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You are here: Home / Anderson On Health Insurance / Root canals, bundled payments and patient friendliness

Root canals, bundled payments and patient friendliness

by David Anderson|  September 12, 201810:53 am| 28 Comments

This post is in: Anderson On Health Insurance

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I had a root canal last March. The dentist told me it would be painful for a week or two as the immediate injury and surgery healed. She also told me that if there was any pain after that to come back in and get it checked out. I left the dentist’s office after paying several fingers and at least one needed toe for the hour long procedure.

Six weeks ago, I had a pain flare-up. I took acetaminophen and ignored it until the pain receded. Two weeks ago, I had another flare in the tooth.

I made a call to the dentist and she had me come in. Once at the office, they took a couple of X-rays, poked and prodded and talked with me as to the types of pain and types of triggers for the pain. Right now she thinks that there is a side canal that might be the cause of the pain but she can’t tell until I come back on the same day as the pain flare up.

When I left the office, I pulled out my credit card to pay for the visit. The front desk worker shook her head and said that the entire bundle of care was included in the original payment for the root canal. Any follow-up for this tooth’s pain will be part of the bundle.

I did not realize that I was buying a bundle of care. It is a more patient friendly experience than the expected fee for service system where every visit drives a new payment. If I knew that I had an episode based bundle, I probably would have gone in on the first complication. I know that if there is another flare-up, I’ll go in as soon as I can clear time from work. My barrier will only by timing and not cost.

Episode based bundled payments may be more patient friendly as they remove a barrier from follow-up of minor to moderate complications compared to fee for service payment modalities.

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28Comments

  1. 1.

    Victor Matheson

    September 12, 2018 at 11:01 am

    Of course, this is an almost perfect story about why depending on consumers and consumer choice playing a big role in driving down health care prices is a huge myth. Here we have Mayhew, a professional medical pricing expert who knows more about health care pricing than 99.9% of the population, and he has no clue what a follow-up visit to the dentist costs.

    (This is not to pick on Mayhew at all. I am a professional economist who teaches courses in tax policy, and I couldn’t exactly tell you my marginal tax rate. So much for the assumption of perfect information that drives the conclusion that free markets lead to optimal outcomes.)

  2. 2.

    HeartlandLiberal

    September 12, 2018 at 11:02 am

    The local dentist who has done dental surgery for me and my wife had given us both free checkups on teeth he has done as much as three years after the surgery. Needless to say, aside from fact he is excellent dental surgeon, that impressed us, too. We left one general dentist because he had clearly target making as much money as possible for any reason as his modus operandi. His partner left and opened his own practice, so we moved to him. Much nicer guy and not a money grubber, aside from being a good dentist. His father with whom I was friends, and also a dentist, sadly deceased, would be very proud of his son.

  3. 3.

    Brachiator

    September 12, 2018 at 11:13 am

    The front desk worker shook her head and said that the entire bundle of care was included in the original payment for the root canal.

    It’s possible that the “bundle of care” price might be higher than a “root canal alone” price. This means that people who have no complications are paying slightly more than people who require some follow-up. Still, the convenience, and encouraging follow-up visits, might result in overall better care, and make this approach a good value.

  4. 4.

    kindness

    September 12, 2018 at 11:18 am

    You are lucky. When I was a poor student and had no money I needed a root canal and ended up going to the UCSF Dental School to get it done. What should have taken 3 visits max ended up taking 6 and then the tooth got re-infected I had to pay to have the crown removed, redrilled, re-disinfected and recrowned. 2 more visits. My thinking it would be half the price of a normal dentist was way off because I hadn’t planned on the extra 5 visits. I paid because I had to.

  5. 5.

    Cheryl Rofer

    September 12, 2018 at 11:18 am

    This was the case for my root canal a couple of years back, but I didn’t need the followup. The endodontist told me up front. My dentist does the same thing for crowns. I like it. Brachiator is probably right, but that’s fine with me too.

  6. 6.

    kindness

    September 12, 2018 at 11:18 am

    What exactly in my comment threw it into moderation?

