One in three people has difficulty paying their medical bills, according to a report from the Kaiser Family Foundation. And it isn’t just those without insurance who are struggling. With the advent of high-deductible plans, some people are finding themselves on the hook for upwards of $10,000 in medical bills before their plan kicks in a cent.
Fortunately, like cars and the carrots at your local farmers market, the price of medical care is negotiable. It’s just that, in the past, only the insurance companies did the negotiating.
However, Steve Neeleman, a board-certified physician, says consumers shouldn’t be afraid to do their own negotiating. Neeleman, who’s also the founder and vice chairman of health savings account provider HealthEquity, spoke to me about how people can successfully drop the bottom line on their medical bills.
Step 1: Keep your bills low from the start
As with most things in life, the best offense may be a good defense. In this case, that means keeping your medical bills low upfront rather than negotiating after the fact.
“The biggest portion of the cost is usually the facility cost,” Neeleman notes.
You can bring that facility cost down by exploring options. Your doctor or surgeon likely has the ability to work in a variety of settings, so ask him or her whether there is a cheaper venue that can be used. For example, an outpatient surgical center may be less expensive than the local hospital.
If you do find a cheaper facility, make sure it’s in your insurance provider’s network. Going to an out-of-network facility could mean you pay significantly higher co-pays or your out-of-pocket cost may not apply toward your deductible.
For more ideas, check out “10 Ways to Fight High Medical Costs.”
Step 2: Wait before calling on an outstanding bill
No matter where you go, it may be inevitable that a big bill is coming after the procedure. In that case, resist the urge to immediately call and plead your case. Billers are unlikely to negotiate a payment right after the bill has been sent.
“We recommend you wait a few weeks but don’t let it go to collections,” Neeleman says.
Step 3: Call in the morning
When it is time to call, try earlier in the morning. By the afternoon, worker enthusiasm wanes, which may make them less likely to want to help you.
Plus, by the afternoon, there’s always a possibility the worker you get on the phone has been beaten down by a dozen angry callers before you. At that point, they may be feeling a bit angry and combative themselves and not inclined to negotiate.
Step 4: Put on your happy voice and ask for a supervisor
Sometimes we think we need to be firm to get our way, but that’s not always the case. Being firm on the phone can come across as grumpy, angry or terse. And all those adjectives are likely to put the person you’re talking to on the defensive.
When you call to negotiate your bill, be pleasant, even happy if you can muster it. Smiling while you talk will make your tone sound friendlier. Tell the person who answers that you need to speak with a supervisor. If they press for a reason why, say that you have a billing question that you were told needs to be addressed by a supervisor. If the press for the reason again, I personally would say, “I’d really rather talk with a supervisor about it.”That said, keep in mind that some smaller offices may only have one or two workers in the billing department, and the person who picks up the phone may also be the person with the power to negotiate bills.
Step 5: Ask for a discount if you pay cash now rather than in installments
Before you call, you should have a dollar amount in mind to offer. Make sure the money you’re offering is something you can access to pay your bill today.
Tell the supervisor you can’t pay the full bill, but you do have X dollars. If you paid that amount today, would they accept that as payment in full rather than having you pay in installments? If they accept, ask for written confirmation saying the amount you send will pay the bill in full.
Neeleman says some providers are willing to accept a lower guaranteed payment in cases where they think a bill may go to collections. In that case, they could end up with nothing. “Normal collection rates in the field of health care are 40-50 percent,” Neeleman says.
Step 6: Request procedures be verified and recoded as necessary
If that doesn’t work, at least ask the billing department to verify your procedures and recode them if necessary. Then the insurance company can be rebilled for payment.
Medical coding is complex, and sometimes several different codes can be used to designate the same service. I discovered that after my insurance company began covering autism-related services. I couldn’t understand why the company was denying claims for my daughter when they clearly fell under what was covered.
In the end, a coding issue was to blame. Our provider’s billing department was using a more general code that, while accurately reflecting the services she was receiving, didn’t indicate that she was getting those services because of an autism spectrum disorder. Swapping in a new code was all that was needed for the insurance company to pay all the outstanding claims.
Step 7: Take it to the doctor, if appropriate
If none of the other steps work, you could discuss the matter with your doctor.
“You don’t want to start with the physician,” says Neeleman, but he does suggest scheduling a follow-up to discuss the bill if needed. This tactic may be best reserved for larger bills and instances in which you have a long relationship with the doctor.
Before you go in, find the going rate for similar services in your area. You may able to find this information through a price comparison tool on your health insurance company’s website or through a third party site like Healthcare Bluebook. If you can show that your bill is higher than what other providers charge in your area, you may be more likely to get the price lowered.
Not all doctors have direct control over billing charges. Some physicians are employed by a physician group that dictates prices. However, your doctor may be able to help you navigate the billing department and put you in touch with the right person.
You wouldn’t dream of buying a car without trying to get a better deal, so why are you resigned to paying thousands of dollars in medical bills, no questions asked? Try negotiating your next big bill and see how much money you can keep in your pocket.
Have you successfully negotiated a medical bill? Share how you did it in the comments below or on our Facebook page.
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