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How much does ACL reconstruction cost?

 

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Question:

I am considering ACL reconstructive surgery - what kind of cost do I have to expect. I live in the USA.

Answer:

The answer to how much *you* will have to pay varies on many factors, in particular on whether you have health insurance and how much your insurance will cover.

In my case I was diganosed (from an MRI) that I had a torn ACL but my meniscus seemed ok according to the MRI.

During the surgery they found that the meniscus was partially torn (75% tear) and they stitched it.

Every service in this procedure is billed and paid separately:

- your doctor who orders the MRI
- the MRI
- the surgeon who performes the ACL reconstruction
- the anesthesia
- the surgeon's assistant(!)
- the hospital (facility) where it all happens
- afterwards the physical therapy

The following numbers will be first what each instance was billed at, followed in () how much I actually paid. Note that my insurance negotiated in most cases on the billable amount, e.g. the facility was billed by the hospital at $2081 for those 4 hours, my insurance negotiated it down to $1600, the insurance paid $1440 and I paid $160.

- your doctor who orders the MRI
$700 ($260)

- the MRI
fully paid by insurance

- the surgeon who performes the ACL reconstruction and meniscus repair
$2500 ($250)

- the anesthesia
$2000 ($250)

- the hospital (facility) where it all happens
$2000 ($160)

- afterwards the physical therapy
$70 ($15) per visit, expect 16-24 visits = ~ $300 co-pay


I would say that the surgery is definitely worth it if you plan to live an active lifestyle. It sure depends also on at what stage in life you are. After the surgery make sure to get the leg *fully* straight right away or you are looking into several months of painful attempts to stretch a shortened muscle. (That's what happened to me, unfortunately.)


Comments:

You are on page 4 of 11, other pages: 1 2 3 [4] 5 6 7 8 9 10 11
2006-12-30, 00:49:07
anonymous from United States  
I live in San Diego and need ACL surgery without insurance. I had wanted to avoid surgery altogether but looks like I'll have to go ahead with it. Has anyone scouted costs in S. California?
2007-01-15, 10:09:42   (updated: 2007-01-15, 10:15:56)
anonymous from Broken Arrow in Oklahoma, United States  
My husband just had outpatient ACL and meniscus repair in Tulsa, OK. This is without insurance.

MRI: $1300
Surgeon: $4000 (he gave us medicare rates)
Hospital: $14,000 (negotiated down to $7000)
Anesthesiologist: $870 (2 hrs) & $500 for a nerve block (best $$ we spent)
Ice Pack that was sent home: $60
Knee Brace: $680
Crutches: $100
Physical Therapy: $60/hr; 2 hrs/wk -- there is HUGE difference in price with this. Call around.
They did not send us home with a compresssion ice (Game Ready) machine or CPM machine.

Save yourself a little $$ by getting the ice pack and knee brace & crutches ahead of time (heck there was a brace on Ebay).
Remember that when you are paying cash, they will negotiate....especially if you can pay a good sum up front. Even if they charge you what they would have negotiated with an insurance company, you can still get a better deal if you pay up front (they will have to wait weeks or months to get their $$ from an insurance company whereas they could their $$ from you immediately)
2007-01-30, 14:03:31
anonymous from United States  
the good thing about any surgery is the advance ment - when I had my ACL reconstruction it was important to have a highly respected doctor--interiestingly enough the doctor died in a bicycle accident..however pretty soon by using neutral (stem) cells in plecenta of the womb one will only have it connect to the right ligmet bone or nerve and the newly stimulated cell will convert to the cells around it---theres that and also micro engineering- this is like building scaffolds from protien molocules to help the already healing process
2007-02-05, 17:44:52
bajdude@yahoo.com from Wayne in Pennsylvania, United States  
Reading these 'blogs' is depressing. Looks like I might be in trouble. I must've twisted the wrong way on the tennis court and now my knee's swollen and painful - been that way for 2 months.

I have no insurance. Sucks to be me. Any advice ... besides running to Canada?
2007-02-07, 07:54:09
anonymous from Turkey  
The prices are somehow huge in Canada and US. Think about travel to Turkey for your surgeries. The cost is nearly ther half.
2007-02-07, 08:57:16
doncha1@alltel.net from United States  
I am a mother of three and just happened to be switching ins. at the time of my accident where i have completely torn my acl and severely torn 3 other ligaments as well as some muscle. Unfortunately my ins. does not cover you from the date of your application and payment but one day after you are approved. I have already come out of pocket $261 for my initial exam and drainage of my knee with the orthopedic and
$550 for the mri. I have not yet received my er bill. I know I am going to have to have surgery and have no idea how I am going to get through this or even if a Dr. will operate know I do not have ins. Any advise or information would be greatly appreciated.
2007-02-08, 08:26:18   (updated: 2007-02-08, 08:27:30)
anonymous from United States  
To doncha1@alltel.net

