Help with negotiating medical bills

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FlyingMoose
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Help with negotiating medical bills

Post by FlyingMoose »

I suppose that like many here I have a high-deductible health plan (HDHP) and an HSA. The company I have seems to have negotiated lousy rates for medical treatment.

In the past (before I had medical insurance), I didn't even know that it was possible to negotiate for medical services, and vastly overpaid for medical treatment.

When I go to the doctor and get billed for it (because it's below the deductible), both the doctor's office and the insurance company say that I can't negotiate the price because it's already been contracted with the insurance company.

In the past, I've had luck with telling the doctor's office that I'll file an insurance fraud complaint if they don't lower the bill, and it worked, but I don't know if I'd feel comfortable going back to the doctor after going through a huge fight with the billing dept. (which that was).

If I try to pre-negotiate a price, they always say they need to bill the insurance company first.

I'm considering telling them that if they don't lower the price, I'll pay the bill off $1 per month (so they can't send it to collections).

I'm tired of getting ripped off by these b***tards...

Note that in this instance the doctors were absolutely no help to me, so I feel no moral issues about using "hard" negotiating tactics.

Does anyone else have any suggestions to play hard-ball with doctors' billing offices who won't negotiate?
Sidney
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Re: Help with negotiating medical bills

Post by Sidney »

Their contract with the insurers may prevent them from agreeing to a lower price.
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BruDude
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Re: Help with negotiating medical bills

Post by BruDude »

Sidney wrote:Their contract with the insurers may prevent them from agreeing to a lower price.
x2, you are barking up the wrong tree.
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cheese_breath
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Re: Help with negotiating medical bills

Post by cheese_breath »

Sidney wrote:Their contract with the insurers may prevent them from agreeing to a lower price.
+1

You can probably negotiate with them if you don't have insurance, but I think you're locked into the contract price if you're insured. If you think they're ripping you off why not investigate insurance with a lower deductable? I bet you'll find the increased premiums will cost you a lot more than you're paying the doctor.
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FlyingMoose
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Re: Help with negotiating medical bills

Post by FlyingMoose »

Sidney wrote:Their contract with the insurers may prevent them from agreeing to a lower price.
Of course they're going to say this, just another negotiating tactic.

That's why I'm saying that I want to play "hard ball." In other words, threaten to default or use a very long payment plan, or similar tactic to tempt them into accepting something rather than nothing.
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interplanetjanet
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Re: Help with negotiating medical bills

Post by interplanetjanet »

FlyingMoose wrote:
Sidney wrote:Their contract with the insurers may prevent them from agreeing to a lower price.
Of course they're going to say this, just another negotiating tactic.

That's why I'm saying that I want to play "hard ball." In other words, threaten to default or use a very long payment plan, or similar tactic to tempt them into accepting something rather than nothing.
I don't think you'll find much sympathy here for this approach. One of my close relatives worked in medical billing and this sort of agreement is commonplace. If you want to negotiate a lower cash price you may be able to do it without involving your insurance at all, but then your deductible won't be counted against by your payments - do you want that?

Why would paying them a dollar a month keep them from sending things to collections? If you pay a dollar a month on your mortgage, I don't believe it will stop you from being foreclosed upon. Hospitals and clinics are not required to extend the courtesy of credit to anyone.

-janet
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FlyingMoose
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Re: Help with negotiating medical bills

Post by FlyingMoose »

interplanetjanet wrote:I don't think you'll find much sympathy here for this approach. One of my close relatives worked in medical billing and this sort of agreement is commonplace. If you want to negotiate a lower cash price you may be able to do it without involving your insurance at all, but then your deductible won't be counted against by your payments - do you want that?

Why would paying them a dollar a month keep them from sending things to collections? If you pay a dollar a month on your mortgage, I don't believe it will stop you from being foreclosed upon. Hospitals and clinics are not required to extend the courtesy of credit to anyone.

-janet

I don't know if the dollar-a-month thing is true, it's just something I've heard, so that's why I'm asking.

I would be happy to accept the payment not being counted against the deductible in exchange for a reduction in the amount. I'll likely never reach even a lower deductible unless there's an actual emergency, and I can afford to pay the whole thing if required. How do you suggest I go about asking them to do this?

Thanks for your help.
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cheese_breath
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Re: Help with negotiating medical bills

Post by cheese_breath »

Go for it if you want, but I think you'll find the insurer's contract price is considerable lower than the doctor's original charge. So you will have to first bargain him down to the contract price before the real haggling even begins.
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mptfan
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Re: Help with negotiating medical bills

Post by mptfan »

Everything is negotiable.

