“Is That the Best You Can Do?” Physicians, Patients, and Haggling Over Professional Fees

July 5, 2011

Alan Weinkrantz of San Antonio, Texas is a healthcare 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; everything else he pays for 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 up to our own responsibility to do that because health care is getting out of wack,“ Weinkrantz said.

Alan is not alone. Stories like his play out in physicians’ offices across American every day. In fact, now businesses based on healthcare haggling are popping up. Alex Fair created faircaremd.com. It is a website 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 are haggling with their physician are using websites 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 websites give patients a realistic idea of what to ask for when negotiating.
Vijay Goel, M.D. a principle with Goel Insights says, 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 said.

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 outsource the haggling through companies like myinsnet.com; medicalcostadvocate.com and billadvocates.com.

Some Physicians Have a Different Point of View

Optometrist Dr. S. Barry Eiden, OD, FAAO of Northern Chicago says the only items he will budge on are items that are not billed to insurance, for example a pair of eye glasses.

“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. 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 can 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,” Dr. Eiden said.

Plastic Surgeon Barry Weintraub, MD, FACS will not haggle with a patient either. Dr. Weintraub says 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 art work on a human being, the medium just happens to be living,” said Weintraub.

Recommendations for Those Physicians Willing to Consider Negotiating Fees

Roslyn Stone the Chief Operating Officer of Corporate Wellness Inc. 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 physicians out there that doesn’t want to be fair,“ Stone said.

“Above all I believe the most important thing is consistency and not to wheel and deal on a per patient basis. 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 a $1,000 more for the exact same thing I think that is a really slippery slope that can only get you into trouble,“ Dr. Eiden said.

Many physicians agree the only time the table should turn is when a patient can prove they are going through hard times and truly can not afford to pay their bill.

“If they truly show financial hard ship we can give them a professional hardship discount courtesy, not based on negotiation but they really have to show us hard ship,” Dr. Eiden said.

Medical practices need to determine an objective standard to base fees reductions upon. 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. The process for determining whether professional fees should be discounted needs to be objective and consistent.

Instead of offering a price reduction, physician 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 Care Credit to help patients finance medical care.
The time within which a patient has to pay for medical care can become another variable physicians can use to address requests for fee reductions. For example, a patient may be told, “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 four equal monthly payments. Again, objective and consistent standard should be applied.

Physician offices should also have a set policy in place to address patient requests for fee reductions. By having a policy in place the 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.

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