Few people realize that in the murky world of medical billing, there is often room for negotiation. If you're paying providers from your own pocket because you have no insurance, have maxed out your insurance, or are seeking treatment out-of-network it's worth asking for a discount on services. Hospitals and doctors will sometimes consider accepting less than the full list price—after all, they routinely give substantial discounts when the payer is Medicare, Medicaid, or an insurance company. Even with an overdue bill, the provider may be persuaded to be flexible. Here are some bargaining strategies you can try.

1. Pay today.

Go to the billing office and offer to pay with cash or by credit card on the spot. “I would try for a 20% discount,” says Larry Gelb, CEO of CareCounsel LLC, a health-care advocacy firm. “Often they will be obliging because they have a big incentive to get it settled rather than to go through a long, drawn-out collection. If you tie it to a little bit of a hardship story, you will increase your chances.”

2. Disclose your family income.

You may be uncomfortable volunteering information about how much money you make, but if you're facing, for example, a $10,000 bill from a specialist, it might help to explain that your family of four lives on an income of $50,000. “Compared to the person with a net family income of $250,000, the health-care provider will look at those two people very differently,” says Marty Rosen, a former Aetna U.S. Healthcare executive and a cofounder of Health Advocate, a provider of health-care advocacy services to businesses and individuals. This is not a good strategy, Rosen notes, for families in an upper-income bracket.

3. Pile on the compliments.

“A lot of doctors really respond to schmoozing,” says Laura Valentine, director of client services at CareCounsel. When she approaches billers on behalf of a patient, she appeals to doctors egos with a bit of flattery. She suggests saying something like, “I really wanted to have my cancer treatment here because my friends and colleagues all say you're the best and the brightest. But I have limitations on my pocketbook. Is there any type of discount or anything that you can do?”

4. Use Medicare rates to your advantage.

Finding out what Medicare pays doctors and hospitals to perform a specific medical procedure will take a bit of research, but it is a gambit professional patient advocates frequently use. To do it, read carefully, because these steps are complicated: First ask your doctors office for the procedures CPT code, which stands for “Current Procedural Terminology” and is a code set developed and maintained by the American Medical Association (AMA) to ensure uniformity in describing medical, surgical, and diagnostic services. Next, go to the AMA websites CPT search engine to look up the Medicare payment for that procedure in your geographical area. (For example, the CPT code for one type of breast reconstruction surgery is 19361. Searching for the state of New York and the city of Manhattan, with the five-digit CPT code 19361, turns up a Medicare payment of $1808.76 for the procedure.) You can use that information in negotiating your non-Medicare rate, which you should do before the procedure. “Whatever you can do up-front is the best,” advises Valentine.

Not only will you have more bargaining leverage pre-procedure, but then, should anything change during or after the procedure, the hospital will also have a record that they cooperated with you before and will more likely be willing to cooperate again. For both hospital and doctors bills, a reasonable offer would be 25% above the Medicare rate, suggests Nora Johnson, the vice president and director of education and compliance for Medical Billing Advocates of America. If you are thinking about negotiating a hospital bill, however, consider hiring a professional advocate, since hospital bills are considerably more complex, Johnson adds.

5. Use your emotional state to your advantage.

You may be feeling a lot of stress, but calling an administrator from the hospital an idiot is not going to get you very far. Instead, say something like, “I am just so frustrated right now. My spouse is ill, and Ive been trying to deal with my health plan, but I really want to make sure you get paid too.” Chances are, “because of human nature, they will try to help you, unless you get someone who is very hard,” says Valentine.

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