It’s really different at the dentist’s office

August 28, 2011 in Member Stories

My son Eli got his top braces last week…
Eli poses mid bracket and I knew exactly what it would cost (and how I long I’d have another monthly bill) before we started. Why is this so different from taking Eli to get stitches, for example?

I have dental insurance. It will cover a little more than half the cost of straightening and aligning Eli’s teeth. So is dental pricing more open and straightforward than other medical procedures because I’m paying a large share of the cost or is there some other explanation?

6 responses to It’s really different at the dentist’s office

  1. Yes, and it’s the same story for LASIK surgery or any other “discretionary” procedure. They “build in” some uncertainty into those rates you pay (in case it takes longer or more visits) while still keeping the rates competitive because they know you can shop around. But, I have to tell you….it’s no easier for me to understand what the orthodontist is talking about than the surgeon so while the consumer can shop around and prices do matter more because we’re paying, the balance of information (or power) still lies with the professional.

  2. Thanks Amy.
    When you say it’s “no easier to understand” do you mean the bills or the steps in the braces process? Or maybe you mean the extensive list of what kids can’t eat (just kidding)? Eli pulled a wire out of the bracket within a week. Oh well.

  3. (I am not defending the system. Just trying to explain it.)

    There are two primary reasons why the braces example is fairly transparent and straightforward.

    First, there are only two entities involved, the orthodontist and your insurance company. This reduces the number of variables to consider. Many medical services involve more players (additional people, lab, facility, etc.)

    Second, the orthodontist has assessed the situation and knows the typical number of visits and amount of work/time required for the entire process. Unforseeable complications would likely result in additional costs, but most are forseeable and are factored into the initial price quote. There are some similar situations in medicine, where the entire course of care is lumped into one single “global” charge.

    You ask why getting stiches can’t be so straightforward. Well, actually, it can and should be. Laceration repairs are coded/charged based on the location, depth/complexity and size of the wound. This could be posted in the waiting room, but most people haven’t measured their wound or know how to judge laceration complexity.

    Just as with the braces, once a wound is assessed it is easy to determine the CPT/procedure code and the charge. Unfortunately, insurance coverage for medical procedures is not always as well-defined as dental coverage. Co-pays, deductibles and exclusions must sometimes be factored in.

    Probably most important is the fact that one has time to consider the pros, cons and cost of orthodontia. There is more urgency with a laceration.

    So, one can usually determine the cost of a discrete service when only one health care provider/entity is involved. Unfortunately, most services add more levels of complexity, often making cost prediction much more challenging.

  4. By the way…

    Eli, you are a good man to allow your mom to post that picture. If you didn’t get an iPhone out of it, negotiate harder next time. :)

  5. Stephen, your comment about coding is interesting in light of my ongoing post (updated Aug. 23) about billing for an ER visit.

    Even without estimating wound depth and such, a patient should be able to see how much a provider charges for some of the popular codes such as the 5 CPT codes that characterize the non-physician component of an ER visit. Are the charges by code available to the public or even to a specific patient when they ask?

  6. Adrian, it is up to each practice/facility to determine whether and how to convey their pricing. My assumption is that few post prices publicly, but pricing certainly should be made available to those who ask. Unfortunately, that is not always the case.

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