I would definitely shop around a little. There are different techniques as I learnt from this thread which differ greatly in price. Someone in Kansas paid almost $40k I think, from his savings, not insurance. Other prices are a lot lower.
2007-02-15, 02:38:15
werkhovl@cox.net from Santa Barbara in California, United States  
rating
To doncha1
I just had one ligament replaced last month. Total billed was 44K surgical center, 2.5K anestesia, 2.5K surgeon fee, 1K MRI, 2K phys therapy. for a total of over $50K. Bottom line if you tore more than one ligament, no one will or should operate until the swelling is down, you have regained some flexibiltiy and strength, you should have an immobilizer and be on crutches for a while. Wait until your new ins coverage kicks in, than go to a orthopedic surgeon.
2007-02-15, 22:43:14   (updated: 2007-02-15, 22:44:54)
[hidden] from Monterey in California, United States  
rating
Hi, at the end of January I tore my ACL, MCL and Medial Meniscus whilst in Tahoe Skiing. I have no idea of cost, however from comments here, I now know what to expect. I will be having surgery at the end of this month with a donor piece. I'm not looking forward to the rehab. I'm hitting it hard right now with PT and home excercise as the DR. wants full range of motion restored in the knee prior to surgery, at this point it seems almost imposible! But i'm motivated and want my normal life back.
2007-02-16, 13:06:30
anonymous from United States  
rating
Lots of good basic info...seems like costs vary wildly.Why does this have to be? I'm pretty sure I recently tore my ACL. Unfortunately, I am without insurance. I think it's shameful that this great? country can't come up with reasonable health care policies for the average citizen. Who's to blame-doctors or insurance companies!!?
2007-02-22, 11:37:10
btmansfi@coastal.edu from Chesapeake in Virginia, United States  
I completely tore my ACL, slightly tore my medial meniscus, sprained my MCL, and bruised a bone in my knee on Super Bowl Sunday playing basketball. I'm 23 years old and very active. I played Division I baseball in college and play, well used to play, basketball at least 4 times a week.

I don't exactly remember how I did it, but I know it happened when I was driving in the lane. I was getting ready to jump for a layup and instead of pushing off on the court, I think I landed on someone else's foot and tried to jump. I immediately heard a pop, it sounded like a bunch of pencils cracking. It sounded bad, and I knew I did some damage.

I went to Patient First the next day just to get it X-rayed, and the doctor tried to tell me I just sprained something. Well the next day I went to an orthopaedic doctor and after he looked at my leg for less than a minute he knew I at least tore my ACL. I don't know how the guy at Patient First couldn't tell that (I mean I pretty much knew I tore something when I did it).

So my orthopaedic doctor told me to let the other stuff heal for 6-8 weeks, then have surgery. I have it scheduled for May 16. I am 99% sure I am going to use a ligament from a cadaver. I don't want to use my hamstring ligament because the doctor said there's a chance I could lose strength there. And I don't want to use my patella tendon because he said that a lot of people have pain there the rest of their life. So I figured the best option was a cadaver...I can use whatever tendon I want and don't have to sacrifice one of mine.

I have Anthem Essential Keycare. I was appalled at first to hear that surgery could cost up to $50,000 and that a ligament from a cadaver could cost over $10,000!!! How in the world can they sleep at night charging $10,000+ for a ligament from a dead person? Luckily, I believe my co-pay is $500 and then I have to pay 30% of the total cost (max $2500). So if I'm going to pay $2500, I might as well get the best surgeon I can and get the best reconstruction possible.

Will update after I have surgery.
2007-02-28, 19:08:57
anonymous from United States  
i need to know where to rent a cpm machine from... anyone here have any ideas?
2007-03-15, 00:38:24
anonymous from Chicago in Illinois, United States  
rating
i'm a 25 year old male i was injured in october i had the a completely torn acl. and a tear in the medial meniscus. i had never been cut open, so you know i asked the doctor every question in the book. if you're still young and play sports STOP!!! the acl prevents your leg and knee from seperating in a forward motion thats why when you run it feels like your knee is buckling. most of the time you dont have pain from an acl tear. you just hear a loud pop and for a couple of weeks there will be swelling. Do not go back to the game.further damage to the knee can and will occur eventually.I was told that not having the surgery, over time, will result in a full knee replacement to be required. i got luck the doctors i have are the best. its been two weeks and my range of motion is about half way. You dont push it when recovering but you do as much as possible. i'm already driving again. my advice to anyone that is wondering whether to have the surgery or not. its not even a question. YES !!! if you dont you will later and it wont be pretty. Stop the sports if you tore it bottom line avoid further damage. its a major joint!!!!
2007-03-15, 11:36:44
anonymous from Chualar in California, United States  
rating
HI I posted earlier in this thread, I have now had my surgery, two weeks ago, I am off any pain meds, off crutches, driving for one week now and back to work in a modified roll. It's pretty stiff in the mornings but after some excercise it gets better.
I have a donor ACL 11mm, repaired Med Meniscus and my MCL although damaged will heal on it's own. I also have a minor tibial plateux fracture (excuse spelling).

In all I am very happy, I have a long way to go before I have full range of motion, but I do see the light.

It is a lot of money, a lot of discomfort and the first 3 days out of surgery suck. But it's your knees, so I don't see an option. I'm an active 35 year old guy. I am not prepared to modifiy my lifestyle yet!

I am very lucky to have a great Surgeon. He has been very helpful, and so far it seems like he did a great job, going by the rate I am healing.

Cost, I am now getting all of the bills in, so far:
ER: $980
MRI $1300
Surgery $29000
Ortho Visits $400
PT Visits, 4 weeks prior to surgery & 2 weeks post @ $70 x 5 days per week.
$2100

To Date $33780.00
Out Of Pocket about $4000

Good Luck.
TB
2007-03-19, 20:56:45   (updated: 2007-03-19, 21:00:00)
anonymous from United States  
Hello, i was wondering if anyone has experience dealing with Kaiser in Los Angeles? Any recommendations for a doctor to do ACL surgery?
You are on page 4 of 11, other pages: 1 2 3 [4] 5 6 7 8 9 10 11

 

 

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