Bill Negotiation

This week, I am going to be talking about Bill Negotiation.

Did you know that you can always negotiate your bill with a health care provider?

Did you know in some instances, it’s cheaper to pay cash than to actually use your insurance (depending on the insurance you have)?

Some insurance companies will reimburse you if you pay cash, but a lot of them you cannot. So that’s important to know.

Tips for ‘smooth’ bills and bill negotiations:

  1. Anytime that you’re going to do a planned procedure, whether it’s having a baby, knee surgery, hip replacement, or any of those things, you’re going to be taking your insurance card to the hospital. Do not rely on them to tell you whether they’re in-network or not.

This is because you’re talking to the person in the front, and unfortunately, they may not have a lot of training. And there are many different kinds of networks for insurance companies. You want to make sure that just because they say they take Blue Cross or UnitedHealthcare, it doesn’t mean they take your exact plan because there are so many plans.

  1. Doing your due diligence is vital. This is your money, and you need to call your insurance company ahead of time, and at the very least find out if your provider in the hospital is in-network. This will make a huge difference in your bill. If they’re completely out-of-network, and you definitely still want to use them, and your insurance isn’t going to cover anything, then I would highly recommend you go back to the facility and ask for the cash price.
  1. You don’t have to show your insurance card. Let’s take the instance above. You can go to the facility and ask to be a cash patient. You won’t get reimbursed, but sometimes it’s cheaper to do it that way. Not all facilities play nice with this option though. Some of them are much, much more willing to work with you. In fact, there’s a facility here in Austin, that will give you an 89% discount if you do not have insurance. And then there are other facilities that want a whole bunch of money upfront if you don’t have insurance.
  1. Part of your homework is figuring out how you’re spending the money. It’s your money. So you want to make sure you’re spending it in the right way, and not overspending. I’ve recently had a client that supposedly the hospital, the facility checked, and they said they were i- network, and they are not. And they are now receiving a bill for $174,000, which is absurd, considering that the average cost for that procedure in their area is only $35,000. So this is major, major upcoding, and major, major overcharging. This can be avoided. So now what’s going to happen in this situation (whether you used insurance or not), is you can do Bill Negotiating.
  1. There are services out there that help you with bill negotiating. There are some insurance companies that have that as part of the policy, which is really awesome because you have an advocate. But even if you don’t, you can call yourself and negotiate the bill. But there are some tricks to doing that. I am by no means I’m an expert, but having done medical billing in the past and running medical offices, I can tell you the number one rule.
  1. Number one rule: they’re much more willing to negotiate with you once your balance hits 90 days old. This is because that requires a lot more effort and a lot more time, and a lot more money for them to collect that balance. A trick you can do, which will sometimes work, is to offer usually no more than half of what it is. Now granted, depending on the size of your bill, you may not be able to do this. As an example, if owe you $5000, you could say that you can give them $2500 cash today, if you count this as paid in full. Some of them will take it and some of them won’t. Let another month go by and call them back and say I’ll now give you $2000 on that $5000. I can give you $2000 today if you’ll take it.
  1. Remember, negotiation takes time and patience on your part. But never ever pay full price. Many times these big bills are not your fault and you get surprised, but that doesn’t mean you can’t explain your case and negotiate. My clients always have the ability to call me, and I can point them in the right direction or if they’re unsure, I help them navigate the situation.

Billing is confusing but based on my knowledge of billing and my experience, I can help point you in the right direction and help you get a lower bill.

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Austin, Texas

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