Medical providers will charge an exhorbitant rate for a service, which everybody knows is a ridiculously high rate, and then they "reduce" the bill to a somewhat more reasonable "contract rate" based on the agreement with the insurance company. It's a ridiculous system. Can you imagine getting a bill from a plumber for $500 for doing plumbing work, and then he "reduces" the bill to $200 because you have pluming insurance?? Did it cost him less to do the same job because you have insurance? And what if you don't have plumbing insurance? Ridiculous.
Last edited by mptfan on Tue Feb 07, 2012 2:31 pm, edited 1 time in total.
Topic Author
FlyingMoose
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Re: Help with negotiating medical bills

Post by FlyingMoose »

cheese_breath wrote:Go for it if you want, but I think you'll find the insurer's contract price is considerable lower than the doctor's original charge. So you will have to first bargain him down to the contract price before the real haggling even begins.
One billed $195 and the insurance wants me to pay $170.89, or about a 12% discount. The other one billed $280 and the insurance wants me to pay $266.22, or about a 5% discount.
bungalow10
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Re: Help with negotiating medical bills

Post by bungalow10 »

FlyingMoose wrote:
cheese_breath wrote:Go for it if you want, but I think you'll find the insurer's contract price is considerable lower than the doctor's original charge. So you will have to first bargain him down to the contract price before the real haggling even begins.
One billed $195 and the insurance wants me to pay $170.89, or about a 12% discount. The other one billed $280 and the insurance wants me to pay $266.22, or about a 5% discount.

Your insurance doesn't want you to pay that, your doctor's office does. They provided the service. Your insurance kicks in after you have paid your deductible.

If you agree to not let the doctor's office bill your insurance (which means the services will NOT count towards your deductible), you can try to negotiate on your own. Good luck.

edit: and are you really trying to negotiate $200 charges? They will probably laugh at you. You get the good discounts when negotiating large services, like an anesthesiologist or surgeon's bill. I've heard of people without insurance negotiating on crowns, they they negotiated for cash up front. If the services are done and you didn't prepay, you are likely out of luck.
Last edited by bungalow10 on Tue Feb 07, 2012 2:44 pm, edited 1 time in total.
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interplanetjanet
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Re: Help with negotiating medical bills

Post by interplanetjanet »

mptfan wrote:Medical providers will charge an exhorbitant rate for a service, which everybody knows is a ridiculously high rate, and then they "reduce" the bill to a somewhat more reasonable "contract rate" based on the agreement with the insurance company. It's a ridiculous system. Can you imagine getting a bill from a plumber for $500 for doing plumbing work, and then he "reduces" the bill to $200 because you have pluming insurance?? Did it cost him less to do the same job because you have insurance? And what if you don't have plumbing insurance? Ridiculous.
Agreed on some level, but also compare and contrast the percentage of people who default on medical debt vs. a debt to a plumber. Healthcare providers are willing to accept lower rates in part because insurance is a more reliable source of payment than private parties are.

-janet
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interplanetjanet
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Re: Help with negotiating medical bills

Post by interplanetjanet »

FlyingMoose wrote:I don't know if the dollar-a-month thing is true, it's just something I've heard, so that's why I'm asking.
It's not, and that should be obvious. If someone owed you $10k, would them giving you a dollar each month keep you from pursuing them in court?

-janet
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Imperabo
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Re: Help with negotiating medical bills

Post by Imperabo »

interplanetjanet wrote:Healthcare providers are willing to accept lower rates in part because insurance is a more reliable source of payment than private parties are.
True, but I have another theory. My (PPO) health plan claims to pay 80% up to your deductible. I've heard from co-workers that the price a provider charges to an uninsured patient can be as low as 1/4 that of what is billed when you have insurance.

So, say the true (uninsured, up-front cash paying) cost of the service is $100. With insurance they might bill it at $400. So my 20% portion of $400 is $80. What does the insurance actually pay to the provider? I'll never know, but I bet you it's not $320.

So basically this system allows insurance companies to flat out lie to your face about what they cover. My portion was supposed to be 20%, but through creative accounting it became 80%.
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Re: Help with negotiating medical bills

Post by bungalow10 »

Imperabo wrote:
interplanetjanet wrote:Healthcare providers are willing to accept lower rates in part because insurance is a more reliable source of payment than private parties are.
True, but I have another theory. My (PPO) health plan claims to pay 80% up to your deductible. I've heard from co-workers that the price a provider charges to an uninsured patient can be as low as 1/4 that of what is billed when you have insurance.

