If you need ACL (anterior cruciate ligament) surgery, you probably have a lot of questions. The question of ACL surgery costs is probably near the top of that list. The answer to that question depends on a few things, including your individual insurance coverage. As you consider ACL surgery, here's what you can expect when it comes to expenses, along with some strategies for managing the cost of your procedure.
Most insurance plans—including Medicare and Medicaid—cover ACL surgery. If yours covers it, your doctor will need to establish that it is medically necessary. It can help to know exactly what your doctor must document to show this. Talk to your insurance provider and ask about your coverage. Find out if your insurance only covers certain types of ACL repairs. Ask if you need preauthorization or any other paperwork before starting treatment.
Coverage for ACL surgery typically includes:
- An evaluation appointment with an orthopedic surgeon
- Pre-surgery appointments including diagnostic studies and lab tests
- The surgery including fees for the doctor, anesthesia, graft, and hospital operating room
- Rehabilitation and physical therapy appointments
Make sure you understand any limits on your coverage.
The amount you will pay out-of-pocket for ACL surgery depends on insurance coverage. Even if your insurance covers ACL surgery, you will likely be responsible for a portion of the cost. Ask your insurance provider about your costs—copays, deductibles and co-insurance—for your surgery. Don’t forget that you can apply flexible spending account (FSA), health savings account (HAS), and health reimbursement account (HRA) funds to your out-of-pocket costs.
If you don’t have insurance and will be paying for your ACL surgery, do a little research. The simple question, "How much does ACL surgery cost?" doesn't have a simple answer. The cost of ACL surgery varies widely across the country and from facility to facility. According to Guroo.com (a service of the non-profit Health Care Cost Institute), the U.S. national average cost of ACL surgery in 2020 was about $14,800.
Your choice of facility can be the biggest factor in the cost of your ACL surgery. Outpatient or ambulatory surgery centers are often more affordable options for having surgery. They can offer the same services at lower costs than hospitals. When you compare prices, make sure you are comparing apples to apples. Find out if the price is for a complete bundle of all services or if it only includes certain fees. You need to know what your total cost will be and not just the facility fee.
When pricing your surgery, make sure the facility and doctor know you are a self-paying patient. Many providers offer a discount for people who are paying for their own healthcare. But you have to ask for it. Find out if you can finance the cost or break your payments into chunks. You can also use FSA, HSA and HRA funds to help pay for surgery.
Keep in mind that “you get what you pay for” can be true in a lot of situations. Don’t automatically go with the cheapest facility and doctor. Your satisfaction with the results is as important as your cost. So you need to consider each doctor’s experience, expertise, surgical outcomes, and patient satisfaction. You also need to consider quality of care at the facility where your ACL surgery will take place. You can access this information on Healthgrades.com.
