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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).

Take the “Free” Benefits of Employment

Whether it’s medical benefits or free cash via a retirement account, I think many people underutilize the benefits they receive from work. I know I don’t think of using my free checkups/physicals until I have to re-enroll for the next year (coming up soon in July). Not only have you already paid for these benefits, it’ll help you live a healthier and fuller life! :)

Medical:
Every medical plan includes a routine examination and physical every single year at usually no cost to you. Ever hear of those stories where the doctor caught something that could’ve been much worse in a routine physical? All you have to do is schedule an appointment, go in, and get yourself checked out. As you grow older, other preventative maintenance examinations are also included. If they don’t find anything out of the ordinary, that’s great. If they do? Then they’ll have caught it as early as realistically possibly, every year. In addition to these, your plan may include chiropractor’s visits or other sorts of doctor’s visits you wouldn’t even have thought of. Take a look at your plans and see what you can get for free.

Dental:
Again, a free dental cleaning every year. You may absolutely hate going to the dentist but if you go every year then small cavities are caught before their large cavities and anything else that could be problematic can be detected early. Plus, if your teeth are cleaned infrequently then it’ll take a much harder scrubbing to get them clean.

Vision:
If you’re enrolled in a vision plan, typically a yearly exam is also included for free. Get those eyes checked and be able to see correctly. Some plans also include a free pair of glasses or a number of pairs of contacts each year for free (think of it really as paying up front).

401k:
I didn’t want to leave “free” benefits without talking about the free company match contribution to a 401k. As much as it’s been brought to the forefront by mainstream media, lots of people still don’t contribute to their retirement plans! My company will fully match the first 2% and 50% of the next 2% of your contribution. At my company, that contribution is fully vested immediately (some plans require a longer time period, 5 years seems to be typical) so it’s worth it even if I intended to leave tomorrow.

Have I missed any? Let me know!

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