Any Ideas to Lower High Doctor Bills - for the Middle Class Family?

Sometimes if you can not keep up with payments they will allow you to pay less each month for a while, you could always ask.

I think that beyond the contracted rate they're already giving your insurance company that they would be unlikely to lower rates even further. Negotiations are usually reserved for uninsured patients.

I would start with questioning the need for services. Providers can't treat HMO, high-deductible and uninsured folks differently in the care that they suggest, but if you are upfront about your need to contain costs, then they can look for less expensive treatments, or hold off on ordering that blood work that might not be necessary (or that you can get through a less expensive lab), or take a wait and see approach on that x-ray, etc.

We switched to a high-deductible plan last year and it changed the way that I approach healthcare and it's my job to let my providers know that it's not just open season on ordering tests, blood work, prescriptions, etc. So rather than take my child for an x-ray to rule out a broken bone that the doctor was 99% sure wasn't broken but she couldn't say with certainty, we decided that it could wait a day or two and we'd go for an x-ray if he didn't improve. Instead of going for the most expensive form of an ADHD medication and ordering a 30 day supply from the get-go, we found a cheaper alternative and started with a 10 day supply so that if there were undesirable side effects, I wouldn't be throwing out hundred of dollars in medication.

I found that by being upfront with providers as we were deciding on appointments, tests, lab work, imaging etc. they were able to provide care in a more cost-conscious way. You might get further with that approach vs. looking for further discounts on services already provided.

First of all, J.B. has some great advice on managing the costs your family incurs.

Secondly, I have some insight on the billing side, having worked in Hospital finance for 13 years. (Keep in mind, this is information primarily based on my facilities policies, but most likely not far from most other healthcare organizations)

1. If you are 100% Self Pay, & have no insurance, or if you opt to not have services run through insurance, many places will give you a discount. In the state of WI, laws were passed that Self Pay needed to be automatically discounted at the same rate as the best insurance contract negotiated. For some facilities, that was up to 45% off the gross charges.
Find out if there is a policy like this @ your providers... if so, & the amount you are responsible for after the insurance pays is greater than the amount you would owe with a self pay discount, it is adventageous to -not- have your services run through insurance.
The exception to this is if the amount you owe is high due to deductible - in that case, you need to weigh the pros & cons of paying your high deductible each year through the services, or going self pay, but potentially needing to pay the deductible anyway in the event of a catastrophic medical need, such as a surgery or emergency.

2. If you have insurance, the self pay responsibility remaining will not be discounted any further. However, you can talk to the billing department customer service to find out if you can establish a payment plan, or if you qualify for any charitable discount.
Charity discounts require submitting your financial information, which is then compared to standards set, & either denied, or approved for some or all of the balance being forgiven. Keep in mind that if you have assets such as investments or home equity, it is considered a resource for paying your medical expenses. No one is -telling- you to tap into it, but the healthcare provider is likely not going to say "you have $100K in home equity, but we will still write off this $1000 bill"
Payment plans can be managed in-house or through a collection agency. where I worked, up to 4 months would be handled in-house. Up to 1 year would be through an agency, but you would not be "reported" to the credit bureau negatively, instead it would be like a loan being paid off. If you needed greater than 1 year to pay off the expenses, your account would go through normal collections & be reported, and any payments made would be done through the agency.

3. It may be too late for this current year (based on your enrollment period) but many companies offer a Flex-spend account. This allows you to designate a specific amount of money to be taken from your paycheck each month prior to taxes. It is held in an account for you, & can be used to pay qualified healthcare expenses. Monies set aside MUST be used by the end of the year - use it or lose it, even though it is your money.
This can be adventageous if you know that you will have a certain amount of expense in a given year, such as a planned surgery, or therapies. In your case, specialists can charge more, & tend to be out of network, so calculating a base number of visits & treatments can give you an estimate of how much to set aside.
The benefit is that when you pay your responsibility, you do so with money that hasn't been taxed on. So, for example, if you make $10K a year, you would pay $3K in taxes, & the remaining $7K would be available for you to spend on medical expenses. Now, you make $10K/yr, set aside $2500, pay only $2K in taxes, & have both the $2500 you set aside, as well as the remaining $5500 after taxes to spend on medical expenses, saving you $1000.

4. If the specialists that you see are out of network, you can talk to them to find out what services can be monitored by your primary physician. Also, talking to the Human Resources department @ work can sometimes result in providers being included in network going forward. This doesn't always happen, especially with "onesie twosies" for specific providers, but if it is a practice or network that has a large presence in your community & is used by many other employees, it can happen.

