Have you ever watched a basketball game where a player holds his knee while grimacing in pain?
One of the most horrible things to witness is someone whose dreams and sports careers crumble before your eyes. To athletes, this is the scariest thing to ever happen to them especially in the early part of their very promising careers.
The anterior cruciate ligament or the ACL is one of the four ligaments that help stabilize the knee and also one of the most commonly injured. Luckily, it is not the end of the world if you experienced injuring your own. This type of injury can be treated by either repair or reconstruction.
Average Cost of ACL Surgery
There have been a lot of cost listings on the Internet when it comes to ACL surgery but we found huge discrepancies and we wonder why.
According to Amino.com, the average cost of ACL reconstruction surgery is $9,276 with the cost ranging from as low as $3,510 to $20,162.
The website further noted the top ten states with least expensive as well as the top ten states with the most expensive ACL surgery price across the United States which are as follows:
- Memphis, TN-MS-AR -$3,510
- Oklahoma City, OK – $4,965
- Birmingham-Hoover, AL – $5,118
- Houston-The Woodlands-Sugar Land, TX – $5,193
- Austin-Round Rock, TX – $5,573
- Providence-Warwick, RI-MA – $5,867
- Miami-Fort Lauderdale-West Palm Beach, FL – $6,313
- Rochester, NY – $6,407
- Louisville-Jefferson County, KY-IN – $6,559
- Tampa-St.Petersburg-Clearwater, FL – $6,750
- San Jose-Sunnyvale-Santa Clara, CA – $20,162
- San Francisco-Oakland-Hayward, CA – $18,577
- San Diego-Carlsbad, CA – $18,271
- Grand Rapids-Wyoming, MI – $18,240
- Sacramento-Roseville-Arden-Arcade, CA – $17,888
- Detroit-Warren-Dearborn, MI – $15,095
- Portland-Vancouver-Hillsboro, OR-WA – $13,750
- Indianapolis-Carmel-Anderson, IN – $13,201
- Minneapolis-St.Paul-Bloomington, MN-WI – $13,157
- Los Angeles-Long Beach-Anaheim, CA – $12,535
These prices seem too cheap compared to what other websites have listed. eHow.com stated that the average cost of ACL reconstruction surgery is $35,000 with the cost ranging from $20,000 to $50,000, to which HowMuchIsIt.org and CostHelper.com seem to agree and Medigo.com being close enough which wrote that the cost to starts at $22,000.
Further adding that insurance coverage would leave the patient paying an average of $1,850 with the price ranging from $800 to $3,000 which usually includes hospital admission fees and co-pays.
To help us find out why this mind-boggling wide discrepancy in the pricing, we have searched some websites that indicated the prices for the ACL surgeries and the knee replacement surgeries as a surgery of choice to some patients and doctors to treat an ACL injury.
The prices above include the surgeon’s fees, anesthesia fees, and the outpatient facility fees so they still do not explain why an ACL surgery would cost as high as $50,000 to $60,000 even if you would have both your knees totally replaced. So we dig a little deeper.
Then we have found an article from someone who has had an actual ACL injury and had it repaired in 2012 in California for a whopping $68,980.13! And we are really glad he had broken down the entries in his bill for us to better understand why it had cost so much.
The answer: he had three types of procedures done at the same time for the ACL injury, to wit:
- Surgeon’s meniscus repair fee – $4,629.00
- Surgeon’s knee arthroscopy fee – $4,629.00
- Surgeon’s ACL repair fee – $8,011.00
The rest of the charges were as follows:
- Anesthesiologist fee – $2,124.00
- Consumables – $2,603.00
- Drugs – $7,087.13
- Equipment – $11,382.00
- Facilities – $28,515.00
We prorated the other charges to each procedure and got these results:
- Meniscus repair – $13,861.30
- Arthroscopy – $13,861.30
- ACL repair – $31,999.53
So we arrived at the conclusion that some ACL injuries could entail so much more than one procedure depending on the damage or severity so be sure to ask everything from the surgeon before agreeing so you would know what to expect and not be surprised (and not have a heart attack) come billing time.
What are Included
Although may vary depending on the surgeon and the facility, the ACL surgery price typically includes:
- The trip to the orthopedic surgeon for the evaluation
- Pre-surgery appointments for laboratory and diagnostic tests
- Physical therapy to prepare the knee for surgery (if necessary)
- Surgeon’s fee, anesthesia, graft, medical supplies, and operating room fees.
- Rehabilitation and physical therapy appointments depending on surgery package. If not included, you would pay extra for this.
If you have insurance, most providers would cover the following:
- Orthopedic surgeon evaluation
- Pre-surgery appointments
- The surgery proper including all the costs associated with it mentioned above
- Post-surgery rehabilitation and physical therapy sessions
Please take note that not all insurance companies are the same and would depend on the coverage you have availed so be sure to ask them first prior to scheduling a surgery.
Treating your ACL injury does not stop after the surgery. Postoperative care is just as important. Physical therapy if not part of the surgery package would be an extra cost on your part and would be charged around $50 to $75 per hour. Depending on your surgeon’s recommendation, you could expect to spend around $1,000 to $3,000 more for this.
There is also the potential of doing the surgery all over again when the first surgery failed or the ACL is damaged for some reason.
The surgery is an outpatient procedure and would be priced as such but older patients or those who develop complications may need a short hospital stay that would entail additional cost.
Shopping for ACL Surgery
You may ask for a referral to an orthopedic surgeon from your general physician if you have an ACL injury. In the case where you have no other sources in mind, you may use Amino.com’s locator for some of the orthopedic surgeons across the United States.
You may also find member surgeons from the American Academy of Orthopaedic Surgeons or AAOS.
Factors Affecting Cost of ACL Surgery
The severity of the injury – not all ACL injuries are the same, thus the treatment may vary as well as the cost.
Location – expect the cost of living and cost of doing business in your area to be a factor in the pricing.
Surgeon – the more expert and experienced the doctor performing the operation is, the higher the cost.
Facility – also expect the price to vary depending on the hospital or facility where the surgery is to take place.
Insurance – most insurance cover ACL surgeries but the amount depends on your policy so be sure to call your provider prior to agreeing to surgery so you would have an idea of what to pay in case of partial coverage and co-pays.
Financing plans – if you are really having financial struggles, you may talk to your doctor about it as some may extend flexible payment schemes for up to a few months to a year.
Cash payment – some hospitals are willing to give discounts ranging from 10% to 35% for patients who have no insurance and paying in cash or credit cards.
Other alternatives – in cases where your insurance does not cover everything and you need to pay out of pocket expenses, you have other options like if you have Flexible Spending Account (FSA), Health Savings Account (HSA), or Health Reimbursement Accounts (HRA).
Not all ACL injuries are recommended for surgery as some either do not qualify or are not really necessary. Examples of these are the following:
- Children who are still continuously growing
- Those people who live sedentary lifestyle
- Athletes who are willing to discontinue playing their sports
- People with partial tears but can move freely and do not have signs of instability
On the other hand, those people who do not fall into any of those categories may well subject themselves to surgery especially if:
- They are athletes who still want to continue their careers
- Those who experience knee instability
- Those who want complete healing