Tonsil removal cost

Tonsils are two glands found at the back of the throat which play a role in people’s immune systems, particularly for children and adolescents.¹ Once a person hits puberty, other parts of the body develop ways to fight germs and the tonsil’s immune system functionality declines, making them less vulnerable to infection. It’s believed this is why tonsilitis is much rarer in adults than children.

Tonsillectomy is the medical term for the surgical removal of the tonsils. An ear, nose and throat specialist will perform the surgery. During the procedure, the patient is placed under general anaesthetic. Tonsillectomies are quick, safe surgeries that take only 45-60 minutes, and negative outcomes are rare.¹

Tonsillectomies are usually recommended for patients with frequent, severe cases of tonsilitis or those with enlarged tonsils that make swallowing difficult.¹ Tonsil removal is also performed to help with sleep disorders, specifically breathing-related conditions like sleep apnoea.

Tonsilitis is the medical term given to inflamed tonsils. Tonsils serve as a first line of defence for your immune system, especially for children. However, this means they take a lot of punishment from bacteria and viruses, making tonsils vulnerable to infection and inflammation.¹ Antibiotics can combat bacterial tonsilitis, but only some tonsilitis cases are a result of bacterial infection. While painkillers and other treatments can manage symptoms, the only sure way to treat the condition and prevent reoccurring infections is to remove the tonsils.

When researching tonsils, you’ll likely see adenoids mentioned. This is because adenoids are a mass of lymphatic tissue found in the back of the nose that plays a similar role in the immune system as the tonsils. Also, like tonsils, adenoids can cause sleeping and swallowing issues when enlarged and can become infected (called adenoiditis). Removing adenoids can help improve sleep, and reduce regular ear infections, snoring and sinusitis. Adenoid removal is called an adenoidectomy, which is often performed in conjunction with a tonsillectomy. This combined procedure is called an adenotonsillectomy. ¹

The great news is that Bronze-tier health insurance includes tonsil and adenoid removal. The exact amount your insurance will pay varies depending on your treating doctor, the hospital that you are admitted to, and your health fund. Depending on your policy, there may be some out-of-pocket costs, such as gap fees, anaesthetist fees and any necessary tests. You may also be required to pay an excess and/or copayment when you are admitted to hospital.

The significant advantage of health insurance is that you can avoid public waiting lists, meaning you or your child will likely get treatment sooner. The private system also allows you to choose both your hospital and your available healthcare provider.

If you’re taking out a new policy or upgrading your level of cover, the waiting period will be 12 months for pregnancy and pre-existing conditions (excluding rehabilitation, hospital psychiatric services and palliative care) and 2 months for a new condition that develops after you take out a policy (including rehabilitation, hospital psychiatric services and palliative care, even if the condition is pre-existing).

Medicare covers around 75% of the Medicare Benefit Schedule (MBS) fee for private patients in either private or public hospitals. If you decide to have your tonsillectomy performed solely through the public healthcare system, the procedure will be free. The catch, though, is that public hospital waiting times are typically longer, and tonsilitis can greatly affect quality of life, causing frequent pain and illness. Private health insurance allows you to avoid this waiting list and greatly increases your chance of getting treatment sooner in a private hospital.