Best of luck, I hope this information was helpful. If you have questions, I'd be happy to try & help explain anything further! T. =-)

We spend a lot of money every year on medical. We get close to being able to include it in our tax deductions, but we are usually 500 or so shy.

Until we take insurance companies out of health care, we will get screwed. Vote for a single payer system, and your costs will go down.

Offer to pay cash and get a discount. If you pay cash it does not go toward your deductible but sometimes it's a better benefit.

We don't carry dental insurance. We pay cash in advance and get a discount on all services.

We have good medical insurance. Our deductible is $7000. I pay everything as we go. However, last August I needed an ankle MRI. The office said my portion was $1250. I said ok but " wow what's a cash price". I was told if I paid cash and saved them the time and effort if dealing with insurance, my cost was $400. You bet I paid cash!!'

Just ask and you never know what the office will say.

In most cases a doctor cannot contractually lower a bill that is meant to meet a deductible. They will almost always take payments without charging interest but the bill is yours to pay.

Discuss your financial concerns with your doctor. Perhaps he can reduce the number of procedures or tests or the frequency of those procedures that must be run to manage your child's illness. Always ask for a drug sample if you are being prescribed a name brand drug (vs a genetic) -that way you can try it for free and make sure that you can tolerate the prescription. If you have drugs you take for chronic diseases, see if you can use mail order for those scripts. Many times that is less expensive. Does your insurance company offer a 24 hour NURSE HOT LINE? Perhaps you can call and ask a question or discuss medical issues with them and eliminate an office call. They will tell you if you need to see your doctor.

Doctors visits are not cheap especially when you have an ongoing chronic condition that needs the attention of a specialist. I currently have that problem times 3 people. It is an expense like every other that you just have to budget for and pay.

I would recommend that you take advantage of a flexible spending account if your employer offers it. Companies fund them 100% at the beginning of the year and then deduct the money with each paycheck. It provides a nice tax savings when you file your tax return.

If your insurance has already paid their portion, and you're left with the cost share and copay, then you have to pay the agreed-upon amount. You agreed with your insurance company to pay the cost-shares and copays.

If the hospital has not already billed the insurance company, you can negotiate for the out-of-pocket cost. But you have to do that BEFORE the claim is sent to your insurance, not after.

Honestly, if you are paying the insurance rate you are already getting a discount, so they are probably not inclined to give you even more of a discount.

I would also recommend that you evaluate whether these expensive visits are really necessary. Sometimes they are, sometimes they can be cut back or you can receive the same services from a general practitioner at a reduced cost. It depends on what these specialties are and the conditions that are being treated.

Good luck.

Do you have a deductible? We do, what I am doing this year is taking out the amount of the deductible from my check, then I get to use a credit account to pay for the dr visits until the deductible is met. Then we are only out of pocket about $10 a visit for most places.

This is the first year we are doing this it sure beats trying to come up with a $1000.00 the first part of the year.

This money is taken out pre tax so that is a savings as well.

Does your company offer such a thing?

I don't know if they will lower a bill that has already been contracted to be lower by insurance, but it won't hurt to ask. Another possibility is being on a payment plan that you can afford. Good luck!

We lower costs by having a HSA to save tax-free money for medical bills. Before that we had an FSA, but your access to that would depend on an employer offering the option and you getting in at open-enrollment.

I take it you have PPO? No chance of getting on an HMO plan?

I hear ya sista!

Sometimes if you pay within a certain amount of time they will discount your bill. Check with your provider's billing office and see if they will do this for you.

I don't have any suggestions, but I sure feel your pain.

I had a cyst lanced and drained October 31, and they billed it as "surgery"..... $550! My insurance is $2400 up front, but they did lower it per the insurance contract... still, my responsibility was $195.

Then, in November I fell, injuring my foot (on a Saturday). I didn't go to the ER or urgent care, but waited until Monday... they "worked me in" as "Medical Emergency" ..... billed at $206! My responsibility was $104..... so... almost $300 to the doctor in less than 3 weeks......

And... insurance didn't pay ANY of it...... it was lowered due to the insurance contract, though, so I am thankful for that.

Find a group that accepts your insurance this way you just have deductible and co pay or co insurance.

About the only way your going to be able to get this lower is to get in with a "practice" that has many specialties. If you have a clinic with all the specialties inside it you will pay lower co pays than outside specialists. You don't say what kind of specialists they are but sometimes a primary care Dr can do the things you see a specialist for. Blood work does not need to be redone for each Dr. Coordinate it so that it's all ordered at one time rather than a dozen separate times.