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Health insurance for tonsils and adenoid removal

A common procedure among children, you can go public, private or pay up to $4,000.

If your child is prone to chronic earache and breathing problems, your doctor may have recommended they have their tonsils removed. While tonsils and adenoid removal is a common procedure among children, surgery can be expensive if you don't have the right insurance.

What are adenoids?

Your adenoids are the glands between the back of your nose and throat. They are part of the immune system and react to foreign invaders in the body.

What are tonsils?

Tonsils are the glands located on each side at the back of your throat. Like your adenoids, they are part of your immune system and prevent your body from infection.

When might you get adenoid or tonsil removal surgery?

Adenoid and tonsil surgery is common among children and teenagers, though more adults are receiving the procedure. You may be thinking of getting your adenoids or tonsils removed if you are prone to things like tonsillitis or enlarged and infected adenoids. As well as causing more harm than good, frequent infections can leave these glands scarred, which can lead to more serious illnesses later in life.

A doctor will also take into consideration you or your child's medical history. Signs they may need to be removed include:

  • Snoring or sleep apnoea due to enlarged adenoids or infected tonsils.
  • Recurring ear infections that don't respond to antibiotics.
  • A build-up of fluid in the ear as a result of gland swelling.
  • Repeated infections of the adenoid or tonsils that aren't cleared up by antibiotics.

How does Medicare cover the removal of tonsils and adenoids?

Medicare will cover a tonsillectomy or adenoidectomy, providing you agree to have the surgery done at a public hospital. Whilst this may suit some patients, the waiting times can be very long, which is why many parents opt for the shorter waiting period private health insurance can guarantee.

Public vs Private waiting list for tonsil and adenoid removal

Source: Australian Institute of Health and Welfare (AIHW) Private health insurance use in Australian hospitals 2006–07 to 2016–17

How does private health insurance cover tonsil and adenoid removal?

With private health insurance, tonsils or adenoids removal is covered with a basic hospital policy. It generally comes with a $500 excess and is classed as "surgical removal of tonsils or adenoids".

Whilst it can cost a little more, private health cover ensures your child's health is your primary concern, not the cost of treatment. There's also a lot less waiting around, so you or your child will get the procedure they need faster.

Private health insurance allows you to use the services of a private ear, nose and throat specialist (ENT), so you know your child is in the best possible hands. It also lets you choose your own doctor and when you want the procedure.

What do different insurers offer for tonsils and adenoids?

Below are some examples from Finder that cover tonsils and adenoids surgery. All quotes are based on a singles hospital policy in Sydney, NSW with a $500 excess. If you've never had health insurance before, you may have to serve a 12 month waiting period before you can claim. If you already have hospital cover, you only ever have to serve the waiting period once, even if you switch.

Fund Policy Cost per month Apply
ahm logo White lite $71.71 Go to Site
HCF logo Basic hospital $83.20 Go to Site
Standard Hospital $98.43 Go to Site

Health Insurance Reforms coming April 2019

As part of the reforms to the Australian health insurance system, we will see hospital policies placed in four categories: gold, silver, bronze and basic.

Each of these tiers includes cover for a minimum number of clinical categories. If you wish to continue to claim benefits for treatment of the tonsils and adenoids, you will need a policy of Bronze tier or higher.

What is the cost of getting your tonsils or adenoids removed?

The average cost of tonsil and adenoid removal is around $4,000. Without insurance, you could be looking at a substantial bill.

What does the operation for adenoid or tonsil removal involve?

Doctors usually place you under general anaesthesia during adenoid or tonsil removal. Because adenoids and tonsils can be accessed through the back of the throat, they don't need to make any external incisions.

The surgeon will cauterize and cut away your tonsils or adenoid tissue. In most cases, the surgery takes less than an hour, and you can go home on the same day. It's common that your doctor will remove both the tonsils and adenoids since they both cause similar problems.

What are the side effects of adenoids removal?

Although adenoid removal surgery is generally safe, the possible side effects and risks include:

  • Swallowing problems
  • Fever, nausea and vomiting
  • A sore throat
  • Sore ears

Although adenoid removal can improve sleep and reduce the occurrence of a sore ear and throat, it's important for parents to remember that they will not disappear completely.

Picture: Shutterstock

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