The Costs Involved in Sinus Surgery

by on Dec 5 2012 - 32 Comments

Throughout the past year I have had chronic sinus issues (also called sinusitis) that eventually led to surgery. I had a septoplasty and endoscopic sinus surgery.

When I first found out that I had to have endoscopic sinus surgery and a septoplasty, I was totally in the dark as to how much the procedures would cost. By writing this article I hope to save you – or someone else you know who is having sinus problems – some time and frustration.

What is the operation?

First let me explain what each of these procedures consists of:

  • Septoplasty:A septoplasty is a procedure that straightens a deviated nasal septum. A nasal septum is the partition between the two nasal cavities. During the procedure the surgeon will move around, and in some cases even take out, small pieces of cartilage or bone found in the nasal cavity.

    A deviated septum sometimes pierces the nasal cavity, causing constant irritation and a high risk of chronic sinus infections. Beyond that, it can contribute to breathing problems because of the restricted airflow.

  • Endoscopic Sinus Surgery: Sinus surgery usually consists of removing polyps from the sinuses. According to the Mayo Clinic:

    Nasal polyps are soft, painless, noncancerous growths on the lining of your nasal passages or sinuses. They hang down like teardrops or grapes. They result from chronic inflammation due to asthma, recurring infection, allergies, drug sensitivity or certain immune disorders.

    While endoscopic sinus surgery removes nasal polyps, it is fairly common for them to return. The good news is that small nasal polyps may not have symptoms. Larger polyps, though, may cause the severe sinus infections that made you seek out surgery in the first place (or will lead to surgery in the near future). I personally had a small group of polyps return. My surgeon told me that polyps often build on each other, which means it’s super important to visit your doctor because the odds of you fighting nasal polyps on your own without medication isn’t very good.

  • Sometimes a septoplasty must be done for the surgeon to get at the polyps that are in your sinuses. When I was being examined by the Ear, Nose, and Throat doctor (ENT), he had trouble getting the scope all the way back in my sinuses because of how deviated my septum was. These surgeries are often done in tandem since someone probably wouldn’t make it all the way to surgery unless they were suffering chronic sinusitis or some other issues caused by their deviated septum.

Pre-Surgery Costs

Before I get to the costs of the surgery itself, let me explain what led up to the surgery itself and the costs involved:

  • Initial doctor visit and prescription of an antibiotic: $170 (after $50 insurance discount)
  • Two rounds of antibiotics including a steroid: $100
  • Second visit to doctor #1 – another round of antibiotics: $170 (after $50 insurance discount)
  • CT Scan: $337 (after nearly $700 in savings – see my post about it here)
  • Third visit to doctor #1 – referral to specialist: $170 (after $50 insurance discount)
  • Visit to the ENT specialist: $450
  • Pre-Surgery Physical and blood work: $200 (includes $50 insurance discount)

Approximate Costs Leading Up to Surgery: $1,597

I should point out that I have a high-deductible plan that has a Health Savings Account (HSA). My deductible, or the amount I have to pay before the insurance company starts paying for anything is $2,200. Because of that, the entire $1,597 was paid by me out of pocket. As you will see below, the surgery “maxed out” my insurance as my plan had an out of pocket maximum of $3,300, which I most certainly hit from all the costs involved in the surgery.

The Cost of Surgery

Please note -> costs will vary by plan, doctor, hospital, etc. I am showing you what I was charged to give you a general idea of what septoplasty and endoscopic sinus surgery costs.

As shown in the explanation of benefits above:

  • Amount Billed: $24,478.60
  • Plan Discounts: $11,260.16
  • Your Plan Paid: $12,200.91
  • Total Amount you owe the provider(s): $1,017.53

Without insurance I would have been on the hook for a whopping $24,478.60. I don’t know about you, but with that in mind I will happily pay my $3,300 out of pocket for the year. The most important thing to realize with insurance is that it is to insure you against large, unexpected bills. At the beginning of the year I could never have predicted that I was going to max out my insurance, let alone go through surgery.

Dealing with the Costs

  • When it comes to paying for sinus surgery, the best approach if you do not have health insurance is to get it as soon as possible. You could easily be saving thousands upon thousands of dollars (especially if you are having surgery). Look at my write up about why you need health insurance or enroll today at eHealthInsurance.com.

  • If you do have health insurance, make sure that your surgeon and anesthesiologist are in your network. It may take some extra time (I am constantly blown away by how time-consuming it can be to verify that doctors, hospitals, etc. are in network) but you will definitely thank yourself later. The last thing you want after recovering from a surgery is a bill that is twice as large as you first expected.

Recovering from Surgery

There are costs involved with recovery as well. It can take up to a week (or longer) to fully recover, especially if you are having a septoplasty and plastic splints are in your nose. The biggest struggle for me in my recovery was dehydration caused by the splints. With the plastic splints, it becomes nearly impossible to breath out of your nose. At night you will only be able to breathe out of your mouth, which you will realize very quickly dehydrates you significantly. I can’t describe to you how happy I was when I got those splints out.

