How much does an ACL operation cost?

Go become a Canadian Citizen. It's all free up there! Heh...anyway, my friend has his worked on and he said it was about $2,500. Maybe more.

 

i heard my friend say it was around $5k with rehab. forgot how long rehab was (usually six months, or 6-12).

 

The $2500-5000 number, is that after insurance, or total cost including insurance? I messed mine up a couple of years ago, and couldn't afford to get it fixed. I'm hoping that once I start my "career" job next year, the insurance will take care of a good chunk of the cost.

 

Probably around 5 to 7k. Since you have insurance, you will probably pay less than a thousand out of your pocket.

My rehab was totally free. But, if it isn't, it can be pricey.

Also, rehab won't last as long as some other poster said. It will be 2 months at most.

One last thing; if you under the age of 40, ask for a cadaver ligament. You will have a quicker recovery time.

 

All these numbers seem too low to me. I had ACL reconstruction surgery a little less than 3 years ago, and I think everything involved with the surgery was getting much closer to 10k, and then you have Physical Therapy (PT) and Rehab costs on top of that.

I'm at work, so I can't verify my costs--I have the bills at home and could check tonight. My insurance covered the surgery 100%. Additionally, you have the costs of the doctor's visits pre- and post-surgery (I had a $10 co-pay per visit) and the PT costs (I had a $10 co-pay for each 1/2 hour.) And there was also the x-rays, MRI, etc. before the surgery which I'm not including in the surgery cost.

The surgery costs include the doctor's surgery fees, the facility's fees, the anesthesia and anesthetist fee, the home medicine (IV) and home care (nurse visits) the day of and the two days following, etc.

 

Re: Re: How much does an ACL operation cost?

Are you saying 2 months after surgery you can be playing soccer again??? I haven't heard anyone get back on the field that fast after reconstructive ACL surgery.

Everyone's body reacts differently, so rehab times will vary from person to person no matter how disciplined you are with PT and rehab. However, if you are disciplined, you can certainly knock off time from the conservative estimates the doctors will give you (usually 6 to 12 months). Based on my personal expereince and knowing several other people to have had reconstructive ACL surgery, I don't think it's unreasonable to say that on average it will take 6 months of PT/rehab before being able to play again. It can certainly be shorter. That depends on your body (out of your control) and your discipline (in your control). I was back playing low-contact pick-up soccer 4 months after surgery and playing in a rec-league 5 months after surgery. That was faster than average and before my doctor wanted my to be out playing. Most of my friends weren't able to return quite that fast.

Here I would concur. I didn't go this route becuase my doctor never explained the differences and advantages/disadvantages of the two methods and never clearly presented it as a choice. The two options for the replacment ACL are (1) a cadaver ligament/tendon or (2) using a portion of a ligament/tendon cut from your own body (usually the patela tendon--the one coming down from your knee cap). If they use your patela tendon (cutting out the middle 1/3 of it) to reconstruct your ACL, PT and rehab has as much to do with the healing and rehab of the patela tendon as it does anything else. In other words, your new ACL could be ready to go before your patela tendon is ready. So using a cadaver can shorten your rehab and make it less painful.

Another suggestion is to start working out prior to surgery. You can't help but experience some muscule atrophy due to a week in bed/sofa after surgery and then a couple weeks on crutches, but if you strenghten your leg muscles prior to surgery you'll be better off once you begin rehabbing your leg after surgery. I didn't do this, but I can see how this would have helped.

 

Re: Re: Re: How much does an ACL operation cost?

No, I meant I had to spend less than 2 months going to those guys who try to turn you into a pretzel. I took 9 months before playing soccer again. However, I ran a 10k race in 2 1/2 months after surgery and ran a marathon six months after surgery.

I think Roberto Baggio set the record for come backs; he came back to playing professionally 90 days after surgery.

 

All I can say is (having had 2 reconstructions on the same knee, both from the patellar graft and the cadaver graft) that you should go for the cadaver. You will recover faster, as the doctor has less cutting and harvesting to do.

Most importantly:

Get a customized brace and make a covenant with yourself to wear it religously (anytime you go out or do anything physical) until your rehab is done; You're very vulnerable after the first 4 weeks until about 8-9 weeks have gone by.

Work on your conditioning and your mental game until you have zero doubts about whether you can play soccer.

Good luck on your surgery and recovery.

 

Just remember that you should start a lifetime of weght training and rehab. I tore my ACL,MCL, and Meniscus 12 years ago when I was 18, have always had soreness when I played sports through the years. Last year I was jogging, heard a POP,thought I had done it again. When I went to the doctor they asked me if I had been keeping up on my therepy(lifting) which I had'nt. I mean come on 12 years later! So it has now been a year of lifting, swimming, bike riding, my leg is much better. I have retired from all sports as a result, not worth the injury again.

 

The cost issue is simple:

Insurance companies pay what they feel the operation is worth. It's called the UCR. (Usual, Customary and Reasonable).

