Unfortunately, paying for health care these days - whether
it's hospital care, group or private health insurance, or
durable medical supplies - is a lot like buying a car: You
gotta haggle. If you can research and take care of your
out-of-pocket expenses prior to surgery, it's possible and
wise to negotiate with the hospital and providers for a
lower out-of-pocket rate.
For example, say you know you have elective surgery coming
up, and you've discussed it with your doctor and agreed on
a date. His office already has the paperwork process
underway with the insurance company, and you read through
your policy and find that it does not cover out-of-network
anesthesia. What do you do? You might call the hospital and
ask how many in-network anesthesiologists they generally
have on hand at the time when you've scheduled your
surgery. If you know there's a good chance the person who
is going to provide that service is not going to be covered
by your policy, this is where the negotiations start.
Today, we have to negotiate these kinds of things, as
difficult as that seems in light of any health issue. We
also have a growing rate of tiered billing practices, so we
can be charged anything from what a provider like Medicaid
or Medicare might have to pay, to the price level of an
uninsured patient, which might be substantially higher, but
since the charges aren't necessarily standardized, there's
a lot of room for discussion. Many hospitals charge
uninsured individuals a lot more for services so they can
make up for costs lost elsewhere in their operations. The
point is, from one end of that spectrum to the other,
there's a lot of negotiation room. Knowledge is power,
especially in this scenario.
Start with reading and digesting your health insurance
policy, whether it is group, government provided, or
private health insurance. Call your doctor and ask what
kinds of surgery-related expenses a patient is generally
expected to cover. These may include radiology (x-rays),
consultation with out-of-network specialists (whose fees
are also negotiable), pathology, and even blood
transfusions. Then, starting with the finance department,
call the hospital and ask them which service providers
operate outside of your network, and get ready for the
talks to begin.
Explain what your insurance provider will cover and what
you can afford to pay for the rest. Many hospitals today
have made their pricing policies transparent and therefore
have prices posted to the hospital Web site or readily
available for consumer perusal. Keep in mind that the
hospitals offering such practices also only guarantee the
prices from the date of printing (or publishing); all the
same, armed with this information you can at least get a
rough idea of the price range you're dealing with.
According to one lawyer at the Texas State Department of
Insurance, pricing is not the only thing you can tweak.
"You can also talk to your own doctor and see whether he
can find other providers at the hospital who wouldn't be
out-of-network. If you have one surgery date, but that
scheduled time doesn't coincide with the physical presence
of in-network providers, but another time does, well, you'd
choose a different time, wouldn't you?" He also said to be
on the lookout for words like "allowable," "usual," and
"customary" in your policy, because those usually signal
"points of flexibility," and we could all use a little
flexibility with insurance companies and hospitals.
----------------------------------------------------
Ryan Patterson is president of US Insurance Online, based
in Austin, TX. He graduated in 2000 from the University of
Texas with a combined business and computer science degree,
and started US Insurance Online in May of 2005 with fellow
entrepreneur Jim Waltrip. Visit
http://www.USInsuranceOnline.com for help shopping for
insurance and for free insurance quotes.
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