Haggle, Don't Settle, When It Comes To Health Costs

Sep 6, 2011

Seems like forever that Consumer Reports has been telling people to haggle over the price of a microwave or a car. Now the folks behind the magazine want you to haggle with your doctor — or at least let her know that you can't afford that bypass.

The cost of health care is expected to almost double in the next decade, and insurers and employers are increasingly shoving that cost onto individuals. As a result, even people with good insurance are finding it harder to pay medical bills.

Shots talked with John Santa, an internal medicine doctor who directs the magazine's Health Ratings Center and wrote this call to medical bargain shopping. He says it's the first time the organization has advised people to dicker with their doctors, he says. And he understands why some people would rather have a colonoscopy than tell their doctor they're having money trouble. Still, he says, "Your doctor needs to know about the stresses in your life."

Doctors' No. 1 frustration with patients is that they don't do what the doctor tells them to do — take the medicine or follow through on treatment. Very often that's because patients can't afford the medicine or treatment. Santa says a doctor really wants to know if money is tight, because there are many treatment options that are just as good if not better, and also less costly.

He cites the diabetes drug Avandia, which got slammed by the Food and Drug Administration for posing heart-attack risks. Patients would have been much better off taking metformin, a cheaper drug without the risky side effects. He suggests starting the conversation with something general, like: "Let me know where I might be able to save on this treatment. That would really help me."

Doctors and other health-care providers also have an ethical obligation to put patients' financial situation ahead of their own, he notes

Talking with the doctor about costs before treatment is the best bet. But it's still OK to negotiate after getting slammed with a big bill for a high-ticket item like coronary angioplasty, Santa says. Hospitals and doctors usually offer discounted rates to insurance companies, and there's no reason that an individual couldn't get a discount, too.

Consumer Reports' advice includes disputing any charges you think the insurance company should pay, and holding off on payment until you've exhausted all options. The nonprofit also suggests offering a discounted price with a payment plan that you know you can manage.

One of the biggest hang-ups in shopping for helath care is that it's hard to find out the real price. There's no Google Shopper for hip replacements. But the Healthcare Blue Book is a good start. This free service provides at least an inkling of what the going rate might be for that hip replacement ($20,566) or dental crown ($959).

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