Healthcare Payment Negotiation

Negotiate Healthcare Charges and Payments

What is this service?
Do you know healthcare services do not have fixed prices?  Providers are free to charge what they want, and those charges vary considerably.  Hospitals and doctors do not display their rates for each service they perform because they do not have to.  Even more important is the fact that most often providers do not get paid the amounts they charge.  The amounts providers are actually reimbursed for their services are the result of negotiation between providers and payers.  That means a provider performing a service will be paid different amounts for the exact same service from different payers.   If you are insured, your insurer negotiates the payment to your provider, usually once a year.  But if you are not insured, no one negotiates for you.  You have no contract with the provider so you are going to be charged higher rates.  Only Maryland regulates the prices providers can charge a person who has no contract with the provider.  If you have no contract with your provider, Smart Health Decisions can help you negotiate your medical charges and payment plans.

How do consumers benefit from this service?
Negotiating provider charges and payment schedules is good for you.  It results in you paying less for your healthcare services, more money in your pocket, and a payment similar to other payers in the hospital’s pocket.  It increases the chances that you will successfully pay your bill, protects your financial history and credit ratings, and helps you avoid collections harassment.  Consider the typical markup for hospital services is about 3 to 1.  That means for every $1 a procedure costs, the hospital will bill you about $3.  The markup for insurers is much, much smaller, typically 10 to 30 cents on the dollar.  Providers seek to make a profit of about 200% on individual payers and 10% to 30% from insurers.  There is a lot of bargaining room between mark ups of 300% and 10%. (Associated Press, 2008.)

When should healthcare consumers use this service?
Negotiate directly with your provider before you receive services for costs insurance does not cover.  Three out of five adults who bargained got a lower rate and 70% who talked to the hospital got a reduced fee.   It is particularly important to negotiate when facing a big bill.  (Harris Interactive Poll, 2008.)

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