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How to haggle for the best medical cost
The cost of health care
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TEXT OF INTERVIEW
Bob Moon: A lot of the health-care debate moved behind closed doors on Capitol Hill this week. Public option in, public option out or, maybe, back in again. And will insurance companies lose the legal protections that currently allow them to get together to set prices? You may not know it, but there are things you the consumer can do in the meantime to set your own prices.
Mark Rukavina of the Access Project is here to tell us how that can work. Hi Mark.
Mark Rukavina: Hello Bob.
Moon: So I am used to haggling over a car or that old easy chair at the flea market, but you can really make your best offer to a doctor?
Rukavina: Many people are surprised to learn that medical bills are, in fact, negotiable. While all patients may be charged the same fee, not all are expected to pay the same fee.
Moon: What are some of the more common things that people might try to negotiate?
Rukavina: Hospitals; doctors; other providers, including ambulance companies; lab fees; for any bills that a patient has, they should approach the provider about charity care or a discount for those fees. Many providers offer what is called a "prompt pay" discount, which is payment at or near the time of service or once the bill is generated. And if people have the resources to take advantage of that, they should be encouraged to do so.
Moon: Now, how do you know what a fair price is for a particular procedure?
Rukavina: Well, what a fair price is is a very difficult question to answer. Good data on pricing and pricing and quality are difficult to find. However, as I said earlier, prices are negotiable. So people that need procedures and have bills that they're struggling to pay, should ask for a discount for those procedures.
Moon: Let's say you didn't set a price upfront. Is it possible to talk down the bill once you get it?
Rukavina: Absolutely, absolutely. People should first look at their bills and make sure that they're being billed for services that they did in fact receive. If they have questions about the bills they've received, they can ask for a detailed itemized bill from their providers. If there's anything on there that seems suspicious, they should pursue that first with the provider, possibly with their private insurer or their public insurance program that they may be covered by.
Moon: Now is this kind of haggling something that mostly people who don't have insurance do or do people who have insurance actually engage in this?
Rukavina: Well increasingly in this economy, people with insurance are engaging in these negotiations as well. Many insured people have a lot of upfront costs that they're expected to pay, very large deductibles or very large co-payments. And again, in talking with providers, often times you can negotiate down those fees.
Moon: Now you help people negotiate medical bills all the time. Is this just about the price or is it about more than that?
Rukavina: Well, it's primarily people are contacting us for help on the price, they have medical bills that they're struggling to pay. Many of them have exhausted their savings and still come up short in terms of paying back those bills in full. But it is in fact about empowering consumers around the kind of care they're receiving and the cost that they pay for that care.
Moon: Mark Rukavina is executive director of the Access Project, a non-profit that helps people negotiate their medical costs. Thanks very much for the valuable information.
Rukavina: Thanks.
In negotiating with a provider, is it relevant to bring up kickbacks that they give to referrers?
How do you bring up the subject of over treatment. I recall, when a relative was hospitalized, all kinds of Medical people walked in and out of the room. In these circumstances, you do not have the presence of mind to ask questions. But you really should. There was one particular infectious diseases doctor who came everyday and asked the same questions and got the same answers. On the fourth day, I kicked her out for wasting our time (and money). Lo and behold, each very pleasant 10 minute chat about other non medical things was rounded up and billed. When I checked with the nurse, they could not tell me who invited all these 'Specialists' in. Apparently, there is a 'Hospitalist' who is in charge of coordinating treatment but I never saw him despite asking specifically for a face to face.
Over treatment is common. You should not have to pay for it.
This is good. My experience is that it's hard to find out, but if you push, it's possible. I've had from 1/3 taken off a (ridiculous) emergency room bill to a bill totally canceled (one biopsy) because I'd gone to a faith-based clinic where the doctor didn't charge me (this is Exceptional, and I figure that I've probably used up my one exception card granted me for life, know what I mean).
Now, with insurance I would have submitted for the e-room visit and probably had to pay nothing out of pocket, just the cost of the monthly insurance....but, as we know, everything's out of whack. I'll pay a fair price but don't mess with my mind as well as my purse.
Good story (when I listen I always want you to go deeper, but we know about funding and time and priorities, damn it.), love the show, love being able to get it on-line when I don't catch the radio broadcast.
I currently have no coverage except for anxiety-related medication/Tenn-care may or may not be the answer, I think the answer is better monitoring of costs...there's a lot of fraud all over the health care systems...but I am well enough and educated enough that I can plunge in and research and keep on going. A lot of people can't do that and there are precious few agencies or people to point you where you need to go. P.S. Emergency room was wrongly diagnosed heart attack, biopsy was for skin viral eruption (yech)
I listened to today's show with interest, as my insurance carrier told me a lab fee would cost me $40 (my share), and then a co-pay bill arrived for $350. The insurance company said the lab cost was indeed $40, but the "facility charge" was the rest (the insurer, Regence Blue Cross/Blue Shield, paid half.) I appealed to the insurance company, who had a recording of my call (I wrote down date and time when I made the call pre-procedure), and I was denied. Now I plan to request an itemized bill from the provider, a rural medical center supported by my tax dollar as well as federal money. Earlier this year, in late April and early May, I had emergency room treatment while in New York City at Columbia-Presbyterian. They were proactive in urging me to apply for charity reduction. Four friends told me about doing this (and they earn more money than I do), so I went ahead and applied. The hospital cut some of the fees in half, and they are allowing us to pay $25.00/month on the remainder. I would urge people with insurance to demand itemized bills, call about the "small print" about "charity" even if they don't think they would qualify - any hospital that receives federal funding HAS TO provide charity reductions, I believe, and if they don't use up that money, they lose it!
I heard some of Mark Rukavina's advice for negotiating fees for physician services. As a physician I do reduce my fees for patients without health insurance, categorizing it as discount for payment at time of service. Private health insurance companies consider it a violation of your contract if as a provider you charge different amounts for the same service. So you really cannot have a fee structure for billing insurance companies and another for those without insurance. In order to discount fees you need to document in the patient's chart that there is indeed hardship and have the patient sign a statement to that effect. Also if you are a participating provider with the patient's plan, and they have a high out-of-pocket deductible, by negotiating what you will accept from the patient you would be violating your agreement with the insurance carrier. It is considered fraudulant because in this instance the patient is getting x amount of money counted towards meeting their out-of-pocket deductible, but in actuality they are only paying a portion of it. The health insurance industry wields alot of power.
