Medical Misadventures: It Never Hurts to Ask

In case you haven’t noticed, the math of who pays what for health care in our country is a bit convoluted. And messed up. I work in the field and have a relatively in depth knowledge about health care financing, and I still find it mind boggling at times. But. Perhaps in part because I’ve had a number of odd health situations and in part because of my background, I’ve had to navigate the payment system a number of times. I thought I’d write a few posts about situations I’ve faced and how I handled them, in the event that they’re helpful to others who may be in similar situations but not be aware of some of the ins and outs that might help them navigate the mess a bit more effectively.

For today’s post, my point is that it’s always worth inquiring about hospital bills to see whether you can get a discount.

For the story:

Our daughter spent three days in the NICU right after she was born. Nothing too serious, she had some fluid in her lungs, and it resolved quickly. Still stressful, but we’re grateful she’s completely healthy. Thankfully, I have good insurance through work, but of course in the moment the “what it would cost” factor was not even remotely on my mind.

But about 6 weeks later we received the bills. The total bill — for her NICU stay alone, not anything for the labor and delivery — was $41,000. My insurer paid $12,000 of that $41,000, because of the contract they have with the hospital. And then we owed a 10% portion (aka coinsurance) of what the insurer paid (i.e., not of the total bill). You would be forgiven for thinking the math of health care is insane. Because it is.

So, that left us with about a $1,200 bill from the hospital. This did not include the doctor bills, which were separate (more insanity), and amounted to several hundred additional dollars. When I got pregnant, we planned and budgeted for the costs of prenatal care, labor and delivery, and a bit of buffer. We did not budget funds for a NICU stay. Because who does?

Now, I recognize as medical bills go, $1,200 is not particularly a whopper, not a doozy of tens of thousands of dollars. Which I know happens to people all the time. Side note- the number one reason people file for personal bankruptcy in America is medial debt. Because again, health care is messed up in this country. But $1,200 is not insignificant for us, and definitely a bit of a punch in the gut. I’m both grateful it wasn’t a lot more, and also grateful that we could pay. But I wanted to see if it was possible for us to get some sort of price reduction.

So I called the number on the bill and this was the conversation:
Me: I’m calling to ask what options might exist for me to not pay all of this. Could the hospital write any of it off?
Him: Well, we can set up a payment plan.
Me: But then I’d still be paying it all…
Him: Right. One other option is that we could give you a 40% discount if you pay the remainder in full by the end of this month.
Me: Ok, that’s a great option.
We have some more conversation about whether I can also discuss the doctors bills with him, or just the hospital bill. The latter was the case. And I maybe should have just said ok, but I thought, hey, if his STARTING point was 40%, he’s probably got more room to bargain, right? Right?!
Me: Alright, well I do still have all these other doctor bills to sort out, sooo I was kind of hoping that it would be possible to get more like a 60% reduction on this hospital bill.
Him: Well ma’am the highest discount I can give is 50%, again if you pay the full amount by the end of the month.
Not wanting to push my luck any more…
Me: Alright, well let’s do that then. And I’ll pay right now. My credit card number is…

I had literally ZERO bargaining chips, I just asked. And kept asking in different ways.

Here’s the deal. Hospitals don’t advertise that they give discounts, of course. But the fact is that hospitals want to get paid as soon as possible and close out accounts. There’s loads of lag between a procedure and when they receive payment either from an insurer or patient, and there is a whole industry around how to optimize and shorten this lag time. An additional fact is that lots of people don’t pay their hospitals bills. At all. Which means a long drawn out process for the hospital that is trying to get that money. As such, they’re often willing to accept some now rather than either receive none or go through a long drawn out process to get all later. This reality is the only ‘bargaining chip’ you need.

I will also note that I tried this exact same strategy the next week when I called the medical faculty about the doctor bills. It fell completely flat and I got absolutely nada. Unfortunately I think this is pretty common — hospitals tend to have such high volume of procedures and huge amounts of cash flow in and out, so a couple hundred dollars here or there doesn’t matter as much to them as it does for doctors. Alas.

Don’t get me wrong, I also have fully paid plenty of bills in full, I’m not always trying to negotiate. But I think it’s important that people know they can negotiate when there are large and/or unexpected hospital bills on the table, even when they’re completely legitimate (i.e., not somehow erroneous charges).

Stay tuned for future posts about contesting erroneous 5 figure bills as well as tackling erroneous charges in the several hundred dollar range.