How Much Does ACL Surgery Cost With Insurance?

What is an ACL?

Your thigh bone (femur) and shin bone are connected by your anterior cruciate ligament (ACL), which passes through the middle of your knee (tibia).

When the leg twists or extends too far, the ACL is injured. Injury to the ACL is frequently caused by abrupt changes in direction. With their cutting and quick directional changes, sports like basketball, football, and rugby put significant stress on the ACL. Both of these and contact injuries can result in ACL tears.

The knee becomes unstable with any ripping or rupture (when the ligament splits in half). You’ll have to put a hold on your widely admired athletic prowess and dance routines until you figure it out.

One of the most frequent knee injuries is a tear of the anterior cruciate ligament (ACL), one of the four major ligaments in the knee that connects the femur to the tibia. ACL injuries are quite common in athletes who play sports like basketball, skiing, and soccer, and studies have indicated that in some sports, female athletes are more likely to have ACL injuries than male competitors. Choosing whether to undergo ACL reconstruction can be challenging and varies on the person.
Typical expenses:

  • ACL repair can cost between a little under $20,000 to $50,000 for those without health insurance, including the surgeon’s charge, facility fee, anesthesia, and any necessary grafts.
  • ACL reconstruction is typically covered by health insurance as a medical necessity.
  • A hospital admission charge, copays for pre- and post-surgical medical visits, a copay or coinsurance for the surgery, and anesthesia are typically out-of-pocket expenses for individuals with health insurance. Out-of-pocket expenses may be as high as $3,000 or even more.

What ought to be mentioned:

  • The patient typically needs to undergo several weeks of physical therapy before surgery.
  • The surgeon will either prepare the graft, if it is from a corpse, or harvest it from another part of the patient’s body during the procedure. To inspect the knee joint, the surgeon then inserts an arthroscope into the knee. After repairing any cartilage damage, the surgeon will remove the torn ACL stump, drill holes into the femur and tibia, insert the ACL transplant, and secure it. The surgeon then confirms that the knee has a complete range of motion and that the graft is under good tension.
  • The American Academy of Orthopaedic Surgeons summarizes ACL injuries and surgical alternatives for therapy.
  • Additional expenses: If you do not have insurance, medical equipment like a knee brace and crutches could cost you $500 or more.
  • At $50 to $75 or more per hour, physical therapy can increase costs by $1,000 or more.
  • Painkillers are frequently recommended during the healing process.
  • The requirement for a second ACL reconstruction could be brought on by injury or graft failure.
  • Discounts: Most hospitals will renegotiate a reduced charge for patients who pay with cash or a credit card instead of using insurance for surgery.
  • When looking at ACL reconstruction, it’s critical to first consider whether you want to undergo surgery and speak with a medical professional. Some folks decide to hold off and try whether several months of physical therapy might address the issue. Waiting too long, however, increases the risk of developing chronic ACL deficits, which makes the knee unstable and susceptible to periodic failure, making it difficult for a surgeon to do successful surgery.
  • A decision-making process for ACL reconstruction surgery is provided by WebMD.
  • You can get a recommendation for a board-certified orthopedic surgeon from your family doctor or sports medicine specialist, and the American Board of Orthopaedic Surgery provides a surgeon locator by state.

The following are potential side effects of ACL reconstruction:

an infection, a blood clot that poses a life-threatening risk, knee discomfort, stiffness, or loss of knee motion, which has been observed in 5 to 25% of cases, and paralysis or numbness in the leg or foot.
More young athletes, particularly female athletes, are undergoing ACL surgery. However, there is a chance of growth plate damage in patients who haven’t reached adulthood, which could cause issues with bone growth. It is feasible to postpone the procedure until the growing process is complete, but doing so carries some risk because waiting too long can result in degeneration and render future successful surgeries impossible.

Cost of Having an ACL Surgery

In the United States, doctors are extremely busy, particularly those who conduct surgery. An estimated 15 million surgeries are carried out in the United States each year. Surgery is not cheap, and it will probably put a strain on one’s resources. The same applies to ACL operations. The network rate that the insurance provider and the surgeon agree upon determines how much an ACL operation will cost. The insurance policy a person has is also important.

As previously mentioned, some surgeons do this procedure under anesthesia. However, paying for surgery while under anesthesia is more expensive than paying for one while awake.

Another element that affects the price is any emergency during the procedure. The location’s geology could also play a role. Below, we’ll go over the expenses incurred:

  • It will cost you between $800 and $3,000 if you have health insurance. This price includes admission fees to the hospital, follow-up doctor appointments, and any other costs that might arise. The balance, however, is paid by the insurance provider.
  • People without health insurance must spend a lot of money. The cost of the graft, anesthetic, facility charge and surgeon fee will range from $20,000 to $50,000.
  • Medical supplies like crutches and knee braces will incur an additional $500 in fees. The extra expense of physical treatment is $1,000.

Patients who pay with cash or credit cards may be given a reduced rate. These reductions can be negotiated. Surgery is not always necessary for ACL injuries. Some patients who receive physical therapy may recover fully. However, you should speak with your doctor first. Prior to selecting the hospital that charges the least, it is also crucial to conduct research and compare costs across various hospitals. After selecting a hospital, sit down with your doctor and discuss the cost in detail.

Insurance Coverage for ACL Surgery Costs

Medicare and Medicaid, as well as the majority of insurance plans, cover ACL surgery. Your doctor must prove that it is medically essential in order for it to be covered by your insurance. Knowing precisely what your doctor must write down to prove this can be useful.

Ask about your coverage when you speak with your insurance company. Find out whether there are any ACL repairs that are not covered by your insurance. Before beginning therapy, find out if you require preauthorization or any other papers.

Typical insurance benefits for ACL surgery include:

  • an appointment for a consultation with an orthopedic surgeon
  • appointments leading up to surgery, such as diagnostic testing and lab examinations
  • The operation, including the surgeon’s fees, anesthesia, the graft, and the use of the hospital operating room
  • Physical therapy and rehabilitation appointments
  • Make sure you are aware of any coverage limits.

Out-of-Pocket Payments for ACL Surgery

The cost of your out-of-pocket ACL surgery expenses is determined by your insurance plan. Even if your insurance covers ACL surgery, you’ll probably have to pay some of the expenses out of pocket. Inquire with your insurance company about the copays, deductibles, and co-insurance associated with your procedure. Remember that you can deduct your out-of-pocket expenses from your flexible spending account (FSA), health savings account (HAS), and health reimbursement account (HRA) monies.


Leave a Reply

Your email address will not be published. Required fields are marked *