How much does grommet surgery cost?
The cost of grommet surgery can vary depending on whether you opt to go through the public or private system. According to the Federal Government’s Department of Health, Disability and Ageing, patients with private health insurance who have grommet surgery in a private hospital might expect to pay an out of pocket fee of around $500. The total cost of the procedure is estimated to be around $1,500, with Medicare paying $480 towards the procedure and private health insurance contributing an average of $560.
Treatment via the public hospital system is typically free of charge thanks to rebates from Medicare, however there may be a waiting list depending on demand at your local hospital. Grommet surgery is generally classed as a ‘Category 3’ elective (non-urgent) procedure with estimated waiting times of up to 12 months. Plus, once out of hospital, there may be out-of-pocket costs for medication and/or relevant allied health services.
What are grommets?
Grommets are very small drainage tubes used to treat chronic ear infections or ‘glue ear’, which is a build up of fluid in the inner ear. Often referred to as ventilation tubes, grommets are placed into the eardrum, allowing air to flow through to the middle ear and any fluid to drain out of it.
Grommet surgery involves making a hole in the eardrum and inserting the grommet. The ear drum then heals around the grommet, holding it in position. The surgery can be carried out under local or general anaesthetic, but general may be more commonly used for children.
There are a couple of types of grommets available in Australia. Short-term grommets last for nine to 12 months, medium-term grommets last two to four years and long-term grommets last between five and 15 years.
Is grommet surgery covered by private health insurance?
According to Canstar Research, most private hospital policies on our database include cover for ear, nose and throat procedures. This may include the insertion and removal (if required) of grommets, but this type of procedure is usually a part of a separate category. This applies to policies from the Bronze category and up. If you have a Basic or Basic Plus policy, check your private health insurance statement (PHIS) or contact your provider directly to see if you’re covered.
Given the potential complexity of the procedure with individual fees from the surgeon, anaesthetist and hospital, it’s often worth confirming with your insurance provider what your out-of-pocket costs will be prior to undergoing the surgery. Your out-of-pocket expenses will also depend on the type of cover you have.
Is private health insurance for grommet surgery worth it?
When weighing up your potential costs for grommet surgery, it's worth keeping in mind both your excess and your potential out of pocket costs. With private health insurance, you'll need to pay an excess for your first hospital admission of the year, and this can be up to $750 for singes or $1,500 for couples and families. Your out of pocket costs will also need to be factored in, and for grommet surgery, the average can be $500.
It's also worth remembering that a waiting period may also apply from when you take out the cover, before you can make a claim for grommet surgery. Some policies have a two-month waiting period, or a 12-month waiting period if it relates to a pre-existing condition. A waiting period may also apply at your chosen private hospital, due to demand.
If you require grommet surgery for yourself or your child, it may be worth investigating both private and public options to see what will suit you best, considering the differences in waiting periods and out-of-pocket costs for both.
