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What You Should Know

Negotiating Healthcare Costs

One of the most difficult things about having no - or bad - health insurance is never knowing how much any medical procedure will cost. Each insurance company (and sometimes each tier of each company) negotiates different rates for how much of the “cost” they will pay for vs. how much gets discounted vs. how much the patient gets left with paying out of pocket.

Right after getting out of school I was severely underinsured and cancelled some medical tests I was supposed to have out of fear of going into severe debt. I wasn’t able to get a straight answer out of anyone about what the procedures would cost. The doctor’s office told me to call my insurance company and the insurance company told me to the call the doctors office. So I called the whole thing off.

Fortunately, my situation was relatively minor and the tests were only precautionary. But many people are stuck with that same uncertainty when the medical care they are seeking is absolutely necessary to their continued health and quality of life.

One of the things I’ve learned since then, and since entering my profession, is that everything is negotiable—including the price of medical treatment. If your insurance company can negotiate a better price, so can you. If your insurance company refuses to pay or underpays for a procedure, talk to the doctor’s office. They would often rather get paid something than lose the business entirely. They definitely don’t want to have to chase you through collections forever.

When I was young I had to have my tonsils taken out. When my surgeon learned how little the insurance company was willing to pay towards the procedure, she offered to reduce the out of pocket amount my parents would have to pay to make the procedure affordable for us.

Many doctor’s offices - and especially hospitals - also have charitable foundations or other programs that can help you get treatment at a reduced rate or on a payment plan depending on need.

This is one area where it never hurts to ask for a discount. It is important to stand up for yourself. Armed with some knowledge and determination you can get a better a price on most healthcare—even if your insurance company doesn’t want to hold up their end of the bargain. One useful tool is the Healthcare Bluebook (https://www.healthcarebluebook.com/ui/consumerfront) which can tell you the average that insurance companies are paying for any given procedure (less than you will be asked to pay out of pocket if you are uninsured). This can give you some valuable insight and bargaining position.

Getting an echocardiogram or a tonsillectomy should not be subject to the same conditions as buying car. But as long as the industry is going to treat it that way, the patient/consumer needs to be forewarned and forearmed.