A friend of mine recently asked me if he had the right to negotiate fees with his doctors. My friend has a very high-deductible family insurance policy under which he pays the first $12,000 before insurance kicks in. That’s in addition to his monthly premium. And while he pays his provider the rate his insurance would pay if he were covered, repeat visits are putting a strain on his finances. The simple answer to his question is YES, he can negotiate fees with your doctor. And there are other things he can negotiate as well, including treatment options. In my friend’s case, he couldn’t negotiate the fee amount, but he could (and did) ask the doctor to not charge for follow-up visits, unless a problem still existed. By the way, the doctor agreed.
Negotiating with doctors, hospitals, and other health care providers is actually common. At least once per year, these providers negotiate with insurance companies, Medicare and Medicaid about reimbursement levels for services. Doctors might also negotiate with hospitals to gain or retain practice privileges. So, negotiate directly with patients is not something too alien.
Here are some ways negotiating with your health care provider might save you a lot of money or help resolve other issues:
Negotiate noncovered services. Not all health care services are covered by insurance. For example, most cosmetic surgery is not covered, and services like physical and occupational therapy usually have annual limits on the number of sessions your insurance policy may cover. An insurer may stop reimbursing for certain cardiac rehab services if they deem it no longer necessary. When any of these situations occur and you need or want these services, it’s time to negotiate fees and charges. Most providers will try to help by working out a deal that might include lower fees or extended payment options. If you cannot afford a prescribed medication, you can negotiate with many pharmaceutical companies for a steeply reduced cost on a particular drug.
Negotiate hospital charges. Studies show that up to 90 percent of hospital bills have errors in them. Most common errors are for services that were never received. As best you can, review your bill for errors, particularly if you do not have comprehensive hospital insurance, high insurance co-payments, or no insurance at all. Ask for a detailed bill, not a general one, and don’t hesitate to question what you consider a billing error. Directly contact the hospital billing office and ask them to provide the support documents for the questionable charges. Then negotiate a reduced charge.
Negotiate with nursing home charges. Most skilled and intermediate care nursing home charges are not covered by standard health insurance. Medicare coverage for skilled care nursing homes is limited in terms of days per year and medical necessity. Most intermediate care is not covered at all. That means you are on your own with nursing home costs. But you have every right to negotiate with nursing home providers. You are particularly in the driver’s seat if the nursing home is not filled, which is quite common. Have a family member or lawyer help you with these negotiations. Since most nursing homes are privately owned, they are often willing to negotiate.