So call your Orthopod and ask him what he's gonna charge for the procedure (and what exactly the procedure is). Then call your insurer and ask them what they're going to pay for X procedure.

What they don't do is say "We'll pay 80% of the bill." What they may say is "We'll pay 80% of the UCR". Something that you can do is then get back to the Surgeon and say "Look, Ace, my insurer is only gonna pay $2300. Will you do it for that? A surprising amount of the time, the guy will say "Sure"

Done all the time.

There will of course be more involved than just the surgeons' fee. Normally you'll get nicked for an OR, an Anesthesiologist and a night in the Hospital.

You'll also want to know the cost of making your knee brace and what is typical for the PT you'll see afterwards. They can tell you what a normal course will involve.

Get the numbers together and then call your insurance company - they HAVE to tell you what they'll pay up front. It's the law.

 

You might want to wait at least six months before declaring your problem/intent to insurance. They may try and deny you with a "pre-existing condition" clause. Remember they are in business not to pay, it is to their advantage.

Additionally your doc may be somewhat required initially to suggest the non-cadaver approach just due to costs and the rewards doctors offices can recieve for being low cost providers by insurance companies. That practice has (I think) technically been outlawed because of the abuse by the major HMO's back in the 80's and early 90's, but there is still kick backs to charity's, research projects and hospital funds etc... that still occur from them. Kinda like no call lists enforcement now means I still get solicited... just everything is a charity or survey now.

 

Well, here's the breakdown of my reconstructive ACL surgery costs from just under 3 years ago. I think the only items left out are the prescription post-op pain killers, gym membership to continue my rehab after insurance stopped covering PT, and some miscellaneous rehab items I bought (excerecise mat, ankle weights, etc).


. . . . . . . . . . . . . . . . . . . . . Accepted. . Personal
. . . . . . . . . . . . . . . Provider. . Insurance . Cost /
Item. . . . . . . . . . . . . Charge. . . Payment (C) Co-Payment
Doctor's Office Visit . . . . $. .95.00 . $. .54.00 . $.10.00
Knee X-Ray. . . . . . . . . . $. .78.00 . $. .49.00 . $. 0.00
MRI . . . . . . . . . . . . . $. 972.00 . $. 437.40 . $. 0.00
Doctor's Office Visit . . . . $. .50.00 . $. .50.00 . $.10.00
Blood Test. . . . . . . . . . $. 137.00 . $. .46.58 . $. 0.00
Knee Immobilizer Brace. . . . $. 340.00 . $. 289.00 . $. 0.00
Knee Surgery - Surgeon. . . . $7,039.00 . $1,204.61 . $. 0.00
Knee Surgery - Facility (A) . $7,826.87 . $1,631.12 . $. 0.00
Knee Surgery - Anesthesia . . $. 845.00 . $. 442.00 . $. 0.00
Skilled Nursing - Home Visits $. 226.00 . $. 191.49 . $. 0.00
IV Therapy - In Home. . . . . $. 265.92 . $. 265.92 . $. 0.00
Knee X-Ray. . . . . . . . . . $. .63.00 . $. .33.00 . $. 0.00
PT - Initial Consultation . . $. 125.00 . $. .67.73 . $. 0.00
PT - Consultation 2 . . . . . $. .75.00 . $. .25.48 . $. 0.00
PT - Consultation 3 . . . . . $. .75.00 . $. .25.48 . $. 0.00
Physical Therapy (B). . . . . $4,790.00 . $2,870.00 . $310.00
Athletic Knee Brace . . . . . $1,370.00 . $1,164.50 . $. 0.00
Doctor's Office Visit . . . . $. .50.00 . $. .50.00 . $.10.00
----------------------------------------------------------------------
TOTALS. . . . . . . . . . . .$24,422.79 . $8,897.31 . $340.00


(A) - Drugs, Medicine & Surgery Supplies, Ambulatory Services
(B) - 128 hours over 10 weeks
(C) - This is the UCR (Usual, Customary and Reasonable) that Bill Archer mentioned. The amount the Insurance Company was willing to pay and which was accepted by the provider as payment in full.


The discrepancy between the Provider Charge and what they accept as Payment in Full from the Insurance Company is huge. I'm not sure if they ever really charge what they say the charge is. In other words, is someone without insurance looking at $25k for reconstructive ACL knee surgery? I have excellent insurance coverage thru work with low copays and very few deductibles. Depending on your insurance, you will likely be looking at much more personal out-of-pocket expense for your surgery than the almost negligible $340 I paid.

 

I've had both ACLs repair. The first was done by filleting the patella ligment at age 36 and the second was done with the cadaver's ACL at age 41. The second worked out much, much better, in that I regain full strength much quicker.

The second one cost just over $16K total, although I don't have the itemized bill like the Weasel. I had insurance, and they do the volume price negotiations.

 

Ohhh ********, i should not have read this thread....

**knocking furiously on wood**

 

Re: Re: How much does an ACL operation cost?