So, say the true (uninsured, up-front cash paying) cost of the service is $100. With insurance they might bill it at $400. So my 20% portion of $400 is $80. What does the insurance actually pay to the provider? I'll never know, but I bet you it's not $320.

So basically this system allows insurance companies to flat out lie to your face about what they cover. My portion was supposed to be 20%, but through creative accounting it became 80%.
Do you read your EOBs? They are usually very clear in how much was paid to the provider. Your doctor's office will also provide the check amounts and check numbers received from your provider.
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njuser
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Re: Help with negotiating medical bills

Post by njuser »

You chose the high deductible plan on your own, and now you do not want to pay your portion of the deductible. I have no sympathy.

Next time pay your insurance company a higher premium so they will cover more of your out of pocket.
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Re: Help with negotiating medical bills

Post by mptfan »

njuser wrote:You chose the high deductible plan on your own, and now you do not want to pay your portion of the deductible. I have no sympathy.
You are missing the point...he is complaining that the doctor is charging an artificially high rate. Doctors should not be allowed to bill whatever they want, no matter how unreasonable it is, and then criticize the person for not paying the artificially high bill, but yet it happens everyday. The medical billing system is unfair and rigged.

Imagine that you paid for an extended warranty for your car, and it had a high deductible for covered repairs, let's say $500, and you took your car to the mechanic for a covered repair, and he gave you a bill for $400 for a service that should cost $200. You would have a right to complain that the mechanic over-charged you, and it would be unfair of someone to say "You chose the high deductible plan, so I have no sympathy for you." If someone charges excessively high rates, that is unfair, regardless of your insurance coverage.
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Imperabo
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Re: Help with negotiating medical bills

Post by Imperabo »

bungalow10 wrote:
Do you read your EOBs? They are usually very clear . . .
Wait, you lost me.
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Re: Help with negotiating medical bills

Post by bungalow10 »

mptfan wrote:
njuser wrote:You chose the high deductible plan on your own, and now you do not want to pay your portion of the deductible. I have no sympathy.
You are missing the point...he is complaining that the doctor is charging an artificially high rate. Doctors should not be allowed to bill whatever they want, no matter how unreasonable it is, and then criticize the person for not paying the artificially high bill, but yet it happens everyday. The medical billing system is unfair and rigged.

Imagine that you paid for an extended warranty for your car, and it had a high deductible for covered repairs, let's say $500, and you took your car to the mechanic for a covered repair, and he gave you a bill for $400 for a service that should cost $200. You would have a right to complain that the mechanic over-charged you, and it would be unfair of someone to say "You chose the high deductible plan, so I have no sympathy for you." If someone charges excessively high rates, that is unfair, regardless of your insurance coverage.
I don't know how your insurance works, but mine (and the OPs) has a pre-negotiated discounted rate. So if the provider bills $10,000, but the insurance pre-negotiated rate is $72, then I pay the difference between the insurance payment and the negotiated rate - which would not exceed $72.
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Re: Help with negotiating medical bills

Post by njuser »

bungalow10 wrote:
mptfan wrote:
njuser wrote:You chose the high deductible plan on your own, and now you do not want to pay your portion of the deductible. I have no sympathy.
You are missing the point...he is complaining that the doctor is charging an artificially high rate. Doctors should not be allowed to bill whatever they want, no matter how unreasonable it is, and then criticize the person for not paying the artificially high bill, but yet it happens everyday. The medical billing system is unfair and rigged.

Imagine that you paid for an extended warranty for your car, and it had a high deductible for covered repairs, let's say $500, and you took your car to the mechanic for a covered repair, and he gave you a bill for $400 for a service that should cost $200. You would have a right to complain that the mechanic over-charged you, and it would be unfair of someone to say "You chose the high deductible plan, so I have no sympathy for you." If someone charges excessively high rates, that is unfair, regardless of your insurance coverage.
I don't know how your insurance works, but mine (and the OPs) has a pre-negotiated discounted rate. So if the provider bills $10,000, but the insurance pre-negotiated rate is $72, then I pay the difference between the insurance payment and the negotiated rate - which would not exceed $72.
Correct. The only time you would have to pay their 'going rate' is if you received a service that was not covered by your insurance plan. Otherwise, you pay the negotiated rate, which goes towards your deductible. And from what OP said above, they are requesting him to pay their negotiated rate. And it's only a couple hundred dollars. Mechanics charge over $100 an hour for labor to work on my car.

