Six Strategies for Minimizing Ear Tube Surgery Costs (a.k.a. Tympanostomy or Myringotomy Costs).
Ear tube insertions (cpt 69436) for children are probably the most expensive outpatient surgery you can have done in less than 15 minutes.
If children weren’t so physically resistant, this procedure could be performed in physician offices with a topical analgesic. However, the fear and physical discomfort of having holes poked in their ears dictate that nearly all children must be fully sedated, albeit briefly, in an outpatient surgery center or hospital. This is unfortunate, because the fees for the surgery facility and anesthesiologist add substantially to the ear tube surgery costs. What’s worse is that these higher costs are most often doubled, because children need both ears done at once.
1) ENROLL IN ONLINE ACCESS TO YOUR HEALTH INSURANCE PORTAL
All major insurance carriers give their enrollees online access to their benefit plan, a list of in-network providers, and the explanations of benefits (EOBs) for all services they have received. I strongly encourage you to sign up for internet access to these services. It is always free and normally only takes a few minutes to set-up. All you need is your benefit card.
Having access to EOBs can come in handy after the surgery because it allows you to see the correspondence between the insurance company and your healthcare provider, how the insurance company applies your benefits to the hospital bills, and how they calculate the patient liability portion.
2) EXAMINE YOUR BENEFIT PLAN FOR OUTPATIENT SURGERY
Find your benefit plan summary and identify your deductible as well as your coinsurance and copayments coverage rates for having outpatient surgery in an ambulatory surgery center (outpatient surgery center) versus having outpatient surgery in a hospital.
Your deductible is especially important to know when planning for ear tube surgery costs, because patients frequently have to pay down their entire deductible for this procedure. You have to pay 100% of your deductible costs, before the insurance company will begin paying anything. So if you have a $2,000 deductible, and your son or daughter needs ear tubes, I would say it is very likely that you will have to pay the entire $2,000 deductible.
The coinsurance coverage rate may differ between ambulatory surgery center and hospital setting or the coverage rate may be the same. Let us assume that the same coinsurance coverage rate applies for outpatient surgery whether it is performed in an ambulatory surgery center or a hospital. For example, if you have a 70% coverage rate then your insurance covers 70% of the cost, and you have to pay the remaining 30% of the cost.
The total ear tube surgery costs in an ambulatory surgery center are almost always lower than the total costs in a hospital. If you have coinsurance, you want the total costs to be lower because your coinsurance portion increases as total costs increase.
3) EAR TUBE SURGERY COSTS FROM THE ACTUAL MATERIALS USED
The actual cost of the ear tubes or “grommet” is about $25-$30 for a set of 2 tubes from a manufacturer like Shephard or Sheehy. This is pretty much nothing in the grand scheme of things. It is pretty impressive to think that patients with high deductibles are quite often personally billed $2,000 or more despite the fact that the supply and material component of ear tube surgery costs are so low.
4) SITE OF SERVICE – SURGERY CENTERS & CHILDREN’S HOSPITALS
You need to determine if you, as the patient, would pay less by going to an ambulatory surgery center with a lower price or by going to a not-for-profit children’s hospital with a higher price and a financial aid policy that will ultimately result in a lower cost to you. Pretty much all of the children’s hospitals in the United States are not-for-profit organizations with a charitable mission statement to provide care “regardless of patient’s ability to pay”.
It my opinion that most insurance companies do a pretty poor job of informing their high-deductible enrollees of how to identify the lowest cost providers. There may be anywhere from 5 to 25 facilities in your area that perform ear tube insertions and accept your insurance. However, currently Cigna is the only insurance company that provides enrollees with a comparison tool so they can compare the prices among all these providers in a meaningful way.
5) PRICE SHOPPING EAR TUBE SURGERY COSTS
The patient portion of ear tube surgery costs can vary widely among in-network physicians and facilities even within the same health insurance plan. If you have a high-deductible or if you are a self-pay patient, then you want to seek out the cheapest in-network provider because the first $2,000-$5,000 of any services rendered is your out-of-pocket cost and your responsibility to pay.
On the cheap end, some commercial insurance companies have negotiated ear tube pricing at ambulatory surgery centers as low as $670 (both ears) for the facility fee. ASC ear tube surgery costs max out around $2,475.
On the expensive end, facility fees for some outpatient hospital departments average around $1,986 for both ears and can even get as high as $3,584 . This is because hospitals need insurance companies to pay them more than other providers to compensate for the cost of all the homeless and indigent patients they see for free. Don’t let anyone fool you into thinking ear tubes insertion is an expensive procedure to perform. The average material costs for ear tubes are only about $30 in supplies and it only take 15 minutes to perform.
You should also shop for the lowest physician’s fee for the procedure as well. You will have to pay the physician and a facility separate fees for the ear tube insertions. You will also have to pay a small amount to the anesthesiologist for sedating your son or daughter.
All-in here is the range of ear tube surgery costs for both ears:
|ASC Ear Tube Surgery Costs||$670||$1,444||$2,475|
|Hospital Ear Tube Surgery Costs||$1,000||$1,986||$3,584|
|Physician Ear Tube Surgery Costs||$158||$336||$395|
|Anesthesia Ear Tube Surgery Costs||$388||$388||$388|
|Total ASC Ear Tube Surgery Costs||$1,216||$2,168||$3,258|
|Total Hospital Ear Tube Surgery Costs||$1,546||$2,710||$4,367|
|Likely Savings in ASC*||$330||$542||$1,926|
6) APPLY FOR FINANCIAL ASSISTANCE WITH THE HOSPITAL
If you can apply for financial assistance before your surgery even happens, you can give yourself a really good headstart. The application is usually one to three pages long. You may have to attach your last two pay stubs or your tax return for last year. The application is the hospital’s tool for assessing your ability to pay your bill.
I advocate for completing this before the surgery whenever possible. The sooner they apply charity care, hardship discounts, and waivers, the sooner you can lock in a payment plan with the new balance.