I dont have much experience with doctors. In the past 2 months, i’ve had my wisdom teeth removed and had a mole removed. These were my first experiences with doctors since I was in my early teens.
So I go to the office and I give them my Aetna card and they take my co-pay and do the procedure and I get my bill for the balance.
But I was thinking, I didnt even ask, prior to having either procedure done, ‘what does this cost’? Do people even do that? I mean, you sit in the lobby, the doc looks at you and then its either done then or scheduled to be done. But price is never mentioned. I have no idea what he charged for the 5 minutes it took to numb me and slice the mole off my skin. i DO know what the charge was for my wisdom teeth was. My portion after insurance was $478.00. The procedure for 4 teeth took less than 1 hour.
I’m not claiming that i’m being cheated or anything, but why don’t we negotiate prices before medical procedures in the same way we do for say a car repair? Or maybe most people do and i’m the odd one?
Anyways, I dont know the best way to phrase this, but do any of you, after the doc checks you and he says, “we’ll schedule you to return in 6 weeks for X procedure” say, ‘how much is this gonna cost’? And have you ever negotiated a lower price? How does this work?
Insurance companies do frequent, typically separate, negotiations with doctors’ groups for what they’ll pay on different procedures, so this happens on a massive scale all the time.
I’m sure that people with poor insurance or no insurance often do ask what the costs are. The medical center I work at is a non-profit institution, so as part of their service to the disadvantaged, they start by knocking 50% off the typical cost, and try to work with people and other services from there.
I’ve never done negotiation, but I’ve been fortunate enough to have decent insurance.
I opted out of an HMO for medical insurance so I pay for doctor/dentist visits. The amount charged for cash visits is substantially less. Without looking it was something like 40-50% less. As for drugs, I bring a list of $4 meds for the doctor to choose from.
You might enjoy thisarticle. It discusses (among other things) how in much of medical care they will not, just will not, tell you the price before you have the treatment. Pretty unique.
I was at a dermatologist (I have vitiligo). While there, I inquired about having some skin tags snipped off with local anesthesia. I offered to pay cash, rather than run it through my insurance, and asked how much it would cost. The doctor told me she was selling medical care, not used cars.
ETA: the reason I offered to pay cash was because I would have to get the procedure approved by my insurance, and the doctor had a 6 month wait for appointments.
Well, at least he had a sense of humor.
I was doing a consultation in an office once when a patient asked if he could get a discount since he was scheduled for a second surgery. The receptionist quipped “We will throw in a free colonoscopy or liposuction, your choice”.
Medical care is negotiable when you are self pay. That doesn’t mean it WILL be negotiable but it is always worth a try. However, when you have insurance, you really can’t negotiate your co pays and co-insurance if the provider has a contract. Most contracts specifically state that the patient must be responsible for their payment amount. There has been issues in the past in my community about doctor’s being accused of over billing Medicare because they were waiving the patient’s 20%.
If you can negotiate to pay the same amount as the insurance companies pay, you got a good deal.
Many times if you want to negotiate, ask if you can be charged Medicare rates. You’d probably be very surprised as to the difference between what the doctor’s charge and what Medicare allows.
My husband had a heart attack last month. The hospital bills so far are $73,000 Our insurance allowed $15,000 and our portion was $3000. The rest had to be written off. There is still $80,000 more pending insurance processing. I would think insurance will allow around the same amount. If we had no insurance, we would be getting billed for the full $153,000.
Everything’s negotiable. But I am under the impression that insurance companies have negotiated fees to begin with which are often cheaper than the standard rates. My explanations of benefits sometimes show the reduction due to negotiated rates.
I didn’t actually negotiate, but here’s my experience from the early '90s. involving one of my kids.
When the orthopedic [sp?] surgeon discovered we had no insurance, but would be paying cash, he offered a payment plan. We declined, and asked to pay for each visit or procedure. The procedure(s) lasted over a several months, and involved iirc about a dozen visits/resettings/leg-casts/etc. We paid for his services each time. On every third visit, he didn’t charge us, since he and the office staff weren’t dealing with insurance, payment delays, forms, etc. It was his contention that at least a third of his costs were in dealing with the “system”.
He offered this, we didn’t ask. I don’t know what luck someone would have today.
I’ve negotiated with doctors often. Usually in terms of which treatments I really need, but sometimes on fees. One GP my HMO sent me to liked lots and lots of tests. I had a nose problem and he said he’d have to send me to a specialist but first have to buy a prescription nose spray. I found the nose spray was to reduce post nasal drip and congestion, neither of which I had, so I asked for a second opinion before I took it. The second doctor fixed my problem without the specialist, and I complained that the first doc should have found the problem, so they undid the copay for his exam.
I always ask what this is going to cost. Most doctors I have seen will tell me what their charge will be but they never tell what something is really going to cost.
Example 1: I needed crowns on four teeth. The dentist told me how much it would cost in total, along with some options like gold vs. silver, and he had a good guess as to what part my insurance would pay. I could have negotiated but I had already found a dentist with lower prices. I just chose this guy because I thought he would do a better job (I may have been wrong).
Example 2: I needed some crap carved off my skin in a couple of places. Doctor tells me I can get it all done in one session and pay X amount or we can do one carving per session and then insurance will pay for each and he will take that. Total cost to me for the latter is $0 and he makes more.
