YONKERS, NY — When we visit our doctors, we don’t typically think of ourselves as “consumers” or buyers of health care, but in these tough times, that is precisely the role a patient needs to play to avoid drowning in a sea of medical bills.  What are the best strategies for haggling with your doctor or hospital?  A new report in the October issue of Consumer Reports and online at www.ConsumerReportsHealth.org features advice from Consumer Reports’ medical expert and M.D., John Santa.   

According to the latest Consumer Reports Index, which gauges the health of the economy from the consumer perspective, 16.3 percent of Americans are unable to afford medical bills.  

“Americans are overwhelmed by health costs and many people simply can’t pay their bills, can’t afford their medications,” says John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center. “The last thing most patients want to do is haggle with their doctors, but a little bit of negotiating can go a long way.  It’s also important to know that there are tremendous variations in health care costs—knowing this can help a consumer get a hand up and politely insist on the fairest possible price.”   

Here’s Consumer Reports’ advice for three possible scenarios:

You’re healthy.  The optimal time for patients to talk with their healthcare providers about costs is before any have been incurred.  While doctors have a professional obligation to take a patient’s financial resources into account, patients should raise the issue with their doctors to let them know that costs are important to them.   “For a variety of reasons, doctors are likely to suggest the most expensive options first.  But you might be surprised by your doctor’s willingness to change course, for example prescribing fewer expensive brand name drugs or choosing watchful waiting over a costly diagnostic test,” says Santa.

The unexpected occurs.  A patient lands in the hospital without the benefit of any planning and gets slammed with a huge bill, say $15,000 for a coronary angiogram, and insurance ends up covering only a fraction of the bill.  Consumer Reports recommends these approaches to get the greatest reduction to their bill:

• Sit down with the doctor who ordered or performed the hospital services to find out how the hospital costs ran so high.  Were all the services needed and reasonably priced?  Consumers can judge for themselves by  checking  www.healthcarebluebook.com  which lists the going rates for many medical services for free.  Closely examine each bill to identify errors, which are common.
• Consumers should not assume the price on their bill is set in stone.  Providers often discount rates substantially to insurers and others, so why shouldn’t a consumer ask for the same rate reduction? Consumers should dispute any charges they think their insurance company ought to cover.
• Patients should not pay their bill until they have exhausted all of their options, but they should make clear to the hospital’s billing department that reaching a resolution is important to them.  They might consider making a discounted offer they think would be manageable within a set time period.  Consumers can consult one of the reputable groups that, for a fee, can help reduce the size of medical bills, such as INSNET (www.myinsnet.com) or Medical Cost Advocate (www.medicalcostadvocate.com).

You’re having an elective surgery.   This situation allows for more planning and research into the best procedure, doctor, hospital, drug or other option.  “Use your time wisely to do the research because variations in health-care costs can be significant, and providers will gladly let you overpay for a service that you could get for less,” says Santa.   Keep in mind the following advice:

• Consumers should shop around, talk to different providers, and bargain for what they think is a fair price.
• Consumers shouldn’t hesitate to ask for the price upfront and get it in writing.  Request an itemized list of all potential charges.  
• As with any purchase, consumers should beware of any offer that sounds too good to be true.  If a provider suggests a shortcut, be wary and ask a lot of questions, and check out providers that are unfamiliar.