Alan Weinkrantz of San Antonio is a health care haggler. Alan always attempts to negotiate fees associated with his family’s medical care. The only health insurance coverage he carries is for “catastrophic” events; he pays for everything else out of pocket. You can bet since he pays providers directly, he watches every penny.
When Alan’s son needed to get his wisdom teeth out, Alan got busy. He lived on the North side of San Antonio. His normal local dentist was going to charge him around $2,000. So he called an orthodontist on the south side and got a quote for $1,200. He called his dentist back up and was able to get the price matched.
“My point is you can haggle with physicians, you can haggle with health care providers, and I think it is our own responsibility to do that because health care is getting out of whack,” Weinkrantz says.
Alan is not alone. Stories like his play out in physicians’ offices across the United States every day. In fact, businesses based on health care haggling have started popping up. Alex Fair created faircaremd.com, a Web site that allows patients to search for lower prices on a medical procedure in their area.
“It is a limited communication system that enables doctors and patients to work out something that is fair,” Fair said.
Alex got the idea for faircaremd.com when he was laid off from work, yet still had to provide medical care for his children. Alex believes his site takes the tension away from patients haggling with their physician’s office face-to-face.
Some patients who haggle with their physician are using Web sites to look up the “blue book value” for a procedure in their area—healthcarebluebook.com, changehealthcare.com, outofpocket.com, and myhealthscore.com. These types of Web sites give patients a realistic idea of what to ask for when negotiating.
FROM THE PHYSICIAN’S SIDE
Vijay Goel, MD, a principal with Southern California-based Goel Insights, says that in an era where patients pay a substantial portion of their bill, physicians need to keep cost in mind and to negotiate rates. He says it is helpful for physicians to list their services and the price that goes along with them.
“Right now, there seems to be this process where a physician submits the chart to the billing organization and that billing organization seems to pick the most expensive code. That may work in an era where the insurance company pays for everything, but in a place where a patient needs to pay and can get substantial sticker shock, they find that the patient just doesn’t pay anything at all,” Goel says.
While Goel’s understanding of medical billing may be flawed, it does represent the views of many consumers.
Some patients are even haggling by proxy. When dealing with a high bill, patients will outsource the haggling to companies such as myinsnet.com, medicalcostadvocate.com, and billadvocates.com.
A DIFFERENT POINT OF VIEW
- Do not give patients different prices for your professional services.
- If a patient can prove they are going through hard times and cannot afford to pay their bill, you can offer a professional hardship discount courtesy, which is not based on negotiations.
- Determine, practice-wide, an objective standard upon which to base fees reductions.
- The process for determining a discount must be objective, documented, and consistent.
Chicago-based optometrist S. Barry Eiden, OD, FAAO, says the only items he will budge on are items that are not billed to insurance—for example, a pair of eyeglasses.
“A patient told me that they went to one of their other doctors and tried to work out a deal with them and the doctor did it,” Eiden says. “The doctor said, ‘Well, you are a good customer; you really did your research. I am going to do this procedure for X dollars even though my usual fee is otherwise.’ I said to her I could never do that because what if I do that for you and then somebody from across the street comes to me and they paid much more. I could look terrible. I think it is a very bad thing to do.”
Plastic surgeon Barry Weintraub, MD, FACS, will not haggle with a patient, either, remarking that his training and decades of experience is not something that can be reduced. “We try to explain to the patient that it is not like buying a pair of shoes. It is basically artwork on a human being. The medium just happens to be living,” He says.
IF YOU ARE WILLING TO CONSIDER NEGOTIATING FEES
Roslyn Stone, COO of Corporate Wellness Inc, Mount Kisco, NY, says it is really important to not give patients different prices.
“There is some equity here. You don’t want to leave yourself open to being discriminatory. And the bottom line is I don’t think there is a physician out there that doesn’t want to be fair,” Stone says.
“Above all, I believe the most important thing is consistency and not to wheel and deal on a per-patient basis,” Eiden notes. “If they start getting into individual dealing, like a car dealership where one person can walk in and spend X amount of dollars and the next person walks in and spends $1,000 more for the exact same thing, I think that is a really slippery slope that can only get you into trouble.”
Many physicians agree the only time the table should turn is when a patient can prove they are going through hard times and simply cannot afford to pay their bill.
“If they truly show financial hardship, we can give them a professional hardship discount courtesy—not based on negotiations. They really have to show us hardship,” Eiden adds.
Medical practices need to determine an objective standard upon which to base fee reductions. In addition, the process for determining whether or not professional fees should be discounted must be objective and consistent.
Some offices ask patients requesting fee reductions to sign a document stating that they are unable to fully pay for the medical care. Other practices ask patients specific financial questions in order to determine the appropriate fee reduction. The method is less important than the process.
Instead of offering a price reduction, physician’s offices may want to offer various payment options to their patients. Consider allowing the patient to make several payments instead of one large payment. Many physicians work with organizations such as CareCredit to help patients finance medical care.
The time frame in which a patient has to pay for medical care can become another variable physicians can use to address requests for fee reductions. For example, tell the patient, “I am sorry that I cannot reduce the fee, but I can work with you on the payment.” This sends the message that the practice is looking for ways to accommodate the request and is not offended by the patient’s request.
Much like fee reductions, the alteration of payment terms should be done by an established policy. The policy might be that full payment is due within 90 days or that the fee can be paid in equal monthly payments. Again, objective and consistent standards should be applied.
Your practice should also have a set policy in place that addresses patient requests for fee reductions. By having a policy in place, your staff will benefit by clearly knowing how to respond and all patients of the practice will be treated fairly. An appropriate policy can prevent future headaches and possible legal chaos while promoting efficiency.
Michael J. Sacopulos is a partner with Sacopulos, Johnson & Sacopulos, in Terre Haute, Ind. His core expertise is in medical malpractice defense and third-party payment disputes. Sacopulos is also the general counsel for Medical Justice. He may also be reached at .