how much should an acl reconstruction cost?

[jasonh]

i have just found out that i have to have an acl reconstruction, and have been given a price by a private doctor, i am just trying to get some idea of how much it should cost, the price that he has given me sounds a bit over the top.

[neildrouet]

jasonh

i had one done last year, the approximate costs for mine were as follows:
surgeon's fees: $1450
Surgeon's Assistants fee: $200
Anaesthetists fee: $450
Of this, your private health fund should cover approximately 60-80% of the surgeon's fees, most of even all of the assistants fees should be covered and it varies for anaesthetists, from 50-90%. You should get item numbers from your surgeon to take to your health fund and find out.
Also are you having a patella or 4-strand hamstring graft? This may affect the cost slightly. Also I am WA so costs may vary from state to state, as may health fund rebates.


There is also the cost of prosthetic screws, etc, which for a hamstring recon are about $700 (might be cheaper at the local hardware store, you should check). They were fully covered by my health fund but again check.

The hospital costs should be fully covered by your health fund, but that depends on your level of cover or whether you want a private room etc. Also expect to have to pay at least part of the costs for inpatient physio, pharmacy and crutches etc.

Hope this helps and good luck...

[sydunisportsmed]

There is more on how much this may cost in Australia at this link:

http://www.injuryupdate.com.au/issues/surgerycosts.php?menu=issues

Remember that market forces apply very much in surgery, so that the most popular surgeons can charge large out of pockets based on supply and demand. Most popular doesn't always mean 'best' but it can be a guide. For a reconstruction, most doctors would advise (if you can financially afford it) choosing a surgeon based on reputation for quality work rather than price.

[bombermad09]

If money is a problem, find a way to sue somebody for it :D

[jasonh]

i am not privately insured and the doctor said it will cost about $4200, does this sound right, thanks for your help

[cc_ncoke]

Unfortunately doctors can charge what they like here in Oz but this may help when you speak to your doctor. The doctor will charge you via item numbers (kind of like a barcode) Each item number has what is termed a schuedule fee, set by Medicare, basically what they think its worth. Medicare will cover 75% of the schuedule fee -- not the doctors charge!! you then pay the difference....eg item 12345 doctor has charged you $150 / schuedule fee $100 / medicare pays $75 / your total out of pocket $75.... basically what this equates to is you should ask your doctor the following.
what item numbers he is charging for and the individual charge for each one / then call medicare ask them what the schuedule fee is for each / you can then put it to the doctor that he is charging X amount over the schuedule fee and ask him to explain the difference... in my expierience i would say once you get the item numbers try and get names of other surgeons and call around for their charges to the item numbers... you will find the difference can be quite surprising at times... Good Luck

[injuryupdate]

$4200 when not insured sounds ballpark about right. However, if you need to stay in hospital for a few days because of pain after the surgery, the costs will get even higher.

An option you have is to take out private health now, wait 12 months, then get it done with insurance (12 month waiting period for pre-existing problems)

[Shenagh]

$4,200 does sound about right. I am not privately insured either and this sounds about the total cost after you get $$ back from Medicare.

One thing to watch out for is hospital fees such as staying overnight (mine was $700 for one night only) and theatre fees. I had to pay $3,600 up front on the day to the hospital and I never saw a cent of it back. Neither of these costs can be claimed back from Medicare. The thing is though, your surgeon will dictate where they operate and you don't have a choice other than to change surgeons.

[Alla]

I'd agree that is sounds about ball park..... I was covered by Private health cover, but I know that if I was not I was up for about $3000 for the surgeons costs, $360 for the Assistant Surgeon, $560 ish for the anethisist. Fortunately my overnight stay cost $50 but I was covered for that too. And I think I had a pretty darn good surgeon.

Alla