Medical Services More Expensive Without Insurance

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This week I went in for a routine dental visit to get my semi-annual cleaning and passed the checkup with flying colors. Today I saw the claim hit my dental benefits website and the disparity between the Fee Charged and the Fee Paid (that is the negotiated price the insurance company agreed to) was a lot larger than I ever expected. My out of pocket expense was a nice $0, as expected for my routine cleanings, and this was the first time I ever looked at my dental claim so I was surprised to see how much less the negotiated fee was compared to the fee charged. (% Diff was calculated as $ Diff divided by Fee Charged)

Line Item Fee Charged Fee Paid $ Diff % Diff
Additional Intraoral Film $21 $4 $17 85%
Intraoral X-Ray $24 $14 $10 42%
2 Bitewing X-Rays $42 $20 $22 52%
Periodic Oral Evaluation $43 $22 $21 49%
Cleaning – Adult $76 $48 $28 37%
Total $206 $108 $98 48%

This was something my friend first pointed out to me whenever he had work done on his car after an accident, that the fee you would normally pay for service is generally higher than the fee you would pay if the insurance company pre-negotiated the fee, but I didn’t think the difference was this high. But, if nothing else, gives you ammunition (and a big of confidence) if you’ve ever considered negotiating fees with your doctor. If the insurance company can get a 48% discount, by haggling a little bit you should be able to knock off a little from the starting price.

The biggest surprise was the “Additional Intraoral Film” item. I accidentally swallowed when they took the first X-Ray so they had to take another X-Ray of my front teeth. To think that it would’ve been $21 to pay for it on my own and a mere $4 otherwise is pretty ridiculous, an 85% difference!

This is a double-whammy for anyone who want to self-insure themselves because not only do they have to pay out of pocket, they don’t pay insurance company negotiated rates, they pay rack rates (to use a hotel booking term). So, if you’re thinking about self-insuring, certainly keep that in mind (and the fact that you have much more leeway than you probably expect when it comes to negotiating the fee itself).

{ 8 comments, please add your thoughts now! }

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8 Responses to “Medical Services More Expensive Without Insurance”

  1. Jessica says:

    Uninsured people can also negotiate medical services. My parents are not insured and my dad recently had to go and see a specialist and get a colonoscopy. He paid $600 for the colonoscopy. Which I feel is a reasonable fee for such a test – not cheap but reasonable. They charge the insurance commpany 3-4k and the insurance company pays $600. There is a lot of greed going on here. If medical charges were reasonable (not cheap or free mind you – these people do have to go to school for 12 years andd buy expensive equipment andd such) then there would be no need for insurance companies. Meanwhile hospitals are putting down wood floors…

  2. Mireille says:

    Jessica is right. I recently let go of my dental insurance (premium $16/mo) when I discovered that the cleaning that showed up on the insurance report as costing $200 ($5 copay) was only $50 if I paid my dentist out of pocket. Since I have never even had a cavity, I actually only pay $100/yr for cleanings instead of $192 for insurance (not including the copay for cleanings).

  3. dong says:

    I think people confuse the point of insurance. Insurance really is intended to cover catastraphic costs, not routine costs that can be covered out of pocket. The model we have insurance in medicine, and how we think about it needs a major overhaul.

  4. I agree with dong; the main reason that I keep insurance is to cover those major catastrophic events, not the simple ones. For any insurance that I pay for, I consider this. For the family cars, we have fairly high deductibles because we’re safe drivers and don’t expect to be involved in at-fault accidents much, and because the insurance is really there to replace the car if we need to for some reason and to pay medical bill if need be (and to cover our butts in case of being sued.)

  5. broknowrchlatr says:

    Providers overprice things for a couple reasons.

    1) they want all charges to hit the maximume allowable with contracts with any insurance company.

    2) they actually want to encourage people to haev insurance as they have less difficulty getting the insurance company to pay them than the consumer. as such, it makes sense for the chagne to be higher since it may take a while to get paid.

    For ininsured, the best option is 2 steps
    1) Get a mediacl Repricing plan. They are free (are nearly) and you can get a similar reduction in price.

    2) Use a medical bill negotiator. I advocate using this if you have a high deductible plan. They have a database of appropriate prices and negotiate a settlement with the provider.

  6. RootAnn says:

    If you take your child in to get him or her vaccinated, there is a HUGE difference in what you pay vs. what the doc’s office charges insurance. (In some states, the vaccination is free but the shot administration costs you. In most states, I believe, insurance is required to cover at least some of the cost of the vaccination. But that’s another story.)

    After my first daughter was born, the doctor’s office had us down as the insurance not covering immunizations. The bill for about three of them was about $45. When I let them know they were covered by insurance, the doctor’s office charged “insurance rates” and billed the company for about $275. I believe it was negotiated down some per contract, but not under $150.

    I can’t prove it, but I believe doctor’s offices have different rates for insurance vs. no-insurance. (I know that psych offices have different rates for different insurances & people whose insurance doesn’t cover mental health. Worked at one back in high school.)

    Big ripoff for everyone!!

  7. Oh please, I love how this has turned into a bashing of medical professionals and a pitying of insurance companies. The reason why medical practitioners charge so high is because the insurance companies never pay them the full price for a procedure (and this isn’t because they are master negotiators); sometimes they never pay at all (even if they’ve authorized the procedure). Let’s not forget that insurance companies often deny patients coverage for essential procedures. You better hope you have a decent enough doctor who will take the time to argue with the insurance company and get them to agree to pay.

  8. Let me give you an example of what happens. The reason there are two rates for no-insurance and insurance is that if doctors charged $100 for a procedure, then people with no insurance would be $100, whereas the insurance company would only pay $50. It’s not that they’ve negotiated the rate; they’d just send $50 instead of the $100 they were charged. So to make sure they get their $100, the medical practitioners charge no-insurance patients $100 and insurance companies $200. Of course these numbers are hypothetical, but I’m just trying to illustrate what actually goes on in medical compensation.

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