) -- While a Nevada candidate's suggestion of bartering for medical care was the butt of jokes -- "In the olden days, our grandparents, they would bring a chicken to the doctor," Republican Sue Lowden said in April -- haggling over medical bills is starting to become an accepted strategy.
The potential prize: medical tests and procedures for half the cost.
Faced with high-deductible plans and uncovered procedures, even those with health insurance are facing increasing out-of-pocket expenses. But the uninsured, bereft of the clout of big insurance companies -- among them
-- can pay up to 2.5 times more for the same services.
As a result, and with unemployment rates at an all-time high, one in five Americans chose not to seek medical care for a recent illness or injury, according to a recent
survey. Four out of 10 cited cost as the primary factor.
Angie Hicks, founder of
, a site that posts consumer reviews on doctors, dentists and service companies, says negotiating over medical care is a trend in its early stages.
In a May poll of 1,237 Angie's List members, 57% said they have never negotiated a medical bill. Nearly 25% didn't even know they had that option. But, of those who did negotiate, 74% did so successfully, with some reporting that they cut their bill in half.
More than 40% of those who bargained with their medical provider said they did so because their insurance didn't cover as much of their bill as they had expected.
"By no stretch of the imagination do we just suggest that you should shop your medical treatment only by price," Hicks says. "But there are ways you can shave some dollars off your expenses without impacting quality at all."
"The health care community has been negotiating with insurance companies forever," she says. "Negotiation is not foreign to them at all. The difference here is that consumers are sitting in the pay seat more today than they used to be, so it is just changing who is doing the negotiating. Consumers should feel comfortable asking these questions."
"It is very hard to get a fair price if you worry about it after you get your care," says Dr. Jeffrey Rice, CEO of
. "It is like buying a car and waiting for them to send a bill in the mail before you know what you will be paying."
P/>Getting a grip on what a specific procedure should cost is a challenge for medical consumers.
Last year, Rice launched his site, as well as a customized application for employers, with that need in mind. It offers pricing data for health care services, allowing visitors to search by type of doctor, procedure, hospital and other criteria to find out what a fair price is in their area.
The data is based on an average of the negotiated fees health plans pay to their network providers for a service in a specific market.
"What most people don't know is if they need something simple, like an MRI or a colonoscopy, the in-network price that they will ultimately pay is going to vary by at least 300% and probably 500% or more," Rice says. "That MRI's price variation, on an in-network basis, could be $600 at one place, while the exact same test across the street could be $3,000 or more. There is a huge price variation among the in-network negotiations that you are ultimately going to pay if you are on a high-deductible plan."
Those with insurance have somewhat limited bargaining power. Prices are negotiated between insurers and providers, and the highly regulated nature of the industry leads to little or no deal-making.
"But what you can do is determine what a fair price is and go to a provider who charges that fair price," Rice says. "You can save $2,000 or $3,000 by changing buildings. Most patients do not have to change their doctor at all, but they do need to get their doctor to consider the cost of where they do their services."
"The biggest thing is that patients have to feel absolutely comfortable asking their doctor about it," he adds. "It is completely appropriate and fair. Doctors want to help patients out. It doesn't do me any good to tell my patients to do this test or take this medicine if they can't afford it and they are not going to do it. You want to make sure your patients get the care they need and being cost effective is part of that."
Those without insurance, especially if they can pay cash upfront, may be able to reduce their bill by as much as 50%.
"You need to be willing to call around," Rice says. "It is a lot of work because it is not easy to get price quotes from hospitals. You will also have to call multiple places if you are going to have a procedure because you typically get three big bills -- one is the doctor, one is the anesthesiologist and the third is the facility."
-- Reported by Joe Mont in Boston.
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