The downside to this is the cadaver ligament can be rejected by your body, so there's some risk involved with going that route.

 

I would get a second opinion from another doctor. I tore my ACL twice (neither one playing soccer I might add). The first time the patella tendon was used and for some reason, my knee never felt right. Three years later, I re-tore it and a cadaver was used. After a full year, I'd say my knee was 99% and definitely feels stronger than after the first tear.

Flying Weasel is correct about the high price tag (I was shocked at some of the low figures I saw here). Both of my surgeries were done through insurance, but I asked my doctor how much it would have cost if it were not. He said it would have been between $15-20K. So including re-hab visits and a knee brace (if you elect to wear one), his $24K figure is right on the money.

I just wanted to point out a couple of things brought up here:

1) It is a fact that rehab is much quicker when a cadaver is used. Any book you read on the topic, will concur. After my first ACL tear, I was on crutches for 10 days. On the second tear, I was "walking" (with an obvious limp) only 3 days later and only missed two days of work.

Although it is true that rehab generally ends 2-3 months after surgery, it's usually because that's all your insurance carrier will cover. Generally, they'll give you a home exercise program and tell you what you can do at your local gym.

2) I don't believe insurance carriers can deny you in some cases of pre-existing injuries. I believe there was some legislation passed during by the Clinton administration pertaining to this, since it was unfair if someone changed jobs and the new insurance carrier refused to cover for a needed surgical procedure.

3) Flying Weasel indicates his brace was $1,350, but I'm sure it was custom made. An "off-the-shelf" knee brace like a Don-Joy goes for about $300. Most insurance carriers do NOT cover for custom made ones.

Speaking of knee braces, I began using one after the second tear upon my request. After playing pick-up soccer with it for 4 months, I finally gave up and play without one since it severely limited my lateral movement. However, I have never played basketball without it (which is how I injured it in both cases).

As a side note, there is NO guarantee that despite wearing a knee brace, that you won't re-tear it.

4. There's no overnight stay. You're home literally hours after the procedure.

5. This is the first I'm reading of Baggio coming back after 90 days, but I know Tony Meola missed "only" about 3 months after his poor impersonation of a forward at practice. Then again, he's a pro and he's following a vigorous workout schedule while we're only weekend warriors. After 6-7 months, you should be fully cleared to play all out.

 

******** all that. I had surgery in october and my total bill came to around 12,000.

 

My surgery used the hamstring tendon. Rehab has been fine and I'll be able to play before the end of march (less than 6 mo. after surgery). Small scars as well.

 

im so happy i stay in the uk and get my medical free. that is a real lot of money you's have to pay out.

 

Yes, my insurance covered my Physical Therapy for about 10 weeks going 3 times a week for about an hour. I got my PT total incorrect above. It was 128 segments of 15 min. for a total of 32 hours over 10 weeks. After that I continued my rehab by getting a gym membership and continuing a program that my physical therapist gave me. I went to the gym for 1-1/2 hours about every other day (3 or 4 days per week) for 2 months additional months. I should have contuinued going but preferred to be out playing soccer than be in the gym.

Yea, I guess mine was custom made. I was fitted for it. It was a Don-Joy. I was never told there was such a thing as an "off-the-shelf" knee brace. Of course, with my insurance covering it 100%, it didn't matter. I wonder how many sizes these "off-the-shelf" braces come in to fit the spectrum of leg sizes. Mine was custom fitted and it still never felt that comfortable. Some people talk about getting so used to it that they practically forget they're wearing it. I never reached that point. I gotta wonder about the (dis)comfort level of an "off-the-shelf" brace.

Well, nothing's free. Someone IS paying for it. Likely it's from the taxes you and/or everyone else pays. I'm not defending the U.S. system (ours certainly isn't perfect), but don't ever think anything is free. It's just a matter of who pays for it and if they are paying a fair and reasonable amount.

 

Absolutely true.

"The Government" doesn't have any money of it's own to pay your medical bill. It's just a shell game.

In fact, of course, the prices in the US are grossly inflated because 1) Medicare has such low allowable charges, ie. they tell the Doctors they will only pay $100 for a procedure that costs $1000. So the cost gets shifted to paying customers and 2) Depending on the location and type of service, as much as 30% of medical expenses never get paid. So again, the price gets jacked up for everybody else to cover the shortfall.

That's how aspirin tablets at the Hospital end up getting billed at $12.00 apiece.

The point is not which system is better - frankly, I think ours is because it still provides choices - but rather that in either system it's just a case of shifting the costs around.

And anything the government runs inherantly sucks.

 

The cadaver ligament is the way to go. I know of one NHL player who didn't go the cadaver route and eneded up a cripple. He can barely play golf without pain and it took at least five years off of his career.

Just call your insurance company or ask the HR people at work to give you a benefit summary. Depending on your plan, you coule be on the hook for a little as nothing for the surgery, a nominal fee for the hosiptal stay, and then copays for medication and rehab visits.