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Please feel free to ask any questions related to septoplasty and sinus surgery in the comments below, and please pass this along to anyone else who is looking into sinus surgery.
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Photo by MilitaryHealth
 

32 comments
MD Kennedy
MD Kennedy

OMG!  $25K???!!!  That is just nuts.  Thank goodness you are lucky to have health insurance coverage!  My husband recently had to spend 2 night in a private hospital in Greece for a serious infection.  Total cost, including meds, Xrays, tons of IV fluids, tons of blood, urine and fecal tests, specialist visits, awesome care, 2 follow-up visits at the hospitals clinic AND a bed for me next to him in his private room for both nights: $1,200.  Something is SOOOO wrong with the US system.

OutlierModel
OutlierModel

Crazy costs!  It's a good thing you had insurance.  I haven't had any major problems yet (knock on wood...) but I have extended health benefits, luckily.

StudentDebtSurvivor
StudentDebtSurvivor

I had to have unexpected minor surgery when I was in graduate school. That one experience (and the bills that I got, before the insurance kicked) terrified me into always having insurance. One night in the hospital cost my insurance company over 20K. As you and other commenter have said, Insurance is so important, even if you're young and healthy. One unexpected illness or surgery and financially ruin you.

Veronica @ Pelican on Money
Veronica @ Pelican on Money

Holy crap, that would have been a lot of money to pay! Good thing you were insured. I pray similar doesn't happen to me as I'm without health insurance right now. We've been going through a difficult time and I'm debating where to make cuts to make up for insanely expensive health insurance.

Beachbudget
Beachbudget

People think they are young and healthy and therefore don't need insurance, but there are so many things that can come, and things add up very quickly. I'm about to see an orthopedic surgeon about my shoulder problem, which scares me about cost because my insurance is not great, but at least I do have it. Wish me luck! 

JustinatTheFrugalPath
JustinatTheFrugalPath

That's why insurance is so smart. Without it you'd be on the hook for the entire 24k, well maybe 20k because people w/o insurance generally get a discount. Your plan saved you 6-8 years worth of premium payments.

TacklingOurDebt
TacklingOurDebt

Thank god for insurance! Between your post and your comments below it sounds like an awful nasty surgery & recovery. But at least it is done, right. I had a manager many years ago that had a similar operation.

iHeartBudgets
iHeartBudgets

GAH! That's a chunk o' change! Sounds similar to our bills frm having a kid, and yes, it's much better to spend a few grand out of pocket than tens of thousands!

Johnny @ Our Freaking Budget
Johnny @ Our Freaking Budget

Insurance to the rescue! That's a pretty complicated-sounding procedure. You might be better off just telling people you got a nose job. :)

 

I occasionally sleep with my mouth open, but I'm sure the dehydration I've experienced is nothing like having splints in your nose. That sounds awful.

Eyesonthedollar
Eyesonthedollar

Ah, but by the beauty of the HSA you likely got another 25% discount depending on your tax bracket. Anyone who can have an HSA and doesn't is just silly. My insurance agent found a similar insurance plan for my daughter and me that would have saved $360/yr but it wasn't HSA eligible. We save a minimum of $500/yr on taxes and the HSA saved us $2K last year because it lowered our MAGI so that we were able to deduct my husband's Master's degree costs. No way I'd change it for $360.

DebtRoundUp
DebtRoundUp

I feel like every surgery's costs are ridiculous.  They end up charging you high prices for things that I can purchase cheap like gauze and advil.  I always will argue the bill with the provider to get them to drop the price.  In one surgery, I was able to drop about 10k due to their "overzealous" billing procedures.  I have not had this surgery, but I have had two surgeries that totaled over $50 in the past 2 years.  Thank goodness for insurance.

Ugifter
Ugifter

1 - It never ceases to amaze me how much US Healthcare costs!

2 - My spouse eventually had rhinoplasty (which apparently included septoplasty), after breaking his nose.  The result was easier breathing than ever in his life!  So, rather pleased with that.  Day surgery too, so pretty straightforward.

SenseofCents
SenseofCents

Wow that's a lot of money! No wonder why two of my friends are putting it off.

RobertaRenstromNyquist
RobertaRenstromNyquist

My Dad had that surgery years ago. It served him very well! I, too, have chronic sinusitus. However, at this point, while I tend to get infections and serious pain (like this morning), my sinuses still seem to drain without need of surgery. I think that your situation points out the terribly high costs of health care and the true value of the HSA. How are you doing now?

FrugalRules
FrugalRules

Wow, glad you have insurance. It always amazes me that they "discount" procedures that much. I agree that the best line of defense is having insurance. I hate spending that money each month, but I rather do that as opposed to shelling out tens of thousands of dollars.

GregatClubThrifty
GregatClubThrifty

I'm glad to hear that you had the surgery, and I hope that you are feeling much better! Health insurance is a must here in the US. I'm glad that you had it!

