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Haggling For Health Care: Savvy Shoppers Barter To Lower Provider Fees

It’s no secret that health care costs continue to rise, but many people don’t realize they can do something about it. Consumers, be advised that you have more power than you think! You have the power to negotiate health care costs.

It’s true. Consumers can bargain with health care providers to lower their costs. Many providers, doctors and health care facilities will work with patients to find affordable solutions for out-of-pocket expenses not picked up by insurance carriers. There are certain steps that all patients should consider taking – both before receiving treatment and after receiving a bill – to help reduce their out-of-pocket expenses.

Timing is critical. Negotiate before services are rendered. Start negotiating more favorable payment options as soon as a need for medical care or a medical procedure arises. It’s easier to get physicians and hospitals to agree on reduced fees before, rather than after, a procedure.

Begin bargaining with the billing office. The quest for lower rates should begin at a provider’s billing office. Practitioners often have little or no direct communication with the billing function, so it is important to go to the source to get the best and most accurate information regarding acceptable rates, insurance carrier billing policies and available payment plans. Also, it helps to have a personal contact in the billing department to ensure responsiveness and, as much as possible, “humanize” the payment process.

Ask about alternative facilities and question the procedure. Having tests and other pre-operative procedures done in a different lab could cost less. Ask whether certain routine procedures are really necessary given one’s particular circumstances and health history.

Get the going rates for uninsured individuals. Find out what fee a practice charges individuals who have no health insurance. Frequently this rate is lower. You can opt to pay for the claim as if you did not have insurance but still submit a claim to the carrier even after paying the discounted uninsured rate.

Research out-of-network options. Even when paying through insurance, it is a good idea to research out-of-network options to determine if there is a better rate available. Out-of-network providers have more room to negotiate because they are not bound by the pre-set fees and rates in-network providers have negotiated with a carrier. And many plans still will reimburse a portion of the incurred out-of-network costs.

Consider paying cash. Ask if paying in cash could lower your fees. Many providers prefer cash payments as it accelerates payment and avoids credit card processing fees. Even after paying cash for a procedure, remember to submit the expenses to the insurance company for reimbursement.

Research other surgical facilities. Reduce surgery costs by asking whether it can be done in an ambulatory surgical center (ASC). According to the Surgery Center Network, the cost of a procedure at an ASC typically ranges from 45 to 60 percent less – and can be as much as 90 percent less – than the same procedure performed in a hospital.

Hire a pro. Services such as Medical Cost Advocate help consumers get better deals, both before and after receiving medical treatment. Prior to treatment, a negotiating service will attempt to find better health care pricing, which can be particularly useful when planning to see a specialist, going out-of-network or obtaining non-covered services. After receiving a bill, a negotiating service can validate billing accuracy and negotiate certain medical costs to make them more manageable.

These companies do charge a fee for their services  – as much as 30-40% of the dollars saved – so be sure the fee does not wipe out any potential savings.

Scrutinize the bills. Even if an individual does not use a service, it is always smart to scrutinize a medical bill for billing errors. Mistakes can be costly and happen frequently, like procedure codes entered incorrectly. Look for inconsistencies and duplicate charges. OneDigital recently assisted in a situation where ongoing therapy charges had been billed twice for multiple visits, resulting in thousands of dollars in erroneous charges.

Real Life Scenario, Real Savings!

We talked to a mother of two who was told her daughter needed an oral procedure not covered under her health plan. The savvy mom got to work before the procedure, researching options and negotiating with providers. As a result of this proactive approach:

  • The surgeon knocked $2,200 off the list price for a cash payment.
  • The use of an ASC for the surgical procedure, rather than a hospital, saved nearly $10,000.
  • Simply by shopping around and working with providers, the total cost of the procedure was lowered by thousands of dollars.

As illustrated above, though trending costs of health care continue to rise, savvy consumers can help rein in these costs by negotiating with providers before receiving services and carefully reviewing their bills afterwards. The more you take charge of your own health and health care costs, the better off you will be!