Yesterday was a sick day. I needed a root canal.
I’ve always thought dental insurance is better visualized as a buyer’s discount club with some minimal insurance features instead of an insurance product with some buyer’s discount club features. I estimate that my dental insurance has an actuarial value of about 50%. The rest is out of pocket.
My endodontist started the procedure and about twenty minutes after I had been numbed up and the drill started to go through the crown of my tooth, she stopped and we had the following conversation:
“This is a little different than what’s on the X-ray”
“Is it a problem?”
“No, but I would like to do a scan to confirm the diagnosis, you okay with that?”
“How much would the scan cost and what does it get me?”
“$300 after your insurance pays, and it slightly decreases the chance you are in pain on Saturday”
“What are my baseline odds of pain?”
“Pretty low, I’m good at what I do…”
“Then no scan”
Twenty minutes later, the temporary crown was on and I was walking out the door. As a health policy researcher and insurance geek, I was impressed with the radical price transparency and the discussion of value as my mouth was being worked on. As a patient, this is something that I appreciated that I was not surprised with an unexpected $300 charge for minimal gain but it is not a decision that I was particularly able to make well. I was operating at massive information asymmetry. I had no way to evaluate whether or not my dentist was telling me the truth on how good she was and whether or not the baseline odds were accurate.
Once I got home, I checked the mail. And joy of joys, I received a revised bill from my son’s pediatrician. We had taken him for his annual well child/vaccination update visit last July to an in-network provider. The doctor’s office did not believe he was insured that day. OOPS!
The HR office made an error on the special enrollment period membership file to the insurer. He was initially deemed not covered so we got billed for the entire charged amount. I fought and it took four rounds of phone calls to get everything straightened out. Now we owe the standard co-pay and I dropped that check in the mail this morning on the way to the kids’ bus stop.
On one side there is radical price transparency fueled by low actuarial value coverage. On the other hand, high actuarial value coverage required the paper work to work right. One system worked as designed, I was a hyper informed consumer who decided to not get marginal care and the other took over six months to resolve to everyone’s satisfaction. This is where we are probably going for health coverage where the insurer is more of a buyer’s discount club but the moment of decision felt like I was still operating under intense informational asymmetry and a power imbalance. Getting the billing right for my son was a pain in the ass but I had allies from the insurer who do this multiple times a day so information and power were closer to symmetrical.