Ruth Levin, corporate senior vice president for a nonprofit hospital system in New York, advises that hospitals are accustomed to negotiating fees with patients.

When money is tight, everything is negotiable — including your health care bills.

As the economy sheds jobs and more people lose their health insurance or are forced to switch to less generous plans, doctors and hospitals are becoming accustomed to patients who are struggling financially. According to the American Hospital Association, half of their members reported an increase in the number of patients needing help with their bills. And that was in November, before the national unemployment rate hit 8.1 percent.

“It’s rough out there,” said Dr. Jacques Moritz, the director of gynecology at St. Luke’s-Roosevelt Hospital Center in New York, who also has a private practice in Manhattan. (Full disclosure: He delivered my son five years ago, but my insurance at the time covered me in full.)

Lately, Dr. Moritz said, “The first thing I say to my long-term patients is, ‘Do you still have a job?’ ” If patients say no, or otherwise indicate that paying will not be easy, Dr. Moritz says he assures them that bills are negotiable.

And keep in mind that doctors, hospitals and medical labs are accustomed to negotiating. After all, they do it all the time with insurers. A hospital may have a dozen or more rates for one procedure, depending on whether Medicare, Medicaid or a private insurer is paying the bill, said Ruth Levin, corporate senior vice president for managed care of Continuum Health Partners, a nonprofit hospital system in New York. Your request for a special arrangement will hardly confound their accounting department.

And it is usually in everyone’s interest to avoid dealing with a bill collector.

If you recently lost your insurance or have a plan with minimal benefits, here is what you need to know if you want to seek a price break from the doctor, hospital or lab.

DEALING WITH DOCTORS

Don’t be shy. “Patients are often intimidated by their doctors — it’s the white coat,” said Dr. Davis Liu, a family doctor in California and author of “Stay Healthy, Live Longer, Spend Wisely” (Stetho Publishing, 2008). “But if you need help, speak up. Most are likely to help out.”

Talk directly to your doctor about your financial situation. If that makes you uncomfortable, then go to the billing manager. The office may be able to offer you a discount of 10 to 30 percent depending on the practice (specialists may offer a bigger break), or propose a plan in which you pay your balance in a few installments or on a monthly basis — typically at no interest.

Offer to pay cash upfront. Doctors can lose thousands of dollars every year on unpaid bills and spend countless hours haggling with insurers over reimbursements. If you can make their life simpler by offering to pay right away, you’re likely to get a small discount — even if you don’t have financial hardship.

Be respectful. You’re negotiating for your health, not haggling over a used car. So Dr. Moritz cautions you not to call your physician and say: “Dr. So-and-So will do the procedure for $300 less. Can you match that?”

“When someone does that,” Dr. Moritz says, “that’s the end of the relationship.”

TALKING TO HOSPITALS

Strike a deal before you check in. If you need shoulder surgery, for instance, but don’t have insurance — or are facing a high hospital co-payment — call the hospital’s billing department and explain that you would like to discuss getting a discount and why. Dr. Moritz suggests saying, “I’d like to pay the lowest rate you give an insurance company.”

Research your final bill, and be ready to make a counteroffer. Like doctors, hospitals would rather be paid something than nothing. They lost $34 billion in 2007 on uncompensated care, up 55 percent from 2002.

“Hospitals would rather set up a payment plan than turn it over to a collections agency and then expect to write it off,” Dr. Liu said.

If you end up with a bill you can’t pay — or at least can’t pay right away — don’t panic. Find out what Medicare would pay for your condition or surgery, since that program tends to pay less than private insurers. You can learn that at the federal Department of Health and Human Services database, Medicare.gov - Hospital Compare, by clicking on the gray button “find and compare hospitals.”

I learned on the Web site, for example, that if I were admitted to my local hospital for chest pain, the average Medicare payment would be $5,732. Use the Medicare numbers as the starting point for your negotiation.

The truth is, said Ms. Levin of Continuum Health Partners, “only a very small portion of consumers or insurers pay 100 percent of our hospital charges.”

If your situation is truly dire or your bill very large, you may qualify for charity care. But you’ll have to show the hospital proof of your income and your hardship.

BARGAINING WITH MEDICAL LABS

Charges for lab work can be exorbitant. But, as with hospital bills, the numbers you see on your statement may not reflect what most insurers actually pay, according to Dr. Woodson C. Merrell, chairman of the department of integrative medicine at Beth Israel Medical Center in New York.

Negotiate just as you would with your doctor or hospital. Quest Diagnostics, the largest clinical laboratory in the country, for instance, offers a six-month interest-free payment plan, as well as financial assistance for those with real hardship.

“But we evaluate each case individually,” says Jerry Diffley, corporate director of patient advocacy and billing compliance.

From NYTimes: Bargaining Down the Medical Bills

Good one Kevin!

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This is not medical advice. Just opinion. Whatever you decide to do your your health is strictly your business and your choice.
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A few year ago I took a stress test. Was wired up with ekg monitoring climbed onto a table and nurse took ultra-sound picture of heart. Heart was beating. Then did a brief trot on a treadmill and back on the table for more ultra-sound pictures. Heart still beating. Total time of testing 20 maybe 25 minutes. Next for the for the real stress part of the test.

As I'm leaving I am given a bill for $1400. Think heart stopped for awhile.

Offered to pay on the spot for a lower price. They knocked off $200. But you have to ask for the reduction.

That's outrageous. Maybe they just purchased their device with bank loans.