HSA for America

How To Negotiate For Less Expensive Health Care

May 9, 2011
Vol. 7, Issue 4

Keep an Eye Out for Over-billing

Forbes Magazine recently interviewed people who were able to lower their health insurance costs by being smart consumers.

For example, a Colorado skier had a $6,000 deductible on his health insurance when he broke both feet at a Vail resort.  Eric Remjeske had 20 percent co-insurance after he met that deductible, too, so he compared costs from three different surgeons at three hospitals.  He ended up having surgery at the University of Minnesota's hospital, which had the lowest estimate.  When the total exceeded what he expected, he scrutinized the bill and fought some charges.

The hospital took off $500 for time in the recovery room.  Remjeske also got them to remove a $200 charge for a leg-lifting device that he claimed was never used and $800 for other items, including physical therapy, that never happened.

Bills often include unnecessary charges.  Make sure that you get an itemized statement from the hospital, and always look for double billing.

Be sure you aren't billed separately both for a room and for standard room amenities like sheets and a toothbrush.  If you have surgery, look for items like "kits" and "trays" and make sure you aren't also charged for specific surgical instruments.  You can typically get a 35% discount from the inflated list price just by challenging charges.

Yes, You Really Can Negotiate Hospital Bills

We get used to so-called fixed prices here in the U.S., but when I was travelling in Morocco a few years ago I really learned do be wary of unmarked prices.  We once stopped for lunch at a little roadside restaurant that was nothing special, ordered off a menu without pricing, and were charged $75 for a lunch that should have cost $15.

This is kind of how health care tends to work here in the U.S.  Rarely do you see prices ahead of time.  Todd Roscoe, a former executive at the hospital chain Tenet Healthcare, says that a 40% discount off the inflated list price is the norm for cash-paying customers.  When a 61-year-old woman got a $13,000 bill for an emergency hospital admission, she learned that her "indemnity" insurance was only going to pay $1,100 for room and board and would not cover drugs or procedures.

When she went to the hospital billing office in Pennsylvania to explain she was paying out-of-pocket, a rep offered her a 50% discount and assumed she would make monthly payments because she was unemployed.  With just $6,500 left of the bill, she asked what they would charge if she paid it all at once.  She ended up paying just over $4,000 by cashing in a 401(k) account.

In California, James Muckle got a $6,000 bill after a four-hour ER visit where kidney stones were diagnosed and he was given pain pills and instructions on how to pass the stones.  When he politely told the hospital he was surprised the bill was that high, he was offered a 40% discount if he paid within 30 days.  Then he asked for an explanation of each charge over about an hour, and finally asked if he could just pay $1,000.  The hospital made a counter offer of $2,300, and he eventually paid $2,000.

How to Negotiate – Or How to Have Someone Negotiate For You

A hospital may have 30 different rates that it charges for insurance contracts and it may double or even triple those rates for customers without insurance.

If you do negotiate for yourself, you should follow this basic script.  First ask: "Are you authorized to give me a discount?" If they are, see what the discount is.  Then ask: "Who is authorized to give me a bigger discount?"

When you get to the final negotiator, have data on what other patients paid for similar services. A website called Healthcare Blue Book can tell you what big insurers are paying for services in your zip code area.  Other websites that publish medical procedure prices include, and

Our subscribers have access to a medical bill negotiation service called Insnet that will review any medical bill over $200.  If they can reduce it, they normally keep 35 percent of the savings, but I’ve negotiated for our subscribers to get back 70 rather than 65 percent of the savings.  If they don’t reduce the bill, you owe them nothing.

The more you know, the easier it is to save money.  I’ll be looking for more ideas to bring you in next month’s newsletter.


To your health and wealth!

Wiley Long
President - HSA for America


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Fort Collins, CO 80524
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