A high deductible plan is geared towards those who want to insure against a medical catastophe at a decent price. It's not meant to get you free, or even really cheap, healthcare.
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Re: Help with negotiating medical bills

Post by ann_l »

mptfan wrote:
njuser wrote:You chose the high deductible plan on your own, and now you do not want to pay your portion of the deductible. I have no sympathy.
You are missing the point...he is complaining that the doctor is charging an artificially high rate. Doctors should not be allowed to bill whatever they want, no matter how unreasonable it is, and then criticize the person for not paying the artificially high bill, but yet it happens everyday. The medical billing system is unfair and rigged.

I also have no sympathy. Hospitals and doctors are required by law to provide care for free to everyone with an emergency who walks in their door, which is unfair and very costly to them. Tons of people default on medical bills because they can't legitimately pay for a serious problem that happened. So everyone else has to pay more. Usually that falls to the insurance companies (and ultimately, the insureds, of course).

The OP chose a high-deductible insurance plan-that was the OP's mistake. Well, that and living in a country that with many citizens seemingly violently opposed to national health care.
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Re: Help with negotiating medical bills

Post by richard »

ann_l wrote:Hospitals and doctors are required by law to provide care for free to everyone with an emergency who walks in their door, which is unfair and very costly to them. Tons of people default on medical bills because they can't legitimately pay for a serious problem that happened. So everyone else has to pay more. Usually that falls to the insurance companies (and ultimately, the insureds, of course).

The OP chose a high-deductible insurance plan-that was the OP's mistake. Well, that and living in a country that with many citizens seemingly violently opposed to national health care.
The Emergency Treatment Act only requires participating hospitals (generally those taking money from Medicare) to provide emergency care. Given that emergency care is treating a condition that if untreated would result in serious impairment of bodily functions (or the like) "walks in the door" may not be the best description. Seems less unfair than letting people die or placing their health in serious jeopardy. What law requires doctors to provide free care?

Otherwise, agreed, although doctors really should be required to disclose fees (and what's not covered by insurance) in advance.
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Re: Help with negotiating medical bills

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FlyingMoose wrote:One billed $195 and the insurance wants me to pay $170.89, or about a 12% discount. The other one billed $280 and the insurance wants me to pay $266.22, or about a 5% discount.
Wow. I feel your pain. :roll:
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Re: Help with negotiating medical bills

Post by cheese_breath »

FlyingMoose wrote:
cheese_breath wrote:Go for it if you want, but I think you'll find the insurer's contract price is considerable lower than the doctor's original charge. So you will have to first bargain him down to the contract price before the real haggling even begins.
One billed $195 and the insurance wants me to pay $170.89, or about a 12% discount. The other one billed $280 and the insurance wants me to pay $266.22, or about a 5% discount.
Well color my face red. :oops: I would have expected larger discounts than that.
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Re: Help with negotiating medical bills

Post by nisiprius »

Well, all I can say is that the original poster's story is exactly what I figured would be the problem with HSAs: what motivation does the insurer have for negotiating as good a price for you as it would have negotiated for itself?
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CordMcNally
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Re: Help with negotiating medical bills

Post by CordMcNally »

It looks like the visit was a non-emergency outpatient visit. The OP should have called around for more information and made their decision accordingly...or invested the time and money to obtain the level of medical knowledge required to manage their condition.
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Re: Help with negotiating medical bills

Post by Ted Kan »

FlyingMoose wrote:
cheese_breath wrote:Go for it if you want, but I think you'll find the insurer's contract price is considerable lower than the doctor's original charge. So you will have to first bargain him down to the contract price before the real haggling even begins.
One billed $195 and the insurance wants me to pay $170.89, or about a 12% discount. The other one billed $280 and the insurance wants me to pay $266.22, or about a 5% discount.
Is it really worth the aggrevation, both for you and the phjysician, in trying to reduce these bills? Besides, it seems to me that the time to negotiate charges is before the service is provided, assuming it's not an emergency. When I was in practice as a family physician I always reduced charges for people I knew would have trouble paying the costs and there are easy ways to do so even if the pt had a negotiated contract thru an insurer but only before the charge is billed! I would never lower the costs for someone who could afford them. When asked to do so I would tell them they'd be better off finding another physician.
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Re: Help with negotiating medical bills

Post by cheese_breath »

interplanetjanet wrote:Healthcare providers are willing to accept lower rates in part because insurance is a more reliable source of payment than private parties are.
And if we're talking HMOs or PPOs they'll get booted out of the group if they don't.
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mptfan
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Re: Help with negotiating medical bills

Post by mptfan »

interplanetjanet wrote:Healthcare providers are willing to accept lower rates in part because insurance is a more reliable source of payment than private parties are.
If you have not met your annual deductible, then you (not the insurance company) are obligated to pay the contract rate to the medical provider, and the medical provider takes the risk that you (not the insurance company) will not pay the bill. And yet the insured still gets the benefit of the contract rate. So the justification that the insurance company is a more reliable payer just doesn't apply to those very common situations where the insured has to pay the contract rate out of his or her own pocket.

