For Help With Medical Bills, Cut a Deal With the Doctor

Patients can negotiate prices just as insurers do.

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Getting a diagnosis isn't the only nerve-racking aspect of a medical visit. The bill you're handed can be even scarier, especially when you lack health insurance or face an intimidating deductible or copay. But just as big employers and insurance companies negotiate prices down as a matter of course, individuals can bargain with doctors and hospitals, too, says Erin Moaratty, chief of external communications at the nonprofit Patient Advocate Foundation.

Ideally, the time to make your case for a discount is before you go in for a procedure. Call the medical facility and ask for the projected fees; if you have insurance, contact the company next to find out how much it will pay. Then talk over your situation with the billing department, requesting a break. You might win as much as 50 percent off full price if you offer to pay quickly by cash or check, says Cindy Holtzman, a medical billing advocate in Marietta, Ga., who's part of a growing industry of professionals dedicated to aiding patients with billing disputes. Providers accustomed to accepting less than they'd like from insurers often realize that getting payment without hassle or delay is preferable to waiting for the full amount or having to hire a collection agency.

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If you can't pay even a discounted amount promptly, you'll likely still be able to get a good deal if you promise regular payments of an agreed-upon size, Holtzman says. Patients with severe financial problems (especially those brought on by illness) may find their physician is compassionate enough to accept the insurer's portion as full payment. And uninsured low-income individuals who make too much to qualify for Medicaid may be eligible for free or reduced charity care.

The most effective way to get the billing department to trim its fees is to request, rather than demand, assistance. "People are always more likely to lend a hand when you acknowledge them as fellow human beings, rather than as bureaucrats," advises Michelle Katz, author of Healthcare for Less. Once you hammer out a payment plan, ask for your revised balance in writing.

You'll also want to scrutinize all bills for errors. Katz's husband was once billed $11,000 for a three-hour ER visit because the hospital had recorded him as having checked in the day before. The corrected total was thousands of dollars less. Holtzman recalls one hospital charging nearly $1,000 for alcohol swabs and cups for medications. Those items, at least, come with the room.

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