ACL Surgery Cost

Cost of ACL SurgeryACL surgery is expensive and plays a large role in the decision of whether or not to have surgery. Insurance companies and coverage varies. It’s wise to get the exact billing codes from your doctor and give these codes to your insurance provider to see if its covered in your plan. Be as specific as possible, for example, besides the codes, note the estimated duration of the surgery, if the doctor will have an assistant and if billed individually, and the anesthesiologist, physical therapy rehab, ice machines (cyrotherapy), leg braces, crutches, pain killers or any other prescriptions, and any other costs. Get it all and be detailed so you don’t have any surprises.

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Advice from my ACL Surgery

knee-braceWould you like to learn from someone else’s knee surgery experience? This is a summary of what I learned through my ACL surgery (which took place in February of 2009):

  • Yoga is an excellent way to build strength and balance prior to surgery- something that I reaped the benefits of post-surgery, because there’s a lot of hobbling around in crutches and balancing on one leg while reaching down and picking up things
  • Wait a while before the surgery. It took 6 months for my swelling in my knee to go completely down where I regained most of my motion back and was able to do strength exercises. The surgery is said to be more successful after all the swelling subsides. Just be careful in the mean time to not reinjure yourself, and it will be worth the wait.
  • Ice machines are good if you have people around to help maintain it. They run out of ice quite often, every 1-2 hours. So, unless you have people helping you with it, you won’t get much rest constantly getting up to fill the machine with new ice and drain out the old. Crushed ice is worst, regular size ice is mediocre. The longest lasting is homemade ice in 16oz cups- denser- and still fits in container- it may last 3-4 hours each batch. There’s also an electrical shock hazard on the Game Ready ice machine I had. Water from the drainage may leak onto the AC outlet underneath. What were the product designers thinking?
  • Try to avoid hopping on one leg with the other one dangling within a week after surgery. I suspect this and other extra movements led to me having some extra pain and internal bleeding- which they had to manually drain with a needle 1.5 weeks post-surgery.
  • A wheelchair is not a bad idea, as an alternative to get around in your home.
  • For rehab, it’s better to listen to your body (pain level) and let that dictate the speed of recovery rather than follow a physical therapist’s recovery timeframe to a T. It’s ok to take the exercises slow- there’s no rush.
  • It’s nice to have a cart on wheels. One that’s not tippy. You can put dinner plates on it, and roll items from the refrigerator to the table, or for moving your heavy ice machine around, etc. Otherwise, it’s a challenge moving objects around the house with crutches.
  • Don’t try to touch toes to put on/off socks- I may have pulled my hamstring doing that.
  • Don’t pay your bills too soon! Wait until absolutely everything is resolved between your providers and insurance company first. You don’t want to start paying bills you don’t owe. There’s a degree of negotiation between the provider and insurance company and it’s best to postpone paying until everything is settled and knowing that you’re not getting jipped- it puts you in a better position to negotiate in case your insurance didn’t cover something they were supposed to.

Post ACL Surgery Timeframes:

  • Same day: went home and used crutches to get around
  • 1.5 weeks – stopped using the ice machine full time, much of the swelling gone
  • 2.5 weeks – started driving (very carefully) and went completely off pain pills.
  • 3 weeks – less dependent on the knee brace- went without it- and start walking.
  • 3.5 weeks – able to climb/descent stairs
  • 4 weeks – started walking without crutches, able to use stationary bike and do light squats

Insurance companies will harass you and will try to find any loophole possible to not cover your benefits. As tedious as it is, it’s best to speak to the billing department of each of your service providers in advance and get price quotes and take good notes with who you spoke to, dates, billing codes, time spent on each procedure, etc. Then speak to the insurance company and ask them based on this scenario what your coverage will be. They are trained to be extremely vague about everything, so it takes some work. Take detailed notes on everything.

How much does ACL surgery cost?

I got a couple quotes (before insurance coverage) and here’s the range…

Surgeon fee – $1,350 – $2,200
Facility fee – $810 – $9,300 (huge range!)
Anesthesia – $748 – $845
Implant fee – $500

Other fees:
Full knee brace – $490
Ice machine rental (2 weeks) – $300 (not covered by insurance)
Prescription pain medicine – $100
Crutches – $30

Get more info on ACL Surgery Costs

If you are having a hard time with the cost aspect of ACL surgery, there’s nothing wrong with shopping around and choosing a different doctor. You can even travel to a larger metro area if its important enough.

Insurance issues

My insurance is supposed to cover 80%, but with the deductible, 20%, and some things not covered, when it’s all done it’s supposed to be $2,000 – $3,000 to me. That’s a little too vague of a price range for my comfort, but that’s part of the billing game.

It’s 5 weeks out and my insurance company is playing the game, saying initially that my benefits are denied, while requesting an ‘incident report’ form to be filled out. Basically, they’re trying every possible scenario to get out of paying, fishing for someone else to be potentially liable for the incident. I think they’ll have to pay though, according to the conditions of the plan.

Provider issues

The providers are also a little tricky in the way they bill. For example, they quoted me only the surgeon’s fee each time I asked about billing with no mention of any other weird fees. But now that it’s over, they decided to bill separately for one of the assistant’s time too. I would have wanted him out of the room if it were up to me- it would have saved $490.

The providers also quoted me one rate and billed another- higher $ of course. They also said the prices will be going up after the new year, which may be reflected in my bill. There’s really no guarantees of anything and the patient is in a very poor position for negotiation.

I hope this information helps someone. I wish I had this kind of info beforehand.

Remember to also read everything on this site and read the ACL surgery tips and comments from other people.

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