Health insurance coverage is becoming less and less generous every year, with deductibles that are getting larger and larger, so this is a common situation. It's amazing to me how people justify the inherently unfair medical billing system that favors medical providers and insurance companies, but they would cry foul if the same system were implemented for other services.
Last edited by mptfan on Tue Feb 07, 2012 5:32 pm, edited 2 times in total.
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Re: Help with negotiating medical bills

Post by BruDude »

nisiprius wrote:Well, all I can say is that the original poster's story is exactly what I figured would be the problem with HSAs: what motivation does the insurer have for negotiating as good a price for you as it would have negotiated for itself?
The same logic would apply to any policy that does not have fixed co-payments for every single service, which is most of them outside the cadillac-coverage Megacorp world. Most "traditional" policies on the individual market only have co-payments for office visits and prescription drugs, everything else applies to deductible just like an HSA plan.

Transparency of pricing is the issue here since it would be difficult for OP to call other doctor's offices and find out what the negotiate rates are elsewhere. Trying to get that information is like pulling teeth. Even within the same network, the negotiated rates can vary substantially between providers.
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Re: Help with negotiating medical bills

Post by Muchtolearn »

I am sorry for saying this but the OP bothers me. First, the insurance company negotiates a reduced rate. Since you are in a high deductible plan, you pay that. They won't take less nor should they. I do not know what you do for a living, but do you negoitate down your pay? Do you negotiate down the price of movie tickets or meals in a restaurant. I had plenty of people like you. If they were poor, no problem. If they were greedy like you, you were told to find another doctor.
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Re: Help with negotiating medical bills

Post by expat »

>> If I try to pre-negotiate a price, they always say they need to bill the insurance company first.

Can you say you do not have insurance, negotiate a cash deal, and then submit a claim to your insurance later?
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Re: Help with negotiating medical bills

Post by RabbMD »

The Emergency Treatment Act only requires participating hospitals (generally those taking money from Medicare) to provide emergency care. Given that emergency care is treating a condition that if untreated would result in serious impairment of bodily functions (or the like) "walks in the door" may not be the best description. Seems less unfair than letting people die or placing their health in serious jeopardy. What law requires doctors to provide free care?

Otherwise, agreed, although doctors really should be required to disclose fees (and what's not covered by insurance) in advance.
Pt fractures their hip, or has appendicitis. Pt goes to the hospital I work. Hospital like I bet every single one in the country takes medicare and is required to treat pt by EMTALA law. I am the anesthesiologist on call at the hospital. The pt has no insurance. I have to provide anesthesia for the pt. I work, and then I do not get paid. Seems like that meets the criteria suggested. Anesthesia billing is honestly even more screwed up that most specialties. It is because it is a case of total lack or total presence of leverage generally. Medicare/medicaid pays literally 33 cents of what our biggest insurance companies pay for the exact same service. This is because we have to take medicare/medicaid in practice to work in the hospital, and thus they ratchet payment WAY down because we can not refuse it. Contrast that with private insurance companies, where we do not have to take them unless they are large, and as game theory would naturally state we charge them 4-5 times what medicare pays. Such a mess, and all because in each case the party that has price power utilizes it to the extreme.
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Re: Help with negotiating medical bills

Post by White Coat Investor »

If you don't like the rates your insurance company has negotiated, try a concierge practice that is all cash. Or buy a different insurance policy. I don't see any way to know the company is lousy at negotiating rates in advance though, so I do sympathize somewhat.