MonsterPiggyBank
MonsterPiggyBank

I have sinusitis and have been dealing with it since I was in my late teens. I have just been to scared to go get anything done about it. The idea of surgery sounds terrifying to me.

My doctor always tells me that I will feel great afterwards, so maybe I should just bite the bullet?

DC @ Young Adult Money
DC @ Young Adult Money moderator

 @Beachbudget I hope it goes well!  I hope your out of pocket max isn't TOO high.  Thankfully providers will sometimes offer payment plans.

DC @ Young Adult Money
DC @ Young Adult Money moderator

 @JustinatTheFrugalPath Yep, and these costs can get much higher if something unexpected happens that requires a hospital stay.  I know someone I know said his daughter's hospital stay (one or two nights) cost in excess of $20k.

DC @ Young Adult Money
DC @ Young Adult Money moderator

 @TacklingOurDebt Yep just went in for another followup, just have to keep monitoring it.  There may be some scarring in my sinuses that are causing irritation and MAY need to be removed, but otherwise I'm good to go!

DC @ Young Adult Money
DC @ Young Adult Money moderator

 @Johnny @ Our Freaking Budget Haha some people refer to my operation as a nose job : )  The splints were terrible.  No blowing your nose for a week either.  If you had crap it was coming out your mouth, not your nose.... #Nasty

DC @ Young Adult Money
DC @ Young Adult Money moderator

Was your out of pocket max over $10k??? I knew I was going to hit mine so I wasn't too concerned about the total cost.  When I got my CT scan I saved over $700 (over 66%!) by shopping around.  The only reason I cared, though, was because at that point it was all out of pocket and I didn't know for certain I would hit my out of pocket max.

DC @ Young Adult Money
DC @ Young Adult Money moderator

Mine was day surgery as well, and I was out the door within 1/2 hour - hour of waking up!  I am still sometimes amazed how much better I can breathe now.

DC @ Young Adult Money
DC @ Young Adult Money moderator

 @SenseofCents Yep, and it can be put off depending on the severity.  I put mine off for a long time, though, because I waited eight months before even going to the doctor the first time :0

DC @ Young Adult Money
DC @ Young Adult Money moderator

 @RobertaRenstromNyquist I think a lot of people have ongoing sinus issues, and sometimes (such as your case) there isn't an incentive to have surgery because it hasn't reached that level of seriousness.  I am doing well, the septoplasty was HUGE because I can actually breathe out of my nose ;) Before the surgery one side was almost completely blocked and I'm sure was a big cause of my sinus infections in the past (though I do have some bad allergies that contributed as well).  As I said in the post a small group of polyps came back.  I just finished a round of antibiotics and steroids and have a followup this afternoon with my ENT.  I told him about my insurance situation and he said if a minor "patching" surgery is needed that he will get me in before the end of the year.  Hopefully he doesn't think it's necessary but we'll see...my sinuses have been so bad for so long that I think it's quite a task to fix me at this point and I'm prepared for a followup procedure.

DC @ Young Adult Money
DC @ Young Adult Money moderator

Yeah the discounts are all negotiated by the insurance companies.  I actually really don't mind spending the money, it's WELL worth mitigating the risk of a large medical bill.

DC @ Young Adult Money
DC @ Young Adult Money moderator

Thanks, I am feeling better!  Like I said in the post, a small group of polyps came back and I may need to have some more work done (seeing the ENT toady), but the septoplasty alone has really helped.

 

I'm excited to see the movement towards more and more people getting covered in the US.  I didn't agree with the health care reform legislation, but I am glad that people will not be denied based on pre-existing conditions.  There is no way I could have afforded this surgery without insurance.

DC @ Young Adult Money
DC @ Young Adult Money moderator

I think it depends how severe the sinusitis is and how much it affects you in your day-to-day life.  For me I put it off until it was really affecting my life.  I definitely think that people should avoid surgery at all costs due to the risks of "going under" but the procedures usually do not have complications...at the same time they are invasive because they are so close to the brain.  Also, because the polyps can come back you may need a followup surgery (I should have mentioned this but I may have to have one and will probably do another post on it).  All in all there is no easy answer or solution with sinus problems.

DebtRoundUp
DebtRoundUp

 @DC @ Young Adult Money  No, my expenses were not that much, but I have found that my insurance company will sometimes give me a discount for reducing their out of pocket expenses, so it ends of being a win-win.  This is also the only way we as individuals can do anything about rising medical costs.  We have to make the doctors and hospitals responsible for their billing.

DebtRoundUp
DebtRoundUp

 @DC @ Young Adult Money I appreciate it.  My wife is in the healthcare industry, so I get to hear about all the issues.  The errors probably go up in the upper millions as well.

DC @ Young Adult Money
DC @ Young Adult Money moderator

 @DebtRoundUp If every consumer was like you we could get costs down quite a bit.  One of the big problems is the coding can be complicated, or there could be errors in processing, etc. Happens daily, and over the course of a year the errors are in the hundreds of thousands.