How do you negotiate a bill for medical services already rendered?

November 12, 2009 7:09 AM

What approaches have worked for you to reduce the size of a medical bill after services have been rendered?

A friend went to her gynecologist after getting an abortion. Among other tests, the office ran STD tests that wound up costing over $900.

Clearly there's been an exchange of fluids if there's an abortion, so it just makes sense to test for STDs. However, her insurance only covered catastrophic injuries etc., not "routine" tests, which these were considered. None of these tests were covered by her insurance.

She did not realize this, though of course she should have, is an adult, and is ultimately responsible for the bills. I recognize that, but I'm still ticked off about the situation. The health clinic in the area offers free STD testing. Every doctor I've ever been to knew exactly what was covered by my insurance, and how much they would be getting, before providing any services to me.

I feel like her doctor's office failed to take her total well being into account. I think they took advantage of her lack of understanding the situation and essentially robbed her. I'm assuming they had no legal obligation to mention any alternate places to get the testing done, but I'm certain they had a moral one, and I'm kind of furious about it.

Hopefully the above venting also provided sufficient background for the question. I've seen previous threads that talked about how medical bills can be negotiated. Is this a case where negotiating is possible? What tactics would you recommend or have worked for you in a similar situation in the past? Who, title-wise, should she insist on speaking to?

posted by anonymous to Health & Fitness (6 answers total)

Many times doctor's offices have a different price for people with insurance and without. All you need to tell them is that the insurance does not cover these procedures and they can give a reduced cost.
posted by JJ86 at 7:23 AM on November 12, 2009

Also, to add to what JJ86 said, sometimes the box that the Dr's office checks makes a big difference. They can often refile under a different code that says the same thing and get paid.
posted by JohnnyGunn at 7:30 AM on November 12, 2009

Her doctor's primary concern is her health; it was really up to your friend to speak up if she thought her insurance company wouldn't pay. I can promise you that the physician who recommended the tests likely has no idea what her insurance coverage is. The billing manager may have, but the doctor? Probably not.

It's a definite possibility that they will write off some of the costs if she calls and asks to speak to the billing manager. She should be able to tell them exactly how much she can pay and when before entering into the conversation, rather than approaching it with an open-ended, "Can you help me?"
posted by something something at 7:39 AM on November 12, 2009

One thing you can always negotiate is the terms of the payment...breaking the big bill into a "payment plan" of monthly payments.
posted by radioamy at 8:13 AM on November 12, 2009

I'm betting that the $900 is not all to the doctor's office. Quite frequently when you get tested at a gynecologist's office there's one bill for the doctor (with no insurance, I'd guess this could run from $100 - $300) and a totally separate bill from the lab where the testing was done. In my experience, the cost of the lab portion is higher than what the doc charges, *particularly* if you don't have insurance. I'm betting that the doctor and her office don't even have a clue what the lab charges; those fees would be negotiated directly between each insurance company and the major labs (LabCorp and Quest Diagnostics, both publicly-traded for-profit corporations, being the ones who have most of the market) or the hospital lab.

She'd have to negotiate the bill for the lab tests with the people who provided it, and the negotiate with the doctor's office for any fees related to the doctors time separately. The doctor will likely not have any control over how much the lab charged for running the tests, and the lab probably won't care what the doctor told (or didn't tell) you about costs. There's no harm in calling up and at least asking, but be aware that it's not just the doctor you'll need to be talking to.

A similar thing happened to me when I was a teenager--went in for a physical, the gyno (I can only assume) didn't believe me when I told her I wasn't sexually active, and ordered a chlamydia and gonorrhea screening on top of the regular PAP screen. I received a bill from the lab a few weeks later for something like $300, which was totally out of reach at 16. When you're naked on that exam table and the doc is "asking" to run a test in a way that doesn't seem much like a question, it's hard to really realize you can say no or go home to cost-compare at other places.

I ended up switching doctors, which may be the best course for your friend as well. I think there are some docs/practices that are sensitive about the financial burden on their patients, and are pro-active about letting patients know what things will cost and making sure patients can pay before running tests. Other docs really feel that it's unethical or unseemly to let money concerns impinge on their practice of medicine, or have just never really thought about it. If your friend has a doc of the second type, she might be better off just finding a new doctor who is aware and pro-active about the issue so this doesn't happen again, especially if she's uninsured.

I'm sorry. I remember how distressing and angry the situation made me, and it sucks.
posted by iminurmefi at 8:45 AM on November 12, 2009

Call, call and call again. Be persistent. That's how I managed to cut a set of bills resulting from an accident from $50,000 down to about $7,500.
posted by randomstriker at 10:19 AM on November 12, 2009