On Friday, October 27, just before I was to head east for the Mont Pelerin Society meetings in Bretton Woods, I woke with the toothache from hell. I arranged an emergency appointment with my dentist. She prescribed an antibiotic, recommended an OTC pain pill, and had her assistant line up an appointment with her favored endodontist. It all worked. I had a successful trip with minimal pain and got back last Thursday.
On Friday, the endodontist’s assistant called to find out what kind of dental insurance I had. The bottom line: none.
So when I showed up for my appointment on Monday of this week, I told the assistant that in light of the fact that I didn’t have insurance, I wondered if the doctor would give me a senior discount. She said she would ask. When I left my consultation appointment, she told me that I would get a 10% discount off the $242 that I had been quoted and a 10% discount off the much larger $1725 for the root canal.
I once negotiated a discount with a doctor who had already done my daughter’s tonsillectomy.
You don’t always get discounts but it usually pays to ask.
READER COMMENTS
Dylan
Nov 8 2023 at 12:11pm
Gt you were able to get this taken care of with minimal pain, David. Interesting contrast with my recent healthcare experience though. I’m on a catastrophic healthcare plan while unemployed. Just getting that plan took months of effort because they are not typically allowed for individuals over 30 unless you jump through a bunch of hoops.
Unfortunately, and this is a longer story, but had an accident and needed to get an MRI and it was recommended I needed one fairly urgently or I risked losing my hip. Even though I was on a high deductible plan and would be paying out of pocket, I found out that I still needed to get a prior authorization from the insurance company. This process takes multiple weeks in the best case scenario, which I didn’t feel I had. But, this was needed to get the negotiated insurance rate. The uninsured rate was 3x higher, and also would not count towards my deductible.
Also, when they “found out*” that I was self-pay after the procedure, they threatened to destroy the images unless I paid them immediately. I had been hoping to pay from my HSA, but needed to wait a day for a trade to settle to have the funds available.
*This is despite the fact that they had called on 3 separate occasions confirming I was self-pay before I went in for the MRI.
David Henderson
Nov 8 2023 at 12:54pm
Wow! What a horror story! Sorry you went through this. On the self-pay issue, you deserved better.
David Henderson
Nov 8 2023 at 12:55pm
I forgot to ask: How much did you end up paying?
Dylan
Nov 8 2023 at 1:42pm
Thanks David, it has been a frustrating experience for sure. The good news is no surgery needed in the near term, which is a big relief.
I paid ~$1500, vs. $500 if I was able to use the negotiated insurance rate. Not the end of the world, and I know some MRIs can be even more expensive than that. Still, I’ve been mostly out of work for the last few months, so the extra thousand stings more than normal.
Luckily, my experience with the rest of the medical folks I’ve come into contact with this month has been positive. But, I’ve tried in each case to ask about self pay and not reporting to the insurance, and each time that rate was significantly more than what the insurance rate would be, even though the insurance wasn’t contributing anything to it. I’ve read about doctors that will give a cash discount online, but haven’t had the fortune to meet them in the wild!
robc
Nov 8 2023 at 4:25pm
While it doesnt help if you can’t make the payment, the good news is you can reimburse yourself from your HSA.
Dylan
Nov 8 2023 at 5:33pm
That’s a good point, Rob. I’d known that at one point, but had forgotten. I’d wanted to leave my HSA alone and let it grow. But, since I’ve got a cash flow problem at the moment, seemed that taking from the HSA was better than the alternatives. Paying myself back from the HSA was something I hadn’t thought of though.
David Henderson
Nov 8 2023 at 5:37pm
Be careful, though, because, if I understand the rules correctly, you can’t replace that HSA money once you become flush.
And if you tell me to mind my own business, I will.
Dylan
Nov 8 2023 at 9:28pm
Not at all, David. I appreciate the advice. You’re right that I can not add the funds back to the HSA. Ideally, I’d prefer not to do that. But, I am running short on cash, so I think my next best alternative is starting to sell stock where I have pretty big capital gains. I haven’t really sat down to do the math, but I’m thinking taking money from the HSA is probably better than selling things in a taxable brokerage account? But, I may be wrong on that.
steve
Nov 9 2023 at 2:11pm
Catastrophic plans are great, until you actually need care. I dont know how much shopping around you did or were able to do (some insurances dont allow it much and some providers have strong preferences for some MRI facilities) but if you are unemployed, and assuming you arent wealthy from earnings before you were unemployed, our network and many others will evaluate your income and offer large discounts along with payment plans so you can stretch out payments over time if its mostly cash flow issues. In general you do have to ask about these.
Which did make me think about Dave’s piece. I think maybe 5-10 times in close to 50 years have I ever had someone ask what something costs before receiving care. Recently people do ask if we are in network. Have had a couple of well known libertarians as pts (their family actually) and they never asked either.
Steve
Dylan
Nov 9 2023 at 3:14pm
Interesting observation, Steve. I had a mixed experience on trying to get upfront pricing. Some places gave it without asking. Other places, I had to ask and they had to check the insurance to get me the negotiated price, but they were able to do it no problem and also gave me the cash price to compare (as mentioned, the cash prices I’ve been quoted so far have been at least double the insurance price) Then I’ve had the places that apparently have never been asked that question before. Initially, I tried to go back to the surgeon I had last year, but they are not covered on my plan. And, trying to find out what the self pay rate was took 2 weeks and only finally happened when I told them I’m not going to show up to my appointment that was scheduled for tomorrow if they can’t tell me how much I will owe them. The answer was $3500, and that was just for the consult, if the doc suggested an MRI that would be more.
As for shopping around, I did try to do that as much as I could. I went to the insurance site which has a tool where you can get estimates for procedures like MRIs at various places, but they only give you their negotiated price, which I later found out I wouldn’t be eligible for. I called half a dozen places on the list, each one was a 20 minute wait on hold before I could talk to one, double check the price and try to schedule something. I went for the one that was cheapest while still having an appointment available over the next two weeks. Then on a Friday afternoon before my Monday morning appointment is when I found out about the pre-authorization requirement and that my self pay price was going to be 3x as much. I tried finding places that advertised for uninsured, but there were none that I could find on short notice.
steve
Nov 9 2023 at 3:52pm
Interesting. Our price would have been $1000 w/o contrast and $1100 with contrast if you had no insurance. If it could be verified you had no income it would be much less. The consult cost sounds way too high. I am a tiny bit surprised that the insured cost didnt apply to you since you had insurance, even if you had to cover the cost. Only a tiny bit as our experience has been that the catastrophic plans work hard to avoid paying for anything.
Steve
Dylan
Nov 9 2023 at 5:30pm
That was the big surprise for me as well. I thought that I’d get the insurance negotiated price just by being a customer. Didn’t think prior authorization would be needed unless the insurance company was going to have to pay something. I could maybe get that it wouldn’t count towards your deductible if you didn’t get PA, but why the heck would I not be able to get the reduced rate.
And yeah, I was laid off from my job in the spring, but I got a decent severance and had a bonus from last year that was paid this year, so my income is likely too high for any kind of program, and I honestly wouldn’t feel right taking it even if I could qualify. I’m cutting into savings more than I would like, but I’m still a long ways away from worrying about missing a rent payment.
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