By the way, EMTALA requires me to provide care without doing a wallet biopsy first, not to provide free care. You darn well better believe I'm going to send you a bill, and if you don't pay it, turn it into collections. Are there plenty of deadbeats who don't care about their credit score? Sure. But that's very different from saying doctors and hospitals are required to provide free care. It isn't free. And I provide approximately $150K of it each year according to ACEP.
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floatingdoc
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Re: Help with negotiating medical bills

Post by floatingdoc »

people like the op are promptly wondering why they are receiving a certified letter from my practice with a notation that I will refill their meds for 30 days or the small claims court date, whichever comes first! Man people like you fire me up. How about we go to your employer moose and negotiate your paycheck next week. Your a piece of work
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Re: Help with negotiating medical bills

Post by grabiner »

nisiprius wrote:Well, all I can say is that the original poster's story is exactly what I figured would be the problem with HSAs: what motivation does the insurer have for negotiating as good a price for you as it would have negotiated for itself?
It's the same negotiated price, arranged under the contract between the doctor and the insurer. The insurance allowance doesn't depend on what type of insurance you have. I have seen this effect because I switched from a conventional plan to an HDHP with the same company several years ago.

Under the conventional plan, the doctor tried to bill $200, was allowed to bill $80, and I had a $20 co-pay and the insurance paid $60. Under the HDHP, the doctor tried to bill $200, was allowed to bill $80, and I paid the full $80 (not having met my deductible). If I had met my deductible under the HDHP, the doctor would bill $80 and I would pay $4 (5% co-insurance for in-network doctors).
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Re: Help with negotiating medical bills

Post by tibbitts »

Normally, except in an emergency, you'd always ask for the amount, net of insurance, for the service up front. That would be the time to determine whether you're comfortable with the charges or not, not after you've received the service. Admittedly I've had occasional misunderstandings with unexpected charges, such as separate charges for nurse for outpatient procedures that wasn't included in the quote. And certainly complications can arise in some cases. But for the most part, the amounts can be known ahead of time. If you didn't make any effort to learn what the charges would be before receiving services, it's not fair to try to negotiate after.

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Re: Help with negotiating medical bills

Post by mptfan »

tibbitts wrote:Normally, except in an emergency, you'd always ask for the amount, net of insurance, for the service up front. That would be the time to determine whether you're comfortable with the charges or not, not after you've received the service. Admittedly I've had occasional misunderstandings with unexpected charges, such as separate charges for nurse for outpatient procedures that wasn't included in the quote. And certainly complications can arise in some cases. But for the most part, the amounts can be known ahead of time. If you didn't make any effort to learn what the charges would be before receiving services, it's not fair to try to negotiate after.
Really? So if I went to a doctor for a routine office visit, and he charged me $1,000, I would have to pay it without any negotiation if I didn't ask about the fee in advance? Wow.
CordMcNally
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Re: Help with negotiating medical bills

Post by CordMcNally »

mptfan wrote:
tibbitts wrote:Normally, except in an emergency, you'd always ask for the amount, net of insurance, for the service up front. That would be the time to determine whether you're comfortable with the charges or not, not after you've received the service. Admittedly I've had occasional misunderstandings with unexpected charges, such as separate charges for nurse for outpatient procedures that wasn't included in the quote. And certainly complications can arise in some cases. But for the most part, the amounts can be known ahead of time. If you didn't make any effort to learn what the charges would be before receiving services, it's not fair to try to negotiate after.
Really? So if I went to a doctor for a routine office visit, and he charged me $1,000, I would have to pay it without any negotiation if I didn't ask about the fee in advance? Wow.
Do you ever buy gas without seeing how much it cost? Do you order food at a restaurant without checking out the price? Why would you go to a doctor for an elective visit without inquiring about the charges? They don't post the prices as visible as gas stations and restaurants but if you ordered the $1000 burger, you'd still have to pay.
mptfan
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Re: Help with negotiating medical bills

Post by mptfan »

CordMcNally wrote:
mptfan wrote:
tibbitts wrote:Normally, except in an emergency, you'd always ask for the amount, net of insurance, for the service up front. That would be the time to determine whether you're comfortable with the charges or not, not after you've received the service. Admittedly I've had occasional misunderstandings with unexpected charges, such as separate charges for nurse for outpatient procedures that wasn't included in the quote. And certainly complications can arise in some cases. But for the most part, the amounts can be known ahead of time. If you didn't make any effort to learn what the charges would be before receiving services, it's not fair to try to negotiate after.
Really? So if I went to a doctor for a routine office visit, and he charged me $1,000, I would have to pay it without any negotiation if I didn't ask about the fee in advance? Wow.
Do you ever buy gas without seeing how much it cost? Do you order food at a restaurant without checking out the price? Why would you go to a doctor for an elective visit without inquiring about the charges? They don't post the prices as visible as gas stations and restaurants but if you ordered the $1000 burger, you'd still have to pay.
In your analogy, I did not order a $1,000 hamburger, I ordered a $50 hamburger, but I was charged $1,000.