  7. 7.

    kindness

    September 12, 2018 at 11:19 am

    @kindness: Oh and this one is in moderation now too? Man, I must have pissed someone off.

  8. 8.

    kindness

    September 12, 2018 at 11:20 am

    @kindness: Oh and this one is in moderation now too? Man, I must have pissed someone off.@kindness: OH. I keyed my email in incorrectly. Can someone please release the original comment and delete these please? Thank you.

  9. 9.

    TomatoQueen

    September 12, 2018 at 11:26 am

    (grumpy complaint about formatting, failed comment button, “balloon-juice is not responding”, browser freeze, reboot) Similar experience with vein clinic last December. The costs of standard treatment and follow up were explained to me at the first visit, and nothing further was scheduled until insurance approved 48 hours later. Extra treatment was needed but not charged. I attribute this to rampant capitalism and/or vein procedures are predictable. Also they’re no fun so I appreciated a less-than-nightmarish billing experience.

  10. 10.

    Villago Delenda Est

    September 12, 2018 at 11:30 am

    It’s like the dentist actually gives a shit about the patient.

  11. 11.

    terry chay

    September 12, 2018 at 11:37 am

    something similar is happening to me. I think he missed a side but I have a follow up this morning where he wil see that the treatment he did last time didn’t work and is back So shocked that I haven’t had to pay for these visit (though the original root canal operation was crazy $$$).

  12. 12.

    MattF

    September 12, 2018 at 11:41 am

    I’ve had several root canals. When my current endodontist looked in my mouth for the first time, his eyes gaped open and he said “Thank you.” That said, he is excellent at his job– he’s done some complicated and chancy surgical procedures– he once delivered the “Just because you have a bad tooth doesn’t make you a bad person” speech– but in the end they’ve all been successful. And they’ve all been single-payment.

  13. 13.

    Walker

    September 12, 2018 at 11:49 am

    Both dentistry and veterinary visits are a completely different world from regular human health care. Completely up-front pricing. In the case of dentistry, it helps that things are rarely life threatening, and so you can make choices.

  14. 14.

    VOR

    September 12, 2018 at 12:05 pm

    @MattF: I’m currently in the middle of the tooth implant process. They did the extraction with an accompanying bone graft in the first procedure. Now it is healing for 4 months. Soon I’ll go back to the oral surgeon for a checkup. If it looks good, they schedule a procedure to implant a titanium post. There is another 4 months of healing and another appointment with the oral surgeon to check the integrity of the titanium implant, make sure it healed right. All of this is one upfront price. You then go back to your dentist to get a crown attached to the implant and that will be a separate charge. My dental insurance now covers both the implant procedure and the crown.

  15. 15.

    Brachiator

    September 12, 2018 at 12:06 pm

    I hadn’t been to the dentist for a while, but I had to go back to have a crown replaced. One thing I found interesting was that the dentist now was able to make the crown in the office, instead of sending a mold out to a separate lab. This was almost like sci fi level stuff. Then again, I am easily impressed.

    ETA: Fortunately, I guess I brush and floss, and take care of myself fairly well. My dentist was impressed that I didn’t have any major issues even though I had skipped cleanings and checkups for a while.

  16. 16.

    Haroldo

    September 12, 2018 at 12:07 pm

    @Victor Matheson:

    I am a professional economist who teaches courses in tax policy, and I couldn’t exactly tell you my marginal tax rate. So much for the assumption of perfect information that drives the conclusion that free markets lead to optimal outcomes.

    I was trained as a physicist where assumptions were made to make the mathematics of the physical situation more tractable – that is, the assumptions were applied to some pretty well established laws. It naively seems to me that in economics, assumptions are the a priori bedrock (Dept. of Redundancy Dept. at your cervix) of the discipline. We are talking about human beings and power, after all. I am more than willing to be talked out of this.

  17. 17.

    MattF

    September 12, 2018 at 12:18 pm

    @VOR: I’m surprised to hear of insurance that covers implants. Does that actually save you any money?

  18. 18.

