Haggle for Lower Prices

Sickened by Doctor Bills? How to Haggle for a Lower Price

You may have negotiated a decent price on your new car or bargained for a great lamp at your neighbor's yard sale, but did you know that you can haggle with your doctor to lower your out-of-pocket expenses?

According to The Foundation for Taxpayer and Consumer Rights (FTCR), everything in health care is negotiable, even the bills from your doctor, pharmacist, and hospital. FTCR's patient guide states: "You're paying the bills, not only as a consumer, but also as a taxpayer who helps fund the medical system." So don't be cowed by your doctor's sparkling white lab coat or by your hospital's credentials. Establish the price you believe is reasonable and go for it.

There's no harm in asking, says Larry Gelb, president and chief executive officer of Care Counsel, a provider of employer-sponsored health care assistance and advocacy services in San Rafael, Calif. "There's nothing new about people asking for discounts on medical treatments," says Gelb. "There's a long history of patients negotiating with their providers for lower prices on elective procedures, such as laser vision surgery or psychotherapy."

Tips On How to Bargain

Many consumers who are either uninsured or left with hefty out-of-pocket medical expenses after their insurers have paid can successfully talk their doctors and hospitals into lowering their bills. (Note: This does not apply to Medicare patients, or to patients' co-payments and deductibles.) Seventeen percent of consumers recently polled by Harris Interactive Health Care News say they have asked a pharmacist in the last year if they could pay a lower price. A smaller but growing number say they have done this with doctors (13 percent), dentists (12 percent), and hospitals (10 percent).

According to Harris, approximately half of all those who have tried to negotiate a lower price say they did so successfully. This varies from 54 percent of those who spoke with their doctors to 48 percent who talked with their pharmacists, 47 percent of those who talked with their dentists, and 45 percent of those who talked with hospitals about their bills or prices.

There's both an art and science to haggling for lower health care prices, according to Gelb. "Research indicates outspoken individuals have better health outcomes," he says. "But even I would think twice about creating bad feelings between me and my surgeon if I was about to have surgery." Gelb says the doctor/patient relationship is as delicately balanced as the employer/employee relationship. "You don't want to march up to your boss and demand a raise," he says. "You're probably much less likely to get the desired outcome by doing it that way than if you calmly explain the reasons why you need to make more money. Same thing goes for asking your doctor to lower his prices."

While there are no hard and fast rules for successfully lowering your out-of-pocket health care expenses, there are a few good guidelines:
  • Find out what others are paying. This isn't as easy as it sounds since doctors and hospitals in different areas of the country charge widely varying amounts. The American Medical Association Web site now has an interactive tool that lists how much Medicare reimburses doctors for certain medical procedures. However, the AMA warns these are "bargain-basement prices" reserved for 39 million senior citizens and the disabled who need government assistance with their health insurance.

    Still, you should never pay your provider more than private insurers pay, says health care attorney Deidre O'Reilly Marblestone. "Insurers never pay more than one-half to two-thirds of the total amount billed," she says.

    Note: You must register to use AMA's interactive tool for Medicare reimbursements. Registration is free, but you are limited to 10 searches annually.

  • Cash talks (so do credit cards). Offer to pay your doctor the discounted amount you both deem reasonable in cash, immediately. If you don't have the cash, offer to put it on your credit card if you're financially able to do that. Says Marblestone, "It works. Just like Wimpy says in the Popeye cartoon: 'I'll gladly pay you Tuesday for a hamburger today.'"
  • Plead your own case. Nine times out of 10, the telephone won't do the trick and neither will a written request. Arrange to get face time with your doctor, pharmacist, or hospital billing officer and plead your own case for paying a lower amount. It also helps if you have an established relationship with your doctor or pharmacist.

    "It's much more compelling when a consumer speaks on his or her own behalf directly to the provider and explains the situation," says Gelb. It's also harder for the provider to turn you down in person.

  • Ask for free samples of medication. If your doctor prescribes a medication that is not on your health insurer's formulary (list of approved prescription drugs), don't be shy about asking for free samples rather than paying full freight at the pharmacy window.

    It's a safe bet that your doctor has plenty of free samples. The number of sales representatives hired by drug firms rose to 83,000 in 2000 (more than double the number that were hired in 1994), according to pharmaceutical consulting firm Scott-Levin. Thousands of those sales reps are responsible for providing physicians with information about their products along with free samples.