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Medical Services More Expensive Without Insurance

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).