Really? This seems too simple to be true and I would assume most hospital billing departments would just respond with a 'haha, nice try' when asked. I guess it wouldn't hurt to try....

@GavinEstecado: Depends on the medical condition I guess.

I assume they'd be willing to hear you out and at least attempt to make a deal. Some money is better than no money especially if you're willing to pay them promptly, or better yet in full.

I wonder how easy it is to get a hold of someone at a larger hospital group who actually has the authority to decrease charge amounts.

"Patients are often intimidated by their doctors - it's the white coat,"

No, I think it's the condescending tone and general attitude problem that makes some of them intimidating.

"I'd like to pay the lowest rate you give an insurance company."

This is just asking to add insult to your injury when the person on the other end of the phone laughs you off the line.

@wgrune: I'm not intimidated so much as I am leery that said doctor will prescribe me medication that isn't that effective or tests I don't really need simply to make himself (or his clinic) more money or because he's getting drug company kickbacks.

@Micromegas: Or maybe cries a little inside. As a former phone CSR I used to cringe when people would want a discount for no apparent reason. I didn't have the power to just give discounts (well okay I did, but I could easily get fired for doing it).

Most consumers have difficulty with the difference between haggling (which should be a back and forth negotiation) and yelling, cussing, bitching and screaming at the CS rep to try and get a deal.

Also I used to love how some customers believed that I was denying them a deal simply to be an ass to them and believed that I could do it for them but simply didn't want to. It's like they just couldn't comprehend "I'm not allowed to do that".

This worked for me after a hospital stay back in the 90s. I racked up about $65,000 in bills after an automobile accident.

After getting out and doing a lot of research I found out about a federal plan (the Hill-Burton Act, I think) which provided funding for indigent patients like me. So I requested the hospital look into it, as the request had to come from them. They refused.

So I went to a bankruptcy attorney. I learned for about $350 I could declare bankruptcy (I was already a barely employed "musician" so it would not have impacted me at all) and wipe the debt clean.

I went back to the hospital and told the administrator, "Look you can either use the federal funding or I declare bankruptcy and you get nothing." I gave him the attorney's card and walked out. Needless to say, they obtained and used the funding.

@pb5000: If you can't afford medical insurance in the first place, I doubt you can afford to pay for a shoulder surgery in full.

I always try to negotiate cash rates to see if I can get it below my insurance company's negotiated rate. Some doctors get it and others have no clue what you are talking about.

After a one night hospital stay and two tests I racked up about $4500 of bills. First I attempted to receive an itemized copy of my stay. According to some you can find a lot of billing errors this way. After we didn't find any, I tried to explain my situation to three different tiers of hospital billing. There was no budging on their part. They would just calmly explain that they are a business and need their money.

Basically, it doesn't hurt to try, but it always annoys me when I see people touting this message of 'just ask and you shall receive' because you probably won't.

@calquist: Not necessarily. Medical insurance is a monthly premium, sometimes a LARGE one if you're not employed -- a medical bill is generally a one-time bill.

I read the title as "Haggis With Hospitals"
Which conjured up all the wrong mental images...

Damn man...I need this article about 10 years ago when I had no insurance and needed to be in a hospital for a week.

Hospitals charged me $2 per percocet pill, and $6 per pitcher of water that I did not ask for. Also charged me per gauze pad, surgical tape, sheets that were clean and a few other things.

This really works? I was under the impression that hospitals were one of the few places that haggling couldn't work. I thought they operate on such a narrow cost line between insurance issues and regulations that it's next to impossible to deviate. Okay, so here impossible is relative and haggling is the crowbar to all loosely locked prices, but hospitals are the last places I'd expect it to give. Good find.

In lieu of haggling with the hospital, is it feasible to haggle with your insurance company? (Answer is yes, but I want to hear stories about it)

While I didn't reduce the price of my MRI, I did get the hospital to throw in 2 goats and a date with the CNO's daughter!

