A few months ago, I went into a medical procedure worried.
Thankfully, I wasn’t concerned about my health. I wasn’t stoked to be getting a colonoscopy at age 32, but it’s about as routine as it gets, and my symptoms were hardly life threatening. Rather, I was worried about what it might cost.
How did I step foot into a surgical center not knowing what the bill would be? It wasn’t for lack of trying. I asked the doctor if the procedure was covered, and he said yes. But my insurance company said I’d be on the hook for a percentage of the cost since I was under 45.
I called the clinic to ask what the full price was, and they told me to call my insurance company. My insurer told me to get in touch with the clinic’s billing department. Billing said they’d call me back. They didn’t. By the time the day of my colonoscopy arrived, I threw my hands up.
The doctor had told me I absolutely needed it. I would just have to eat the cost, whatever it was.
Have you ever tried asking a services-based company that takes insurance what they charge for anything? They don’t know. They always have to “look it up”. How does a dentist office not know the cost of a cleaning? I asked our dentist once before my two kids’ appointments for preventative cleaning, and it took them 20 minutes to get back to me, you know, after the kids were already seated and getting their teeth cleaned. I’m not even talking about how much is out of pocket after insurance, I’m talking about how much they charge the insurance, aka their “fee”. I’m fairly certain they need to calculate the most they can charge the insurance and still keep my out of pocket expenses within the insurance guidelines. It’s like buying a used car.
These bastard insurance companies will tell your dentist how much they are willing to pay for a treatment.
So say the dentist would normally charge $300 for a cleaning, with full x-rays, flouride varnish, and comprehensive exam
The insurance company can dictate that they will only pay $250 with flouride. Another plan with the same company might pay $175, but won’t cover flouride. A seperate insurance company will pay for flouride up to age 14. Another will… you get the point.
Further, with the exceptions of exams and cleanings (which I think they HAVE to cover by law) they can dictate a fee of $500 for a crown, but then only a porcelain fused to metal crown, and then only pay like 60% of that with you needing to pay the rest. The dentist may normally charge $800 for a crown, but prefer using something like zirconium.
The receptionist has to go through each and every patient’s insurance schedule fee, and can only give you an estimate because even though they call the insurance company, the rep on the phone can make mistakes.
It’s a horrible, horrible, system that serves no-one except the insurance companies and I hate it
(Worked in dental, tried doing up front stuff but I have ADHD and the insurance garbage breaks my mind)
Right. So the reason I can’t be told the price is because the “auction” is still going on when I come in for my appointment. It’s a racket.
For complex reasons, there was a period where I had dental insurance, and my wife didn’t. The dentist offered a $10 per year discount program for people with no insurance. With that discount program, my wife’s cleaning was $55. Mine was $220, but the insurance “paid” $170 of it.
The receptionist said the insurance insisted on a huge discount, and paid them $10 towards the actual service cost. Pretty much, with twice a year cleaning, my insurance company and I were paying $120… and my wife with no insurance was paying $120.