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Doctor discounts: Do surgery on your medical bill

/ Source: Kaiser Health News

Looking to save money on health care? Consider asking your doctor for a discount.

That's what Shelly Gordon of Palo Alto did. Gordon, who has a Blue Cross health plan with a $5,000 deductible and a $500 monthly premium, buys her own insurance since starting her own public relations and communications firm. When she had her annual checkup, she learned that it came with a $350 price tag.

Gordon explained to the doctor that her insurance would not pick up any of the expense because she had not yet met her deductible and that the payment would be a financial struggle for her. So the doctor removed a few routine tests from the bill, saving Gordon about $125.

"I asked the doctor directly for a discount and she agreed," says Gordon, 57. "Given what I was paying and how ridiculous it was, I just got in the habit of asking all my doctors."

Gordon's situation is far from unique. As monthly insurance premiums, deductibles and co-payments increase, even people with insurance can have trouble paying their out-of-pocket medical expenses.

Rising premiums also have prompted more people to choose high-deductible plans that require payments of about $1,200 or more before insurance will cover a dime for medical care. Employers too are turning to this option for workers. According to a recent health insurance report from the federal Centers for Disease Control and Prevention, about 20 percent of Americans with employer-provided coverage and 47 percent of those with individual coverage were enrolled in a high-deductible plan in 2009.

"It's very difficult for consumers to control their healthcare costs," says Betsy Imholz, director of special projects with Consumers Union. "But that's not to say it's not worth trying."

Adds Carrie McLean, a consumer specialist with the online insurance broker "Do your homework and negotiate upfront … It's better than trying to do it once it's already happened."

Here are some tips to help get the best price on medical services:

Understand treatments

"The best way to save money is to avoid care you don't need," says Dr. Jeffrey Rice, founder of the Healthcare Blue Book, an online consumer guide to fair healthcare prices.

Researchers with the Dartmouth Atlas Project have found that as much as 30 percent of healthcare is unnecessary. Such unneeded care is caused by many factors, Imholz says. "It could be duplicative things, like two mammograms because you got referred to another place that did it again because they didn't have the first mammogram readily available. Or it could be an intervention you didn't need and would have been better off without. The problem is we're not used to thinking that with healthcare less can be more."

Candice Butcher, chief executive of Medical Bill Advocates of America, advises patients to ask their doctors precisely what is involved in the procedure, what it will be used for and if there are options. She also recommends getting a second opinion about the need for the treatment.

Although that can add some initial cost, it may save you more overall.

Find the best price

Ask your doctor, hospital or other provider up front how much you'll be charged for the medical service you need. Prices vary greatly among healthcare providers. A recent survey-of-charges report by the insurance industry trade group America's Health Insurance Plans found that some doctors charged patients who did not have insurance as much as 1,000 percent more than the Medicare reimbursement rate for the same procedure.

When negotiating for a better price, remember: Cash is king. "Some providers will give anywhere from 10 percent to 60 percent off for paying cash," McLean says. "It saves them time in having to bill you or set up a payment plan."

For those staying within an insurance network, it is also important to ask the doctor or hospital about price. Insurers have a separate contract with each provider in their network that establishes how much they'll pay for medical services. Providers with stronger negotiating power tend to be paid more than others for the same medical procedure. If you are picking up a share of the cost for the visit or procedure, finding the facility that gives your insurer the best price will save you money.

"Even people with managed-care plans who understand that it's cheapest to see a doctor or have surgery at a hospital that is in their insurer's network don't often realize that even in-network prices can vary by as much as 500 percent," Rice says.

Also, if you have insurance but the procedure is not covered by your policy, ask the medical center to give you the same discount it gives to your insurance carrier.

Location, location

Setting makes a big difference too.

"If your doctor sends you to the hospital for imaging or labs, you'll pay significantly more on average," says Rice, pointing out that freestanding ambulatory centers and doctor's offices are typically less expensive.

To make sure you're comparing like services, ask your provider for the CPT code, or common procedural terminology. These codes are assigned to every medical service and procedure and are used by healthcare providers to bill insurers. Call your insurance company to find out how much they reimburse and what you’ll be responsible for paying yourself.

Also, you can look at a federal website for a tool that compares hospitals. Among the listings there is data on what Medicare pays individual hospitals for some common procedures. This can be a helpful guide for non-Medicare consumers, but they should expect to pay about 25 percent above the Medicare payment.

Get it in writing

After you've reached an agreement with your doctor or medical facility, get that price in writing.

"Most provider organizations don't do their own billing; it goes to a billing company. If they agree to a discount in the doctor's office and there is staff turnover, the information may not get to the billing department or they may not remember," Rice says.

Butcher suggests consumers write that they "agree to pay fair and reasonable costs, and for compliant billing," in the financial responsibility section on hospital admitting forms. This can help to deter hospitals from engaging in unfair billing practices, such as charging for items such as sutures and cotton balls that should be included in the price of the hospital room. "Put your initials [next to the statement] and have the administrative personnel sign and date it as well," she says.

Having this kind of documentation, Butcher says, will make it easier to fight any unfair charges after you've left the hospital.