    Gin & Tonic

    September 12, 2018 at 12:28 pm

    @MattF: My insurance covers, I think, half the cost of implants.

  19. 19.

    David Anderson

    September 12, 2018 at 12:52 pm

    @Brachiator: Exactly, the bundle price is average cost of the initial treatment + a share of the complications costs

  20. 20.

    Victor Matheson

    September 12, 2018 at 1:08 pm

    @Haroldo: Well, if you are an honest scientist you build a model with a bunch of assumptions, collect and analyze a bunch of data, and then see if results match the assumptions. If the predictions match reality, then you might be able to put the model to use in the real world despite the assumptions. For example, the basic principles of economics 101 supply and demand model has a huge amount of what look like pretty heroic assumptions. But when you observe actual behavior, the model does a pretty good job of matching reality.

    Sometimes economics is like a ball bearing falling through the atmosphere for a short distance. You can make the assumption of no air resistance, and reality pretty much matches the simplified model. Sometimes economics is like a feather falling through the atmosphere and you can’t get anything like a real answer from a model that assumes no air resistance.

  21. 21.

    origuy

    September 12, 2018 at 3:03 pm

    My insurance covered half the cost of my implant, I think. I did have to stretch it out over two years because I hit the annual cap for dental coverage. It takes several months for the implant to be firmly attached to the bone before they can put on the final false tooth. I waited a couple of months longer for January, so that the cost for the tooth would be in the new year’s coverage. The implant itself was done by the oral surgeon, while the tooth was fitted through my regular dentist.

  22. 22.

    Capri

    September 12, 2018 at 3:32 pm

    I experienced the negative side of bundling. I was seeing a nurse midwife when I was pregnant with my third child.The idea was that they’d attend my hospital birth, with M.D. back-up in case things went sideways. I went to her office about 6 times for regular pre-natal check-ups. Then my son decided to come out in a hurry, the total labor time from first contraction to crying baby was 1 hr 25 minutes, and we never made it to the hospital. I was billed for standard prenatal, labor and delivery, and post-natal care. When I called to complain I was informed that I was paying for the “package” and that it wasn’t the midwife’s fault I didn’t make it to the hospital. I didn’t put up too much of a stink because insurance covered the whole thing.
    So bundling is great if you need more than the standard treatment, but not so hot if you need less.

  23. 23.

    John

    September 12, 2018 at 3:32 pm

    Of course, this also means that all of those patients who do not require follow-up care are significantly overpaying for their root canals, right?

    Personally I prefer the bundled care model, like what you experienced, just because then I don’t have to be afraid to go in for follow-up. But I’m pretty sure that it results in higher costs for the majority of patients without complications.

  24. 24.

    Mnemosyne

    September 12, 2018 at 4:10 pm

    My first root canal was done by my regular dentist, but it failed because it turns out that I have oddly-shaped roots that require an endodontist. My regular dentist gave me a credit for what I’d paid for him to do the failed root canal, which is why he’s still my dentist to this day.

    Oh, and once my endodontist opened his own practice, I discovered that my dental insurance only made me pay a $250 copay for a root canal, including follow-up. That was a nice surprise.

  25. 25.

    Duane

    September 12, 2018 at 4:38 pm

    @David Anderson: Might have been nice to let you know about the all- inclusive fee up front. I’m wondering why they didn’t, and none of my answera reflect well on the dentist.

  26. 26.

    patrick II

    September 12, 2018 at 4:44 pm

    I am so impressed with myself. I figured that one out before you did. That’s the very first time its happened. I’m putting it in my diary.

  27. 27.

    Procopius

    September 12, 2018 at 8:16 pm

    @Victor Matheson: Glad to see an economist recognizing that markets need not be perfect. I often wonder if the economists who were the biggest salesmen of that belief (Friedman, Hayek, Mises) really believed it themselves. At least in the medical care field a few minutes thought and a minimal abount of data should be enough to explode the belief.

  28. 28.

    David Anderson

    September 12, 2018 at 9:07 pm

    @Duane: they might have. I was in significant pain that morning.

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