What Does a Balloon Sinuplasty Cost With & Without Insurance?

David Cuthbertson, MD

balloon sinuplasty cost with insurance

At ENT Associates of Lubbock, we never rush a surgical procedure.

If you’re at the point of needing a balloon sinuplasty, it implies your ENT has maximized medication treatment options. At this point, the alternative treatment options are worse than a sinuplasty itself. The only other option to sinuplasty (after medical treatment) is taking numerous antibiotics and dealing with the GI complications that come with it.

The key here is trusting your ENT. Always make sure you’ve tried medical management as the first-line therapy.

But when that’s not working, it may be time for surgery — which leaves you wondering just how much this will set you back. While we wish there was a clear-cut answer, there’s not. In reality, the sinus surgery cost with insurance (or without) varies based on the following factors.

Do You Have Insurance?

If so, balloon sinuplasty cost with insurance first depends on the deductible. To better estimate your costs, find out:

  • What’s your deductible?
  • How close are you to meeting your deductible?

How high or low your deductible is and how much you’ve already paid will determine how much you’ll owe. Depending on the plan, you may also have a percentage to pay after meeting the deductible.

Balloon sinuplasty costs without insurance vary as well. The total cost depends on how many sinuses we need to dilate and if we need to couple the procedure with another (such as a turbinate reduction) at the same time.

For patients without insurance coverage, we offer payment plans on a case-by-case basis.

Is Balloon Sinuplasty Covered by Insurance?

Most insurance companies cover the procedure, but there are different requirements for approval depending on the companies. Each company has different metrics for determining if the patient needs the treatment.

In order to get it approved, we always perform a CT scan and exhaust all medical treatment options with medications before recommending a procedural option. With this approach, most insurance companies take the recommendation of the doctor and cover the procedure, but some smaller companies still claim that balloon sinuplasty is “experimental or investigational” to avoid covering it.

If your insurance company denies coverage, our office has steps in place to see if we can overturn the denial decision with a physician peer review or appeal.

What Alternative Treatments Exist for Chronic Sinusitis?

We always try medicine first. Topical sprays, saline irrigations, oral antihistamines, oral antibiotics, and oral steroids are our first line of medical defense against sinusitis. Before we consider a procedure, we want to make sure the problem can’t be managed with medicine.

Before we opt for a sinus procedure, we also need to see an established pattern of infections or a chronic long-lasting infection that won’t go away. By the time we recommend a balloon sinuplasty, a patient will have tried all the possible medications for the issue and show signs that this is an ongoing problem.

What Can You Do to Relieve Symptoms Instead of a Balloon Sinuplasty?

There aren’t many alternatives after medications have failed to solve the problem. When a patient needs sinuses addressed, we either recommend a balloon sinuplasty or an endoscopic sinus procedure. The problem likely comes from an anatomical narrowing or blockage in the sinus cavity. The only way to address the issue is to physically open up the passageways. There’s not much else you can do to relieve these symptoms without surgical intervention.

What’s the Best Next Step?

The best way to know if a balloon sinuplasty is right for your sinusitis (and how much it will cost for your situation) is to give us a call and come in for an evaluation. Perhaps you’ve tried some medications but didn’t use them properly. We may be able to coach you on the use of these meds and solve the problem. Or maybe it really is time for a balloon sinuplasty and we can start looking at the details of what your cost with your insurance.

When we meet with you, we can evaluate what you’ve tried, what you need to do, and what you might change. Only when it’s necessary will we then move on to consider if a balloon sinuplasty is the solution to your sinus problems. Our office staff will work with you and your insurance company to find out the most accurate pricing and establish a payment plan that your comfortable with if needed.


Disclaimer: The content on this website is written and/or reviewed by a qualified medical doctor and great care is taken to provide accurate general information. However, it is for informational purposes only and is not to be taken as a substitute for medical advice from your own physician who is familiar with the details of your medical history. Always consult your doctor regarding health concerns before deciding any course of medical action.