Are you happy paying thousands of dollars in healthcare costs you don't use? Are you angry at the medical bills you incur for services that should cost a fraction of that amount? Are you looking for answers?
This week we interview a healthcare industry insider, Scott Heiser. He spills the secrets on what is actually causing the problems in our system. He also gives us some simple tips and tricks to save yourself thousands of dollars with only a few minutes of your time.
Wall Street Insider Secrets: How to Negotiate Your Healthcare Costs To Save Yourself Over $10,000+ In Only A Few Minutes
By Scott Heiser
If you’re not unhappy with the escalating costs of healthcare, you should be. You are paying for all the increases, whether it’s through your premium (which usually goes up every year), or increased out-of-pocket costs through deductibles, coinsurance, or co-pays. If it were any other consumer good, people would be boycotting or buying alternatives. Yeah, yeah…I know what you’re saying, “My healthcare is not a 12-pack of beer, a TV, or a car. I’m not willing to challenge individuals entrusted with my care.”
That’s one of the main reasons we are where we are! If you’re like most, you’re a passive participant in the system. Third parties, insurance carriers, the government, your employer, hospitals, and doctors have been making the decisions for you.
That’s about to change. The revolution is going to start with you. I’m not suggesting storming the ramparts and single-handedly taking on the healthcare industrial complex. What I’m talking about is taking an active role—one you’re entitled to—in the purchasing of your healthcare at the point of service. We’ll start small and work on areas that you’re comfortable working with and in which you can make a difference.
As your confidence grows through knowledge and practice, you will grow into a healthcare consumer and that will impact your life. The more knowledgeable you are, the more confident you’ll be. Better communication and mutual respect flow out of that confidence, which allows you to start negotiating prices with your healthcare provider.
Before we become healthcare negotiation gurus, let’s answer an important question.
Why is Healthcare Consumption Treated Differently?
Common reasons include the following: it’s too complicated! Doctors spend years studying, so how can I begin to understand or second-guess them?
My insurance company takes care of all that. I don’t want to mix money discussions with my health situation; I’m sick and want to get better—that’s it! I’m not qualified.
I don’t know what it costs until after I receive the bill. Doctors never talk about the cost. What if I make a mistake and offend my doctor, my caregiver?
A faculty radiologist at one of the top thirty medical schools in the country said it this way, “Since the 1950’s, medicine had made spectacular advancements: antibiotics, organ transplants, vaccines, birth control in a pill. Medicine became transformative. They were miracle workers. The generations growing up in the fifties, sixties, seventies, and eighties grew to expect miracles from their doctors. You don’t question miracles.”
A new report in JAMA published in March of 2018 comparing the US with the highest income countries in the world, points out the US spends far more per capita on healthcare when compared to other countries but has less in healthcare outcomes to show for it. In defense of the US, there are mitigating factors including a more diverse population, freer, quicker access to care, and a litigious environment—but we still spend more on healthcare. We don’t ration our healthcare like other nations.
Fortunately, the environment is changing in the US. Transparency is driving options and causing the system to reevaluate the efficacy of the treatments being performed. Options are beginning to exist, and it’s our job to find them when they do and when they are appropriate, partnering with our providers to find the most cost-effective solutions.
President Clinton appointed a commission in 1997 to draft a “consumer bill of rights” for the healthcare industry. Although never fully adopted and subsequently watered down by the American Hospital Association, it directed healthcare professionals to provide consumers with easily understood information and the opportunity to decide among treatment options with an informed consent process.
Specifically, with regard to treatment and costs, it stated:
Discuss all risks, benefits, and consequences to treatment or non-treatment.
Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
Disclose to consumers factors—such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience—that could influence advice or treatment decisions.
The good news is the budding transparency movement offers the meat to enact those initiatives highlighted in 1997. So, let’s get going.
Basic Concepts of Healthcare Consumerism
Let’s start with the basics on how to become an involved consumer of healthcare.
- Know your objective. Why are you seeing the doctor? Why did you pick that doctor? What do you want to get out of the appointment?
- Be prepared. Do your homework. Who is the right provider to address your issues? Bring your health record. Identify your symptoms in detail.
- Develop questions. Write them down in a checklist.
- Communicate efficiently and on a factual basis. Listen with an open mind.
- Ask about treatment plan options and cost. Tell them you are paying for the care.
- Don’t be afraid to talk about second opinions or seeking alternative cost solutions or cash flow options. Understand how they’re paid, by whom, and for how much.
- Research alternatives and search for the most cost-effective care.
- Re-consult with your caregiver regarding your findings. Solidify an action plan.
- Seek out advocates who can help you organize, listen to, and speak with your caregivers. Look to family, friends, even concierge case managers provided by your health insurance carrier.
Questions to Ask When Negotiating
As you begin to think about trying to negotiate with providers on cost, remember one key factor: doctors are people, too. They know the pain of paying for healthcare. They are trained to recognize and understand when patients need financial help.
