedure?
- What’s the best way to recover from tonsillectomy or adenoidectomy surgery?
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