Negotiating for medical services

When you have an insurance policy, the rates that you pay for services have already been negotiated between the provider and the insurance company.

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With a few negotiating skills and some research effort, you can pay less for the medical services you receive.

We all know we need health insurance. If we're caught without it and something catastrophic happens to us, the financial devastation can last for years. There are many very affordable options available. Generally speaking, the higher the annual deductible and out of pocket maximums, the less expensive the plan will be. The more risk an individual is willing to take, the more that an individual can save. Want to save even more?

Try negotiating your own rates for medical services.

When you have an insurance policy, the rates that you pay for services have already been negotiated between the provider and the insurance company. This means that you are paying a discounted rate simply because you have the insurance. You will ultimately be billed for your share of costs referred to as "patient responsibility" noted on your Explanation of Benefits (also known as an EOB). Many think that this negotiated price is better than a price that they could get if they negotiated themselves. This is not always the case. This is where we all have the ability to take control of our healthcare spending. With a few negotiating skills and some research effort, you can pay less for the medical services you receive.

Understand your plan benefits.

Know what your annual deductible is, out of pocket maximum, coinsurance percentages and applicable copayments. The more you know about how your plan works, the more you'll know just how much you can save when you start negotiating. Did you know that not all plans out of pocket maximum include the annual deductible? This is an area that you should definitely pay attention to.

Always stay in-network.

Unless unavoidable, do not visit a doctor, hospital or any other health care facility unless they are specifically contracted as an in-network provider associated with your insurance company and the specific plan you have. All carriers today have online access where you can locate in-network providers that are contracted. If a specific doctor is not listed, chances are they are not contracted which means you pay a higher cost for services. Click here for provider information

If you encounter an unexpected out-of-network hospital visit where you don't have time to research costs and providers, it may be worth some extra effort to do further negotiating after you receive your bill. In some instances, you can get this amount you owe reduced. Talk to the doctor, the hospital and the insurance company.

Compare in-network pricing.

This is the big one. Most of the insurance companies now are displaying price information online for medical procedures and services. If you can't find this information online, call the specific insurance company. Tell them what medical procedure, test or surgery you are planning, and get pricing. Take that information and compare that with what other providers would offer. Then take it a step further and talk to your doctor. See how much it would cost you for that medical procedure, test or surgery if you were to pay cash (also known as "self pay") and not involve your insurance. In some instances, you could be pleasantly surprised. Also costs for various tests and procedures can vary by zip code. Visit http://www.healthcarebluebook.com where you can get some pricing information by zip code and procedure that you can use as a guide when you're comparing.

Paying the medical bills when you have insurance.

Be sure you pay only the bills that match the "patient responsibility" amount on the Explanation of Benefits that you'll receive from your insurance company. You may need to add a couple or a few bills together to match the amount that is your responsibility to pay. If you cannot reconcile the bill(s) with the Explanation of Benefits, make a phone call to your provider. They are the ones who initially file the claim for you. If you happen to overpay on a bill, it's very difficult to get that money back.

One last thought.

We are in the midst of health care reform. There is a lot of work that needs to be done to improve the quality of our healthcare system. Our biggest challenge is controlling the costs of care. If every consumer was more proactive in their efforts to reduce costs, the system would be improved at a much faster rate. Having insurance is essential we all know but remember, just because it's a negotiated rate, doesn't mean there isn't a less expensive option available to you.

If you need assistance with individual and family plan options and enrollment, call us today at
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