Example 3: In a knee operation I asked the Doc how much it was going to cost. He says $3000. That is what his fee was for that 4 hour operation. The total cost for the whole thing (I added it up) including hospital stay, equipment rentals and that stupid water jug you have to buy for $45 was … $145,000. There were so many players involved and I was unconscious for a part of it, so there was very little opportunity to negotiate.
Always ask the cost. Always refuse anything you are offered in a hospital unless they can show a need. If you are in a hospital and a doctor comes to your room, ask if he will be charging you for that visit, then ask who he is and why he is there. I’ve had anesthesiologist drop in the ask how I’m doing (“fine”) and been changed for that as a consultation. I’ve talked doctors into not charging in a couple of cases when they wanted a follow-up and I didn’t. I’ve also talked doctors into not charging in a couple of cases where they were terribly late.
Last time I went to a dentist he was also an oral surgeon. He did a few things my ins covered like CLEANING, and I ask for an estimate for everything that needed done. It was $2500-$4000 my cost cash.
My 401 was gonna cover it, my ins was crap, pay for almost nothing.
Until the market collapse stole my 401, so I couldn’t get anything done at the time.
Fast forward 10 years different ins different dentist.
I ask the same question, much better ins, total cost out pocket $800, almost same procedure. Ins pay all the rest, I say let’s gi’ter done. So, we get things started.
Here’s the fun part…
I get sent to an oral surgeon who wanted 5k cash on top of what the dentist wanted. Ins won’t pay oral surgery…lol.
THIS WAS NOT IN THE BROCHURE!!!
Now since I didn’t have 5k for the oral surgeon the insurance didn’t pay the dentist, which was 3k, since he didn’t finish his procedure, and could not with out the oral surgeon.
So, i’m stuck owing the dentist 3k instead of $800, for unfinished work. :dubious:
At no point did anyone tell me about the TOTAL COST outta pocket.
Like it was a big SECRET, like all of us had 10k sitting around in the bank doing nothing.
In 10 years prices doubled and my pay went up like a couple bucks.
In elective procedures, especially cosmetic surgery, there certainly can be some payment “option”.
Other than that, only ask if you don’t have insurance.
There’s a few exceptions. I have a prescription, and I pay $10 for the generic, much more for the name brand. Also, I pay by the bottle, no matter how many pills. So,my Doc easily agreed to give me two months in one bottle, and the generic.
*
I am not a real doctor.*
If you look at your Explanation of Benefits from Aetna, you should be able to see their negotiated prices, which are ridiculously low.
For instance, I had some bloodwork done. The lab submitted a bill for $342. Aetna’s pricing is $112. The $230 difference just goes poof into thin air. The differences are not always this much, like office visits are fairly close, but it’s pretty shocking.
I tried once. I was a new patient to my doctor (my insurance changed, so I had to change doctors) and I called to schedule a “new patient” consultation to get my yearly exam and talk about some other concerns I had. The receptionist asked what concerns I had and I told her. Well, when I got in to see the doctor, she didn’t do a full exam because I had been booked as a consultation for the concerns I had, not a physical. When I got the bill, it was over $800 for a visit I thought would be free. I called, talked to the billing department and they sent my chart for “review” by the AMA or something. The auditing organization said that my doctor didn’t do enough to have it count as a physical, so I had to pay. I was pissed.
Clearly my doctor’s office is more concerned with making a buck than putting the patient’s needs first. I am looking into a new doctor. I have to find an office that gives a crap. I told them more than once that I wanted a physical. And I couldn’t get it. Screw them. There’s more than one doctor in my town.
Since I do not have insurance and have been declined by every company licensed in the state, I always ask. For a recent 45 minute procedure in Nevada, I was told $10-12K. Instead, I bought a ticket to Prague (where I moved to after leaving the US), and the total cost was $450 (no insurance involved).
When I worked for a temp agency I spent two weeks in a dentist office, helping set up their computers, and at least this dentist, had a negotiated rate with a slew of different insurance companies.
It would be the insurance of company A charges a range of so much and an insurance of comany B would charge so much and so forth.
For instance, a root canal from “Acme Insurance, Company” the insurance company would pay up $650. The “Road Runner Insurance” would pay $700, and the “Coyote Insurance,” would only pay $500."
Anyway the software I helped put in, the dentist or rather the office manager usually would put in what the dentist said and it’d spit out a range of prices and the dentist using said information would quote a price.
Looking over this dentists quote they would vary per patient up to $100.00. I assumed that the varience was due to the difficulty of the procedure. A root canal may be paid out at "$600 by the insurance company but each person’s mouth is different so the dentist would add or subtract from the estimate after determaining how difficult it would be
Here in Soviet Canuckistan medical services are mostly covered by the state, as you know. However, my sister in law does ER medicine in a big ski town. Americans who injure themselves deal with their medical bills in one of 3 ways.
take a bill, offer to settle via insurance, then never do
take a bill, send money later (rare)
offer some random amount of cash. This is the most amusing, since Canuck MDs often don’t know the list prices of their time and services, and the patient usually has a pretty poor idea as well, so the patient will say: “fifty bucks?” and the doc will say “uh…sure”, and then use the money to buy stuff for the staff in the ER, or stick it in the pizza slush fund.