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How do you negotiate charges with medical providers?
One of my young adult children recently made three office visits to a medical provider, none of which exceeded an hour and none of which involved any "hands-on" medical procedures; they may have taken his weight/temp/BP/pulse but the remainder of the visits were basically consultation/counseling. The son in question has health insurance through both his own employer and through mine. However, the medical provider in question seems to be using an approach of "set the prices so high that they will exceed any insurer's covered amount so that we can get the maximum payout". In this case, the provider is trying to charge about $3700 for three office visits. Negotiated discounts with one of the insurers will drop it by 10% and the combined payout of both insurers is about $1400, leaving about $1900 outstanding that the medical provider may be billing us for. This exceeds by a huge amount the copay we might reasonably have expected to owe for services of this nature (I would have thought $50 per visit would be reasonable if a little steep; anecdotally, my son claims he was told would be covered by insurance and would cost little or nothing out of pocket).
Some recent news stories on medical costs indicate that medical charges of this nature should not be treated as a final amount owed, but as a starting point for negotiation. Frankly, I strongly dislike the fact that I am in this position, but it may well be that the only way to avoid paying the full remaining balance is to negotiate. I'm worried that having already negotiated 10% off with one of the insurance carriers they may be unwilling or less willing to negotiate further discounts with me. I have no idea how to approach this. Can anyone offer any suggestions on how best to engage in negotiations of this nature with a medical provider?
I've already been in contact with both insurance companies. They've been cooperative, and with one possible exception we're still looking into, the amounts they've paid are in line with Healthcare Bluebook rates. The real problem in this situation is that the medical provider is charging a rate that far exceeds those Healthcare Bluebook rates.
4 Answers
- ZarnevLv 78 years agoFavorite Answer
This is called balance billing. Depending on your health plan and the contract the doctor has with the insurance this practice could be illegal. Apparently, that is not the case in your situation or the insurance companies would have told you.
To negotiate with the provider you'll need to contact the billing department. Be aware that some providers do not have a billing department and instead use a central billing office that is also used by other providers. If this is the case you don't have much negotiating power because they'll say they don't have the power to negotiate and will just send the bill to collections if you don't pay. You'd then need to go back to the doctor and complain.
If the provider has their own department you can go in, set down with the people, and work out a plan. How you do that will depend on the situation and why your son went to three visits where they didn't do anything beside consultation.
Source(s): Independent Ägent - Super™Lv 78 years ago
Usually the insurance company is the one who negotiates the charges. They have a set price for these procedures and tell the doctors that they are only going to pay that much for that procedure. Then you are responsible for a percentage of that negotiated rate as dictated in your plan, possible copay and if you have met your deductible.