One way you pay more for healthcare if you don’t have insurance

Unfortunately, my son didn’t have the best luck recently with his teeth. He had 4 cavities and a painful abscess in 2019 and 3 cavities in 2021. (1) The procedures to fix them were stress free, done by a fantastic children’s dentist. The main difference in the experience was that in 2019, my work insurance paid. In 2021, I paid directly. When I went to look at the recent bill, for $2100, I was really surprised at the price. $200 for a filling, $50 for dental sealant, times 3. Also, over two sessions, nitrous oxide for both sessions at $130 each.

I was curious.

I went back and looked at my insurance statement from 2019. The fillings were charged at around $200, but the insurance company only paid about $130. The dental sealant also wasn’t on it. Overall, googling the billing codes like 02392, I was able to find an insurance table from Joint Benefits Trust, that showed what JBT pays. Again, $200 reduced to $130, about a 50% up-charge for the unwitting.

Now, this is old news for the indoctrinated in the insurance industry. For me, a 20 year health IT leader, with some time spent at a giant medical coding company, I’ve only experienced this tangentially, and it still is a charge I put on a credit card before I went looking. I can imagine if I was disadvantaged and had less time or education to inspire and allow me to do such a search. I might pay it or I might not take my kids to the dentist.

Theres a philosophical argument that will come up at this point in US politics. Is this just a case of “buyer beware” or “personal choice,” “freedom,” or “personal responsibility?”

First I think dental care is essential, not a luxury. (2)

Second, In my case, I can say my situation was “buyer beware.” Yet, I have every advantage, including time, education, and financial security to ask the questions. I would not project that onto other parents who don’t have insurance, who don’t have the advantages.

Third, I fully intend to engage my dentist and discuss this. I strongly assert, healthcare and business in general, work best when based on a foundation of trust. (3) I need to trust that my dentist is thinking about my situation, without insurance, and giving me the same treatment he is giving an insurance company.

If I were financially stressed and unaware of medical billing codes, I would want someone helping me. As I tend to believe in the golden rule and that society doesn’t work if we don’t trust and help each other, I am willing to pay a little extra or live under a law, not to help a dentist buy a Porsche, but to help a poor family take care of their kid’s teeth.

  1. Luckily all the work was on baby teeth. Thanks for asking.
  2. I won’t argue this here, but am willing to discuss with anyone who thinks otherwise
  3. Again, this assertion is beyond the scope of this, but if you read any of the top business books, this is a core theme (4.)
  4. I’m not going to really defend this either. I may be full of it… But the business books I’ve read are definitely pro-trust.

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