Private health insurance for ear grommets
In this guide we’ll answer the questions you might have about kids’ grommets and private health cover, like how much they cost and whether or not they’re covered by insurance.
As a rough estimate, they can cost from $800 to $3000 in Australia.
Part of this fee may be covered by your health fund, though it will depend on your policy.
They are an elective surgery. You may wish to try alternative methods such as waiting it out or auto-inflating balloons.
What are grommets?
Tiny tubes inserted into a child's eardrum to help drain excess fluid buildup.
They are also called tympanostomy tubes, and let air into the middle ear to reduce fluid.
It is less than half a millimetre long, and is inserted into the middle ear during a short operation called myringotomy.
It takes about ten to fifteen minutes and your child will be under general anaesthetic.
They usually stay in for anywhere from 6 to 12 months, and they come out on their own.
In some cases, they may stay in for 18 months.
If they do not come out on their own, a brief removal procedure may be required.
Why do kids need grommets?
They are usually recommended if your child has persistent ear infections or glue ear.
Ear infections are often associated with other illnesses or infections, like the common cold.
Germs make their way up the eustachian tube, which goes between the back of the nose to the back of the eardrum.
The tube then swells and becomes infected, making it difficult for air to get through and leading to fluid buildup.
You may notice that your child's ear is red and swollen.
The middle ear is typically filled with air, which allows for clear hearing and normal levels of comfort.
However, in some young children, mucus builds up in the inner ear and does not drain out.
This can cause discomfort and blocked hearing.
When a grommet is inserted, air rushes in from the outside and balances the pressure in your child's ear.
The mucus inside is drained out as it normally would be, providing relief and returning normal hearing.
Doctors have varying opinions on when to move forward.
As a general guideline, they go in after glue ear has been present for three months.
For ear infections, they are often recommended after a child has a minimum of three infections in six months or four in twelve months.
Ear infections can be very painful. The pain can affect your child's performance at school as well as in other activities.
The good news is that these ear infections usually do not persist beyond childhood.COMPARE & SAVE
Who inserts grommets?
They are usually inserted by an ear, nose, and throat surgeon.
Your GP can recommend a specific surgeon or write you an open referral to visit a specialist of your choosing.
Your specialist will explain what to expect before, during, and after the surgery, including any precautions you may need to take.
How much do they cost?
The Medicare Benefits Schedule (MBS) is a suggested schedule of fees for a range of medical procedures.
Surgeons are not required to adhere to these fees, and most do not.
The MBS fee is currently $246.25 per ear (correct as of May 2021).
However, the actual cost of will be determined by the surgeon and the hospital.
As a rough guide, they can cost around $800 to $3000.
The price may be at the higher end of the scale if your child needs bilateral ones (one in each ear).
The price range reflects associated fees, such as an initial consultation with the ENT, anaesthetist fees, and hospital fees if applicable.
Your surgeon should provide you with a written quote prior to the surgery, which you can take to your health fund.
Your health fund should be able to confirm how much they'll cover prior to the surgery, so you are aware of any out of pocket costs.
Are they covered by private health cover?
They are an elective procedure.
If you wish to have them inserted through the public system, you may be on a long waiting list for the procedure.
If you want to have your child's grommets inserted sooner, relieving their pain and restoring hearing, you may want to go through the private system.
Private health cover can take care of some of the costs.
However, this depends on your policy and your surgeon.
Policy Factors -- The more comprehensive your policy, the more likely it is to include grommet insertion.
You can refer to your policy's terms and conditions to see if they are covered.
It's also a good idea to contact your fund to get explicit information on what is covered and how much.
Grommets Surgery Cost
Your surgeon can set their own fees for the procedure.
Your health fund will likely contribute a set amount towards the surgeon's fees.
The remaining amount is known as 'the gap,' and this is the amount you'll have to pay out of pocket.
If your health fund offers a gap cover scheme, and the surgeon participates in that scheme, this can reduce your out of pocket costs.
You may also have to pay an excess, which isn't the same as the gap.
When you set up your policy, you should have nominated an excess amount.
This is a set amount you pay towards the cost of hospitalisation before your health fund makes a contribution.
What are alternatives to Grommets?
There are a few things you can try first that may be less invasive and less expensive.
Discuss the options with your doctor before making any decisions.
Let it naturally clear up
In some cases, glue ear or infections will resolve themselves within a few months.
You can talk to your doctor about this option before moving forward.
Glue ear can lead to temporary hearing loss.
If you're waiting for the infection to self-heal, you can consider hearing aids in the meantime.
These balloons are inserted into the nose and inflated, then used to push air up the eustachian tube.
However, it requires the child's participation and consistent use to be effective.
Antibiotics may help with bacterial infections, but are useless against viral infections.
Painkillers can also be used to relieve pain if you are waiting out the infection.COMPARE & SAVE
This article is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.