How to Cut Your Doctor's Bills

Patients should haggle with doctors and hospitals to bring down medical costs.

July 28, 2009, 3:33 PM

Aug. 3, 2009— -- Eric Remjeske, 38, was skiing in Vail, Colo., this February when he missed a jump. The result: broken bones in both feet and the prospect of big medical bills. Remjeske needed a night in the hospital plus an orthopedic surgeon to put two screws in each heel. His health insurance required him to meet a $6,000 deductible and pay a 20% share of any expense after that.

So Remjeske, a financial planner, returned home to Minneapolis for surgery and set out to trim his costs. He got quotes from three different surgeons at three hospitals and tried to anticipate related expenses, like anesthesia and physical therapy. The estimates ranged from $14,000 to $18,000. He picked the University of Minnesota's hospital, which had the lowest estimate.

After the successful surgery, the bills arrived, totaling $16,000--more than what he'd expected. Remjeske fought back, objecting to specific hospital charges. The hospital agreed to strike a $500 charge for time in the recovery room, $200 for a leg-lifting device that Remjeske claims wasn't used and $800 in other charges, including the cost of physical therapy sessions that never happened. Remjeske says he missed out on the opportunity to get a deal on his sedation medicine because the anesthesiologist wasn't able to tell him the price ahead of time.

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"If you go in unknowing and come out unknowing, you could end up with an unbelievable bill," Remjeske says. As for the hospital, "We think we give the best care," says spokeswoman Jennifer Amundson, "so it's nice to know that we're also competitive."

Haggle with your doctor and hospital? These days you'd be crazy not to.

The rise in health care costs, and especially in the share paid by the patient, is giving people a lot more incentive to gather their courage to try to bargain down prices. Last year, an average insured family spent $3,350 on copays, coinsurance (the percentage that is the patient's responsibility), premiums and deductibles. That's twice the average of a decade ago.

Among the many uninsured patients, the ones who are not impoverished are getting skilled at negotiating. Patients pay cash for elective procedures like stomach-stapling or laser eye surgery, so these customers get in the habit of searching for bargains.

Don't try to lowball a doctor. Cheapskates beware: On, an online "virtual lounge" only open to physicians, many doctors scoff at the notion of negotiating prices with patients. "There is no negotiating," writes one family physician. "You'd better come with your credit card or cash." Doctors don't like it when they feel like they're being taken advantage of.

Instead, try to work out a reasonable deal in advance. Debra Snell, a co-owner with her husband of T&D Body Shop in Bowman, S.C., has Crohn's disease. Unable to get an insurance policy, she's skilled at shopping for care. She pays her gastroenterologist, Dr. Narayanachar Murali, accepts $35 per office visit, compared with $150 for a typical patient. For a scope of her lower intestines, she pays $400 rather than $750 (or $1,500 at a hospital). What's in it for Dr. Murali? Snell pays promptly and fills out her paperwork ahead of time. "Most uninsured people who see me," he says, "do this part of the work and get quality care at a very low cost."

Once you've gotten service, ask for the complete, itemized bill and look for mistakes. Double billing is common, says Candice Butcher, who runs Medical Billing Advocates of America in Salem, Va. Some of her tips include making sure you aren't being billed separately both for a room and for all the standard amenities in a room, like sheets and a toothbrush. Those who have had surgery should look for items like "kits" and "trays" and make sure there aren't also individual charges for specific surgical instruments. Ultimately you can get a 35% discount from the inflated list price just by challenging individual items, she says.

Other tactics include being aware of providers sending big bills and negotiating with the right person or people.

Not a negotiator? For those with bills more than $300, many companies will gladly handle that for you. Medical Cost Advocate in Wyckoff, N.J., and its competitors say they can get anywhere from 10% to 40% knocked off any kind of medical bill by using proprietary data, making legal maneuvers or simply by having a good track record with a particular hospital or doctors office.

These services require no retainer, but typically cost one-third or so of whatever savings are achieved. But you can also negotiate a lower fee with these companies--including and will charge as little as 10% of total savings if the bill is big enough.