@GMFish: But you realize that the hospital lost money on your stay driving up insurance costs for everyone else. Some payment for them was better than nothing and hospital's are not in the business of bankrupting their patients.

@laserjobs: I've had a pretty good success rate with this for mundane things (physicals, checkups, etc.) leaving the insurance for catastrophic things like kidney-stones, car accidents, etc.

If you think about it, who wouldn't want cash today for a discount rather than waiting 90-120 days for an insurance company to process a claim?

You want a cure to the health care woes in this country, get more people to pay cash up front for the small stuff.

I've never done it before the fact, but after a couple of emergency room visits (one without insurance, one with but total was below the high deductible).

Both times, the hospitals negotiated a cash discount with us, both giving us 45-50% off the billed rate. Of course, this was the "cash on the barrel-head" price--if it wasn't paid in (discounted) full in 30 days it reverted back to the old full price.

As I always tell my kids--you may as well ask; the worst they'll say is no, and you're no worse off than when you started.

Many hospitals will give you a very discounted cash price.

My cousin was pregnant and uninsured, but she had some money saved up. The hospital was willing to give her a 50% discount if she paid in cash.

My dentist charges lower prices for patients without insurance, as his overhead is lower (no forms to fill out, no waiting for claims, no insurance-required price adjustments).

It pays to ask.

Yes, this really does work sometimes. Last March I went in for my yearly pap, and i'm uninsured. I pay for the doctor's visit up front with the cash I had saved up, and my doctor gave me a 30% discount for paying via cash.

Unfortunately, my doctor did not tell me that during the year in between that pap and the one before, they had changed their policy so that anyone under the age of 24 would get multiple STD tests done due to being an "at risk group" and failed tom inform patients about this new policy.

Imagine my surprise when I got the bill 6 weeks later from the independent lab that runs the pap test (and others). I was not expecting to have to pay an extra $130 for 2 tests I never ordered, nor wanted, nor needed, nor even got results for! After consulting with both the lab and doctor's office, I found out about the doctor's policy change, yelled at them for a while, and talked to the lab and told them bluntly- "Look, I did not ask for these tests, they were done without my consent or knowledge, i'm uninsured and I will not pay for these unauthorized tests, period. I will only pay for the one I went in for. If you want additional payment, take it up with the doctor's office."

They said they'd call back in a few days to see what they could do. Few days later I hear back from them saying that the bill was all set, and to just pay for the pap test like I had wanted to do, they got me financial aid for the other 2. So it just goes to show, it's out there and available to people. Doctors are very willing to take cash at a lower rate or work out a payment plan if it means they get any money at all.

@GavinEstecado: It really depends on the hospital and your situation. Some will just laugh in your face. Those are generally the ones that drag people though hell if they end up unable to pay in full also. Others will try to work with people on either a discount or a payment plan beforehand or after the fact. If you have the option of choosing what hospital you have the work done at this might be a good way to get a feel for how they will be to deal with.

I've had experience with doctors or a hospital where you can ask if they will accept the insurance payment as payment in full. That's helpful in an unexpected case where you've spent days in a hospital. That 10 or 20% that your insurance doesn't pay really adds up. Sometimes they will accept the insurance and wave your part. You just have to ask the right people, and be nice.

@Xerloq: or implement a single-payer system to pay for the small stuff & basic emergency care & leave the insurance for catastrophic/specialized care.

hey, it works for sweden...

This worked for me too! When I got a $2000 hospital bill by sitting in the ER for 45 minutes, I had no idea how I was going to pay for it, since I had just started a new job and was completely uninsured.

I called the hospital billing department, explained that I was completely uninsured and asked if they had a payment plan. The person on the phone offered something better: The hospital can provide a flat out 50% discount for most uninsured patients and would allow up to 6 months to pay off the rest of the bill.

It really was as simple as just asking if there was anything they could do for uninsured patients. They cut my bill in half and I was able to pay the rest off within the given timeframe.

