Didn’t know you have to negotiate your hospital bills? Maybe you are a healthy person who rarely gets medical bills or deals with them when they do come. Two of my experiences have shown me that yes, negotiating is possible and has a significant ROI. But the bigger problem with that “solution” for lowering healthcare costs is time.
I live in a middle-sized town and had both my sons at a smallish hospital. I had insurance for both pregnancies and deliveries. I manage the bills at my house and when I got the one from the hospital for my maternity stay, I noticed the surprising offer: 20% off if you pay within 30 days. The bill was several thousand dollars and I had the money to pay right away, so I did.
Recently, I took my son to an “out of network” pediatric dentist. The guy was fantastic and getting two cavities filled took 10 minutes and only required nitrous gas, no Novocain. The payment conversation took twice as long: pay $70 now, bring in the rejection letter, sign the check over to us, refile the secondary insurance, wait for the second check. I had just interviewed Lisa Maki of PokitDok, so I offered to just pay in cash if they would give me a deal. The nurse said, “Oh honey, you have insurance, somebody will pay for it.”
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Expecting Obamacare to make healthcare affordable for all automatically shows that you haven’t really been paying attention to the details. When the healthcare reform bill was at the Supreme Court last year, I talked to several analysts and advocates who said that the bill was about improving access, not cutting costs. It would take another massive effort to cut costs. Also, ask a Republican about PCORI or IPAB. These are potentially cost-saving efforts that are part of Obamacare, but Republicans have been trying to tear them down as energetically as all the other aspects of the bill. And, of course, Democrats are too timid to defend either project. (Why do I think PCORI will reduce costs? Because often if patients learn about all treatment options, they often choose lower cost procedures.)
The biggest problem with negotiating is who has time for that? Can you imagine navigating the labyrinth of each provider’s billing office? If we had a cash-only system and didn’t have to change providers all the time, you could potentially develop a relationship with the nurse who knows all the codes and can find your file, but we are nowhere near that system.
Also, people who most need to negotiate a better price – the ones with high deductible plans – are not in jobs that allow them to hang on the phone for hours at a time – haggling about the price of a CT scan or a hospital stay.
There are startups working on the cost angle, even for scans. But until we do something radical like cut out the middle man or go to a single-payer system, the prices are not going down significantly.