All I can say is wow. I can't believe how many people think that if you don't ask about all charges in advance, then a doctor can charge whatever they want, no matter how unreasonable. If that is really your position, why stop at $1,000?.... doctors should be allowed to charge $10,000 or $100,000 for routine procedures anytime a patient makes the foolish mistake of not asking about the charges in advance.
CordMcNally
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Re: Help with negotiating medical bills

Post by CordMcNally »

mptfan wrote: In your analogy, I did not order a $1,000 hamburger, I ordered a $50 hamburger, but I was charged $1,000.

All I can say is wow. I can't believe how many people think that if you don't ask about all charges in advance, then a doctor can charge whatever they want, no matter how unreasonable. If that is really your position, why stop at $1,000?.... doctors should be allowed to charge $10,000 or $100,000 for routine procedures anytime a patient makes the foolish mistake of not asking about the charges in advance.
Judging by your post, it sounds like you have all of the facts of what was done during these visits to ascertain that the services provided weren't worth the prices charged...or do you not?

Healthcare is a service, not a right. It is provided with the agreement that the provider will provide service with a charge. Nobody is going to argue that the prices in this industry aren't as transparent as they should be but that shouldn't stop a patient from doing their own research instead of blindly going into an appointment with no idea. Just like any other good or service, you have to pay for the time and investment needed to be able to provide that good or service. Medical care isn't cheap and neither is a lot of things not as important as being in good health.
Last edited by CordMcNally on Tue Feb 07, 2012 10:27 pm, edited 2 times in total.
mptfan
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Re: Help with negotiating medical bills

Post by mptfan »

When you go to a gas station, it is not necessary to ask the price of gas, because it is clearly posted. When you go to a restaurant, it is not necessary to ask the price of a hamburger, because the price is listed on the menu. (The cost of gas or hamburgers are the same, whether you have insurance or not, by the way) I have been in many medical offices, but I don't EVER recall seeing a list of prices for services. It is a basic tenet of contract law, and of fairness, that when someone provides a service without the price being established in advance, then there is an implied contract at a reasonable price. The service provider does not have free reign to make up any price after the fact, no matter how unreasonable, just because the person receiving the service did not ask the price in advance. I consider this to be a matter of basic fairness. If you disagree, then we will have to disagree about what we consider to be fair.
mptfan
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Re: Help with negotiating medical bills

Post by mptfan »

CordMcNally wrote:Just like any other good or service, you have to pay for the time and investment needed to be able to provide that good or service. Medical care isn't cheap and neither is a lot of things not as important as being in good health.
You are setting up a straw man argument.... no one has ever suggested that you should not pay for goods or services. :roll:
birdy
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Re: Help with negotiating medical bills

Post by birdy »

I work in an outpatient imaging clinic. We call our scheduled patients the day before their appointment and tell them what their portion (out of pocket) will be. If they need it, they can pay 1/3 down and work out a payment plan with the billing department. If a person is added onto the schedule the same day they are told we will file their insurance first and then send them a bill for their out of pocket portion. If someone comes in through our ER, they are treated even though they have no insurance. I have seen plenty of procedures done we know will never get paid for but it is still in the best interest of the patient to treat them (of course it's better if we get paid!!!). We have patients all the time cancel their appointments when they find out what their out of pocket will be--I guess they think the insurance was going to pick up the whole cost. It is surprising to me that alot of people don't even know how their insurance coverage works. As to people that want to pay cash for their visit they are given a discount but I am not sure what % of one.

Because there are so many underinsured or out of work people now, my own job has been cut to parttime due to a decrease in patient load. Everything is connected--because you can't or won't pay I don't get paid. I realize how expensive healthcare is (I have to pay for it myself as a "parttime" employee now). There are consequences all the way down the "chain" when people can't afford to pay their bills.

From a Health Care Workers perspective: birdy
CordMcNally
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Re: Help with negotiating medical bills

Post by CordMcNally »

It's as simple as taking some initiative and asking about prices beforehand. Most people don't. Again, how do we know the prices the OP was charged were not reasonable? None of us know exactly what services he was provided.

The idea of reasonable price is lost in healthcare because it involves things no other businesses involve...life and death. Some people feel like a $200 doctor visit is outrageous yet will gladly pay $200 for a nice dinner out. Which is truly more valuable to a person? Some people have misguided priorities.

