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How to Negotiate Healthcare Prices with Doctors and Hospitals

• Be knowledgeable about the specific service you need
• Do not be afraid to discuss pricing with providers
• When possible, always discuss pricing BEFORE you get the service, specifically BEFORE the appointment

If you haven’t received the service yet, start here.

If you already received the service and the bill seems too high, start here.

1. Know what specific service you need - Make sure your doctor tells you the specific services that you need. Get the specific names and write them down. All medical services have billing codes, make sure you get this code also. Most physician services have CPT codes and most hospitalizations have DRG codes. When you are shopping for prices, it is best to be able to describe the service you need in the terms that are familiar to the providers. The more specific you can be, the easier it is for them to provide the price to you. Knowing the specific services will also let you look up the prices on the Healthcare Blue Book.
2. Determine what a fair price is - Look up the services on the Healthcare Blue Book website. If you can’t find your services, then submit a request to Healthcare Blue Book to see if we can find the fair prices for you. You can also do research on state databases, when available.
3. Print the "Printable Detailed Pricing Agreement" - When you find pricing for a healthcare service on the Healthcare Blue Book, make sure you select the "Printable Detailed Pricing Agreement" page and print it. You can use this for your records and may need to have it signed by your provider.
4. Discuss pricing with your provider BEFORE your appointment date - You should call the provider’s office staff or meet with them before the appointment date for the service. Doing so will give the provider time to consider what they can do for you and get any required approvals to give you a fair price. In addition, you won’t be stuck at the appointment not knowing what you will have to pay. If you don’t talk with the office staff in advance of the appointment, you will probably be responsible for full amount of their billed charges and you won’t have any rights to receive a discount. Be sure you talk with the proper people at the healthcare provider’s office:
   • For Doctors- ask to speak with the office manager or ask who is responsible for discussing services and pricing
   • For Hospitals- ask the registration or scheduling staff if they can discuss pricing with you or to refer you to the person that can do so.
5. Set a price that is fair and agreeable to the provider and you -
   • Take your printed pricing agreement with you if you meet with them.
   • Let the provider’s staff know if you are not using insurance and will pay yourself (this is known as "out of pocket" or "self-pay").
   • If you have a low income and might qualify for charity care, make sure to inform them of your situation and ask what options they offer. Many providers, particularly hospitals, have guidelines for charity care discounts.
   • Ask them what price they will charge you for the service.
   • If the price is higher than the price listed in the Healthcare Blue Book, ask them if they accept Healthcare Blue Book pricing. If not, then ask them what they charge Blue Cross/Blue Shield patients. (Why should you have to pay more than the other patients they treat when you are paying cash?)
   • If you can’t get a discount from the first person you talk with, don’t be afraid to ask for a higher level manager or to talk with the doctor.
   • Try to establish a fixed or specific price for the service instead of a percent discount off charges. If they will only agree to a percent discount, then get an estimate of what the price will be for your service with that discount.
6. Get it in writing - Always document the pricing amount in writing. Have them provide the price in writing, by email, or have them sign the Healthcare Blue Book Pricing Agreement. The staff that sends out the bills for providers is often in another office or company and may not be aware of the price that was promised to you. If you get a bill that is higher than the price you were quoted, you will need to send them your written agreement to have the billing office adjust the charges to the correct amount. Remember, the office staff is busy, people forget, people change jobs, and other things can happen; so always get it in writing.
7. Compare providers’ prices - If your provider does not offer you a fair price, then don’t be afraid to call other providers to check on their pricing. You may find that another acceptable provider will offer the discounted pricing that you are seeking. Also, your provider may be willing to adjust their price if they know other providers are offering the same service at a fairer price.
8. Other Considerations -
   • Location matters - Surgeries may cost different amounts depending on where you have them. In general, in-patient surgery is the most expensive option, followed by out-patient surgery at the hospital, ambulatory surgery centers, and the doctor’s office. Many surgeries can be performed at an ambulatory surgery center or your doctor’s office and doing so will lower the cost substantially. Ask your doctor what options you have for the location of your surgery. Select the one that you are comfortable with and that you can afford.
   • Timing may matter - For some procedure and imaging studies, you may get a discount if you can have it done at non-peak times. Ask the provider if they have pricing flexibility if you are willing to come in at non-peak times.

Sometimes we have urgent or emergent situations that do not allow us the time to ask a provider about pricing and set a fair price in advance. In other situations, the provider visit goes very fast and lots of tests or services may be performed before a patient realizes what it might cost. When this happens, and if we don’t get insurance discounts, then the providers will often bill patients full "billed charges". Billed Charges are often five to ten times higher than the provider typically accepts as payment in full from insurance companies. When you find yourself in this situation, you should talk to your provider about reducing the billed charges to a fair amount. Use the Healthcare Blue Book as a resource to work with the provider to agree on a fair amount.

1. Know what specific service you received - Make sure your doctor tells you the specific service that you received. Get the specific name and write it down. This can often be found on the medical bills. Knowing the specific service will let you look up the price on the Healthcare Blue Book.
2. Determine what a fair price is - Look up your service on the Healthcare Blue Book. If you can’t find your service, then submit a request to Healthcare Blue Book to see if they can find the fair price for you. You can also do research on state databases, when available. You may want to print the "Printable Detailed Pricing Agreement" page.
3. Find the right person to discuss the billing situation - Most providers have a team member who is responsible for handling billing issues.
   • For Doctors- ask to speak with the office manager or ask who is responsible for discussing services and pricing
   • For Hospitals- ask the accounts receivable staff if they can discuss pricing with you or to refer you to the person that can do so.
4. Discuss a price that is fair and agreeable to the provider and you -
   • It may be best to meet in person with the provider’s staff. Remember, you are asking them to do you a favor (reduce your bill), so a positive and pleasant attitude will help you.
   • Take your printed Healthcare Blue Book pricing agreement with.
   • Let the provider’s staff know if you are not using insurance and will pay yourself (this is known as "out of pocket" or "self-pay").
   • If you have a low income and might qualify for charity care, make sure to inform them of your situation and ask what options they offer. Many providers, particularly hospitals, have guidelines for charity care discounts.
   • Ask them what discount they would be willing to provide.
   • If the price is higher than the price listed in the Healthcare Blue Book, ask them if they accept Healthcare Blue Book pricing. If not, then ask them what they charge Blue Cross/Blue Shield patients. (Why should you have to pay more than the other patients they treat when you are paying cash?)
   • The person you meet with may not be able to adjust the bill to your satisfaction, so don’t be hesitant to ask to speak with a higher level manager or have them talk with their boss.
   • Once you have established an agreeable price, you will be responsible to pay the bill promptly. Some providers may offer a payment plan over time. However, it is much better to get a substantial discount and pay the bill rather than paying them an unfair price for years to come.
5. Get it in writing - Always document the pricing amount in writing. Have them provide the price in writing, by email, or have them sign the Healthcare Blue Book Pricing Agreement. The s taff that sends bills for providers is often in another office or company and may not be aware of the price that was agreed to with you. Remember, the office staff is busy, people forget, people change jobs, and other things can happen; so always get it in writing.