@chrisjames: The actual margins may be narrow, but discovering what those margins are can be tricky because not all insurance companies pay the same. They have negotiated rated, max-allowed billing, etc.

It's a viscous cycle with doctors/hospitals/insurance companies raising rates to get more money, and Joe public with insurance doesn't care because the premium is withheld from his paycheck and only "feels" the copay.

Then, suddenly you realize that insurance premiums are increasing at an exponential rate.

If you don't have insurance, you end up paying "list price" for services. List price is grossly inflated.

Whether you have insurance or not, it's always good to review your bills to make sure your not being charged for stuff you don't use. The bills for my last child had an epidural listed ($1500) but my wife didn't have one because the baby came so fast (it took 10 minutes from the time we walked into the hospital before the baby was delivered). After talking to the billing department we discovered that all patients are billed for a standard "maternity package" as a "time-saving" measure.

"I'd like to pay the lowest rate you give an insurance company."

That is a volume price. Are you having a volume of proceedures done? Didn't think so.

Therefore you ain't going to get the lowest rate you give an insurance company. Won't happen.

Can you get a discount? Absolutely. Will it be the "best" price? Nope. Oh, and you will only get that price after you swear out an affidavit or sign a formal contract that you will not be processing the claim with an insurance company at a later date. (such a processing claim with an insurance company would amount to double discounts)

On a side note, make sure you keep receipts for these negotiated payments - they may be tax-deductible. Usually, insurance premiums (not co-pays) are withheld pre-tax. If you're paying without insurance don't give up the tax benefit.

1) this is assuming, of course, that your hospital's billing office doesn't resemble the basement storage of initech. unfortunately, i have a feeling most do.

which brings me to, 2) how come we don't have any consumerist postings on the poor, consumer-unfriendly billing practices of hospitals?

I had to have a lot of dental works done in the past few months, even with dental insurance the price was unaffordable. After speaking with my dentist, she gave me a 30%~50% on the fees I had to pay out of pocket. I don't know how well this would go in a hospital though...since I've only been to Kaiser and you pay at the check in counter?

Most hospitals will give you 10 to 20% discount usually without asking. That is the standard discounts most insurance plans take.

Don't expect any discounts if all you can do is pay 10 to 20 bucks a month or if it will take you years to pay off the balance after a discount.

If you have the money and can pay in full you can generally get a 30 to 50% discount off the final bill. It does help as the article stated to know what the medicare allowables are for your hospital stay

I myself have a 10,000+ hospital bill that I am currently paying off at 25 dollors a month. At the time I made to much money to qualify for any indigent or charity plans, despite losing 40% of my salary 3 weeks after getting out of the hospital. In about 3 years I will have about 60% of the blanace savied up and I will then offer to make a settlement. If they refuse I will just pay 25 a month for the rest of my life.

Especially in these parlous economic times, hospitals are definitely more likely to work with you. They will negotiate discounts in many cases, such as when their alternative is not getting paid at all. I asked for a monthly installment plan with an ambulatory surgery center and they said yes in a second.

@GavinEstecado: Here, hospitals are required to treat you for emergencies whether you have money or not, so if they can get some money rather than none, and won't shoot your credit to hell, it's a win for both sides.

I would love to try this out at a restaurant:

"Hey, before I eat here, I don't want to pay the prices on the menu. I'll pay whatever your best vendor pays you for meals, and nothing more. Please be sure to spit in my food ahead of time, too."

Sounds like an excellent way to "accidentally" have surgical instruments left inside of you.

On a related note - the show "Breaking Bad" is probably one of THE best series out there right now.

I watch all of 1st season last month and now watching 2nd season as they arrive.

Google it if you haven't seen it.

I recently had to take my son to the emargency room for an eye injury. While he was being treated a person from the business office showed up in his roomand started demanding that I pay a $150 deposit even though I have insurance. In the politest way I informed them that I had insurance, did not have $150 dollars and that it would be in their best interest to leave the room while my son was being treated. She said that she would be back after he was treated and that I would have to pay the deposit before I would be allowed to leave. After the doctors released him, we left and never did pay the $150 deposit. What were they going to do? Take back the treatment if I did not pay the $150 dollar deposit?