It appears we'll have to agree to disagree.
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cheese_breath
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Re: Help with negotiating medical bills

Post by cheese_breath »

mptfan wrote:It is a basic tenet of contract law, and of fairness, that when someone provides a service without the price being established in advance, then there is an implied contract at a reasonable price. The service provider does not have free reign to make up any price after the fact, no matter how unreasonable, just because the person receiving the service did not ask the price in advance. I consider this to be a matter of basic fairness. If you disagree, then we will have to disagree about what we consider to be fair.
OP didn't tell us what services were performed, only that he thought they were priced too high. Maybe the charges were reasonable. Who knows? It depends on what the dcctor did, and we don't have that information.
The surest way to know the future is when it becomes the past.
mptfan
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Re: Help with negotiating medical bills

Post by mptfan »

cheese_breath, I agree. I was not talking about the OP, I was responding to this statement from tibbitts....
tibbitts wrote:If you didn't make any effort to learn what the charges would be before receiving services, it's not fair to try to negotiate after.

Paul
mptfan
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Re: Help with negotiating medical bills

Post by mptfan »

CordMcNally wrote: It appears we'll have to agree to disagree.
Indeed. If you think that a doctor can charge and bill patients whatever price he wants for any service, assuming the patient didn't ask about the price in advance, then we do disagree.
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interplanetjanet
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Re: Help with negotiating medical bills

Post by interplanetjanet »

mptfan wrote:When you go to a gas station, it is not necessary to ask the price of gas, because it is clearly posted. When you go to a restaurant, it is not necessary to ask the price of a hamburger, because the price is listed on the menu. (The cost of gas or hamburgers are the same, whether you have insurance or not, by the way) I have been in many medical offices, but I don't EVER recall seeing a list of prices for services. It is a basic tenet of contract law, and of fairness, that when someone provides a service without the price being established in advance, then there is an implied contract at a reasonable price. The service provider does not have free reign to make up any price after the fact, no matter how unreasonable, just because the person receiving the service did not ask the price in advance. I consider this to be a matter of basic fairness. If you disagree, then we will have to disagree about what we consider to be fair.
Interestingly, from what I've seen of medical offices elsewhere in the world, posting fees for routine services is commonplace (probably because insurance was less common there). The two situations are not equivalent as medical care in the USA has the potential to be far more complex (and expensive), but it is interesting.

I wonder if this has evolved as health insurance has become more prevalent. 50 years ago, was it more common for doctors' offices to post their fees up front?

-janet
tibbitts
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Re: Help with negotiating medical bills

Post by tibbitts »

mptfan wrote:When you go to a gas station, it is not necessary to ask the price of gas, because it is clearly posted. When you go to a restaurant, it is not necessary to ask the price of a hamburger, because the price is listed on the menu. (The cost of gas or hamburgers are the same, whether you have insurance or not, by the way) I have been in many medical offices, but I don't EVER recall seeing a list of prices for services. It is a basic tenet of contract law, and of fairness, that when someone provides a service without the price being established in advance, then there is an implied contract at a reasonable price. The service provider does not have free reign to make up any price after the fact, no matter how unreasonable, just because the person receiving the service did not ask the price in advance. I consider this to be a matter of basic fairness. If you disagree, then we will have to disagree about what we consider to be fair.
Maybe not McDonalds, but many restaurants have various discounts for customers based on promotions, and volume discounts, and you don't always order exactly what's on the menu, so yes, it's pretty common to have to ask ahead of time what a meal will cost. I've sometimes clarified before sitting down or eating whether a coupon is applicable, or what a certain combination of items that might not be on the menu would cost.

In a doctor's office, when you go for just a standard office visit, you have your co-pay or insurance-negotiated-rate, or cash price. They're all essentially as predictable as a McDonalds meal,but there are so many of them that it's not practical (or contracturally allowed in some cases, perhaps) to post thousands of customer/rate combinations. And yes, when you have more complex services that the doctor may outsource, such as lab tests, you may have to ask whether the lab is in your network, and how much that will cost. It's just a function of the complexity of medical services vs. hamburgers.

Of course the price should still be "fair", even if the customer doesn't ask up front, but certainly charges to various customers can vary by perhaps a factor of 2x at least, for example, without being unfair. That's common in most businesses. But in this example I don't see where anybody is being charged an outrageous amount, just not an amount the OP feels is as good a deal as he deserves.

Incidentally, for many medical procedures you have to pay up-front at least half of the final bill, before you get the service, so it's essentially impossible to not know the final cost. Maybe the OP was complaining that this wasn't the practice for his doctor. There is no harm in asking to pay up front if that's not the standard policy, although obviously complications can occur in some procedures that would lead to unanticipated charges later - again, due to the complexity of the service.

Paul
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