Your primary care doctor needs to be involved in your financial well-being, and many of them will be—if you ask. Here’s a list of questions to begin asking your caregivers:
- If your diagnosis is complex and treatment is extensive and/or invasive, ask for all available options, their outcomes, and their cost. Ask for referrals of those they successfully treated. Ask for referrals for second opinions.
- When shopping for alternative care, tap into the transparency tools. Costs can vary wildly even in the same city (MRIs from $650 to $1,350 in the same town). Look also regionally and nationally for the best costs and outcomes. For example, if the average cost for knee replacements in San Francisco is $61,817 versus $27,674 in Detroit, it may be worth traveling.
- If you’re challenged by deductibles, co-pays, or out-of-pocket costs, ask providers (hospitals/physicians) for payment plans and discounts for paying up front.
- For example, an individual opted for a High-Deductible Health Plan with an HSA. She had a chronic condition requiring costly monthly medication, which caused short-term cash flow challenges. Her physician agreed to a monthly payment plan that stretched her deductible payment over twelve months instead of her having to pay all at once. She was even granted a discount on the amount owed if she paid the last three months at once!
- Ask out-of-network providers if they’ll offset increased out-of-pocket charges.
- Doctors and hospitals generally reduce their retail rates by 45 to 50 percent for major health insurance companies. Ask what they’ll do for you.
- Ask if there is a further discount if you pay cash.
- Check the place in which a treatment or procedure is being performed.
- Outpatient services aren’t always less expensive.
- Diagnostic testing services performed by the same provider are convenient but often more expensive.
- Scrutinize freestanding health facilities. You may think you are at an urgent care facility, but it may be an emergency room extension of a hospital. Charges are significantly different!
- Ask for detailed hospital invoices listing all services upon checkout and look for duplicate charges and services not performed.
- If you end up reducing the bill, share your story with your HR department.
- If you used an “in-network” hospital and doctor, make sure all the hospital charges are “in-network.” Oftentimes, certain medical practices at an “in-network” hospital are actually out-of-network. Thus, they’ll cost you significantly more in deductible costs and non-discounted rates.
- Try to clarify with the hospital how all the charges will be assessed before the treatment. A perfect example is the anesthesiologist. They are often not covered as “in-network” providers and are expensive. Your approach should be that you have complied with the insurance plan and attended an in-network facility that does not make all services available on an in-network basis. How can you be liable for that?
- Question them: should you have gone to another hospital to have the anesthesiologist perform their service before your surgery at their hospital? Stand your ground with the hospital and insurance carrier.
- If you have already received care and are now facing unmanageable medical costs, you may want to hire a billing advocate. This type of advocate will normally charge for their services but may be able to save you thousands. They can either charge an hourly rate, generally $100–$200 per hour, or a percentage of the savings from your bill, usually 25–35 percent. You can find patient and medical billing advocates through the National Association of Healthcare Advocacy Consultants or the Alliance of Claims Assistance Professionals.
- Ask for charity care if you’re uninsured and at a nonprofit hospital.
- ACA mandates all nonprofit hospitals have a written charity care policy.
- Individually, you may qualify for discounted or waived charges.
- Regardless, no uninsured individual may be billed for more than the discounted insured rates accepted by the nonprofit hospital.
Negotiating is About Relationships
Again, you don’t want to walk into your doctor or hospital and be a belligerent jerk. You are all looking for the best outcome. You have the right to ask questions, and, as you can see, there isn’t just one simple, cast-in-stone fee for every service.
There is, like any other service industry, a range of options and costs. Remember this and this alone: cash is king. By reducing billing and collection issues, streamlining payments to providers, knowing that discounts are available, and confirming the services billed were performed, you may be able to receive discounts or more favorable treatment. You must ask, research, and audit to achieve.
For more advice on negotiating your healthcare costs, you can find the book Healthcare is Making Me Sick on Amazon.
Scott Heiser has more than twenty years’ experience as a consultant for clients in the insurance and healthcare system. Scott was a partner and owner of a commercial insurance brokerage, in which he led and developed an employee benefit practice that managed more than half a billion dollars in health benefits. Scott is a strategic innovator who knows the ins and outs of what can feel like the overwhelming world of healthcare and insurance. Today, he is dedicated to sharing his knowledge to help educate and empower his readers. His goal is to improve your health outcomes while lowering your costs. To get started, visit www.UncoveredHC.com.
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Today's Guest: Scott Heiser
Scott Heiser has more than twenty years’ experience as a consultant for clients in the insurance and healthcare system. Scott was a partner and owner of a commercial insurance brokerage, in which he led and developed an employee benefit practice that managed more than half a billion dollars in health benefits.
Scott is a strategic innovator who knows the ins and outs of what can feel like the overwhelming world of healthcare and insurance. Today, he is dedicated to sharing his knowledge to help educate and empower his readers. His goal is to improve your health outcomes while lowering your costs. To get started, visit www.UncoveredHC.com .