Perfect example of how its done, long story short: Got into a jet ski accident, huge wave, steering bars slammed into my chin at the perfect angle at the tip of the bone, even though they were padded, created a nice 2 long gash, i make it back from the water, look in the mirror and have to decide: super glue or hospital... I have no insurance but its on my face so i want it to heal neatly, friend drives me to the hospital, they get me stitched up, and send me a bill. $695. I figured approx $300 that I will pay max, for the 10 minute stitching session with the doctor. I send them a nice letter describing that I have no insurance, just recently lost my job (which i did) and send them a copy of my tax returns as proof that I had crap wages while employed anyway, 2 months later a revised bill comes for $75.

@mac-phisto: Was thinking that also. We need more about hospitals and less about a jumprope minus the rope.

This worked for my wife and I, my wife was in a bad car accident, and racked up over $500,000 in hospital bills over a 6 month period. We contacted a lawyer who haggled with the hospital for us, and ended up settling the debt for about 40% of the original amount.

@chrisjames: I haven't done outright haggling, but I've definitely had bills change with persistence and discussion (and, once, crying). The thing is, I didn't know until later that they'd actually adjusted stuff, so it wasn't like I had cut a deal. (Both times it was a gray area about what they would cover and what the hospital should eat, to the tune of several thousand dollars.)

@mac-phisto: Seconded. Holy cow, that's a snake pit.

@chrisjames: My last statement said some basic, standard tests were $465. The hospital's negotiated rate for my insurance was $85. That is a HUGE difference. In theory, the insurance brings alot more business, but you, as a consumer, can get a heck of a deal, especially when you point out it can take months to get paid from insurance, and lots of man-hours to track, and how much will they charge if you pay cash RIGHT NOW..

@mac-phisto: I'd prefer the opposite.

@chrisjames: reposting in the right place: I haven't done outright haggling, but I've definitely had bills change with persistence and discussion (and, once, crying). The thing is, I didn't know until later that they'd actually adjusted stuff, so it wasn't like I had cut a deal. (Both times it was a gray area about what they would cover and what the hospital should eat, to the tune of several thousand dollars.)

I did something similar after a bad car wreck landed me in the ER with multiple tests. Luckily, I was okay, just scraped up, bruised, and sore for a couple of weeks, but I only go to the local Catholic hospital. They do alot of community outreach. I called them after I got my bills and told them, "Look, I want to pay you, and I have every intention of paying you, but I can't afford this. What can we do?" They sent me a form to fill out that basically examined my income and insurance info (none- I'm a college student who waits tables.) They got back to me a week and a half later and let me know that I had qualified for a charitable reduction of my bills. From ~$6,000 to a little over $500. I was able to spread out my payments, which ended up being about $20 more than I told them I could afford to pay monthly. It was fair.

@Corporate-Shill: You're an idiot.

@Corporate-Shill: You should be able to. It's unjust for uninsured patients (most of whom are uninsured because they can't afford it) to pay more for health care just because they don't have the same "negotiating power". I don't blame the insurance corporations for aggressively negotiating prices down, but I do blame our society for perpetuating this unfairness.

@mac-phisto: No kidding on the billing stuff. A lot of the billing practices I've seen (not just from hospitals, but also from doctors) should be illegal. Double-billing, billing for services never received, sending bills with NO details or itemization of costs, costs that don't add up, billing AFTER the payment deadline with late fees and credit reporting threats already tacked on...I could go on and on. Hospitals and doctors seem to often be among the most disorganized places imaginable on billing. I've seen a few that were organized and modern, but most seem to use a cobbled-together system with 30-year-old billing software written in COBOL and running on a collection of computers held together with duct tape and mutually incompatible with each other.