Are Some Things Non-Negotiable?

Health insurance is expensive these days any way you look at it.  There’s no way of getting around the fact that you’re going to pay more for health care than you did even a few years ago.

I’ve seen a lot of advice on how to save money on health care costs to counter-act some of these rising costs.  One of the items that shows up on almost every list is to negotiate your bill.  In other words, try to get the doctor’s office to accept less than what they bill you for.

This sounds great, but I’m wondering how effective it really is.

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In most cases when you have insurance, the provider bills at their standard rate, but agrees to take less of a rate when they participate with an insurance provider.  The mindset behind this is that by participating in a plan, they’ll ensure themselves business by offering their services to the insurance companies subscriber base.

Using a recent example, my wife had an epidural for her recent delivery of our second child.  The anesthesiologists standard billing was around $1,300.  But, the negotiated rate for that service was around $550, meaning that they had to essentially write off $750.  Our plan calls for a 10% co-pay, so the insurance company sent them a check for $495 and we had to cover the remaining $55.

It seems to me that they are not going negotiate with me on that $55 because they, in essence, have already been negotiated with by the insurance plan.

I can see trying to work with them had they been an out-of-network provider that we wanted to work with, in which case there would have been no negotiated rate and no pay-out by the insurance company.  In that case, we would have received a bill for the entire $1,300 and I could see them working with someone in that situation.  But not in our situation.

Am I off here or should I be trying to negotiate even these co-pays?  Has anybody had any success negotiating with their providers and if so, what was your insurance situation?

4 thoughts on “Are Some Things Non-Negotiable?”

  1. In my experience (and I've been in healthcare for 11 years) the only time you can really negotiate is when you are paying for the service out of your own pocket. Insurance companies have already negotiated for you. That's one of the reasons you have them- as you saw in your bill, they already negotiated your bill down by over 50%.
    And in some cases, if the doctor were to discount your protion of the bill, the insurance won't pay at all.
    If you were having to pay that whole $1,300 yourself, then you'd have room to negotiate. You wouldn't get the rate the insurance company gets becuase you don't have the buying power they do, but you could probably pay $1,000.
    I have always worked with MDs who were willing to work with patients who didn't have insurance. They've given them enough free samples to last the Rx period, they charge lower rates, etc.
    But if you've got insurance coverage, just pay your copay. You're already getting an amazing discount.

  2. I have never tried to negotiate with these guys, though I never feel like i've been grossly overcharged or anything like that either.

  3. When paying out of pocket, one should definitely negotiate. You see from this post what healthcare deliverers are expecting to receive. The feds are doing all the strong arm negotiating for you.

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