Do you think health-care costs are staggeringly steep these days? Few would disagree—even the health-care providers themselves understand that their bills can be ruinous, and in certain situations, some are willing to negotiate down from their usual rates. But patients need to know when and how to ask.
Bottom Line Personal’s July 15, 2021 issue offered a strategy for what to do when a big medical bill arrives in your mailbox (“Massive Medical Bills? 6-Step Plan to Help You Pay Much Less,” available at BottomLineInc.com). But with non-emergency medical procedures, it also is possible to cut bills down to size before the medical procedure takes place. Acting in advance reduces the odds of unwelcome billing surprises later…gives you the option of shopping around to find a better deal…and opens the door to payment strategies that could benefit both you and the provider. This process can be time-consuming and frustrating, but it also could save you hundreds or even thousands of dollars.
Here are the best strategies to negotiate the cost of non-emergency health-care procedures in advance…
1. Find out if your insurance/Medicare will cover the procedure. If it will, negotiating with the provider is unlikely to save you any money—the amount you end up paying will be based on your plan’s co-pays, co-insurance and other out-of-pocket costs, not on how much the provider bills. Besides, your insurer/Medicare already will have negotiated a price for this type of procedure.
If you’re not sure whether your insurance/Medicare will cover the procedure: Call the coverage provider and ask. In addition, ask whether you need “prior authorization” for the procedure and, if so, what you need to do to get that authorization. Also confirm that the provider is “in network” for your insurance or Medicare Advantage plan. If you have original Medicare, the term “in network” doesn’t apply but it is worth contacting the provider’s billing office to confirm that it “accepts Medicare assignment.” Whatever your insurance/Medicare provider tells you about your coverage, ask to have this information sent to you in writing.
If a procedure isn’t covered by your insurance/Medicare—perhaps because it is elective—or if you don’t have insurance/Medicare, you’re going to end up paying out of pocket and then it is worth trying to negotiate with the provider using the steps on the next page.
If you haven’t met your deductible: Whether it’s worth negotiating is less clear cut if you have insurance and the procedure is covered, but you will have to pay much or all of the bill out of pocket because you haven’t yet met your plan’s deductible. It’s possible that you might be able to negotiate a lower cash price with the provider than the amount you would pay through your insurance. However, if you did this, your payment almost certainly wouldn’t be credited toward your deductible, which means that your total out-of-pocket medical expenses for the year could increase. Even if the amount was credited toward your deductible, it would be a lesser amount, so you still would have to make it up in the end in order to meet the deductible. And if you’re not using your insurance, chances are low that the cost would ever count toward your deductible.
Rule of thumb: It tends to be worth making a cash payment rather than using insurance and making progress toward your annual deductible only if it’s unlikely that you will meet your deductible for the year. Perhaps the end of the year is approaching fast and you are not close to meeting your deductible and you can obtain a significantly lower price by paying in cash rather than with insurance. It usually isn’t worth giving up progress toward a deductible for a small savings.
2. Obtain a price quote from the provider’s billing department, then ask about ways to lower that price. Specify that you’re asking about the “cash price” if you don’t have insurance/Medicare that will pay for the procedure. If you do have insurance but also have a large unmet deductible, provide your insurance policy details and ask to be quoted both the price if you use this policy and the cash price.
After you obtain the quote, ask the provider’s billing department if it will lower its cash price if you “make a lump-sum payment in full.” Some providers are happy to offer discounts of 10% to 30% to patients who pay their entire balance when treatment is received—upfront payment not only assures the provider that it won’t have to deal with the hassles of insurance companies, it also eliminates the risk that the bill will go unpaid, which is not uncommon with large medical bills.
Helpful: If a significant savings is offered in exchange for making a lump-sum payment in full but you don’t have sufficient cash to make that payment, it might be worth tapping an investment account…borrowing from a family member…or even applying for a credit card that has a 0% initial rate for new customers and using this to pay the bill. Speak with a financial advisor if you’re not certain. Caution: Use the credit card strategy only if you are positive that you will be able to pay off this balance before the end of the 0% interest rate introductory period. Otherwise, you will face steep credit card interest rates.
Also ask the provider’s billing department if it has a “financial aid program” for patients who cannot afford treatments and how you can apply. Such programs are most common with large health-care systems and hospitals, but there’s no harm in asking smaller providers, too.
3. Get quotes from other providers. If your current provider won’t negotiate, contact other providers in the area, explain the procedure you require and request their prices. Ask these providers about lump-sum payment discounts and financial-aid programs as well.
Patients often are loyal to their health-care providers, but it can be worth seeking treatment from a different provider if the savings are considerable and/or if the procedure is something that doesn’t involve a long-term provider/patient relationship. Example: If you need an X-ray or MRI, it really doesn’t matter if you go to the imaging center recommended by your doctor or a different one in your area that offers a lower price—your doctor/patient relationship is with the doctor who ordered the scan, not with the imaging center itself.
If you do obtain a lower quote from an alternate provider, call back your preferred provider’s billing department, tell them about the quote you received and ask your preferred provider if it can match the quote.
4. Get the quote in writing. Few if any medical providers would intentionally charge more than the amount they agreed to…but a medical provider’s billing office could easily overlook a negotiated price when it compiles a bill. Having an e-mail or letter that quotes the agreed-upon price will help resolve a dispute.
