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While my brother in law was in the hospital with lung cancer my sister (his wife) was admitted for a heart attack and had several stints or shunts or something surgically put in to keep her alive.

She is close to her parents and they took care of her daughter for her during her stay but she had no one to advocate for her.

Even with good insurance she walked out of the hospital owing $50,000. Yikes!

Fast forward to a few years later and her husband has died, she is still paying off the $50,000 and has another major surgery planned.

Now, my sister is one of the least assertive people that I know. If there is a problem with her phone bill and she has to call and try to get it straightened out, she will end up crying and probably yelling as well. I just don’t get it.

So before she went for this next surgery I had her practice role playing with me and my niece. I actually wrote out scripts for them to follow.

The idea was for her to make an appointment with the billing department of the hospital and go in and negotiate. Her goal was to get the hospital (and all doctors) to accept ONLY what the insurance company paid. Which is a huge chunk of money, they should be happy.

So if they said no to that she was to ask what the best deal they could make her was. Would they give her 75% off? 50%? 25%?

Really, for anything less than 100% of her portion as a deduction I told her to write down all the numbers, thank them for their time and tell them she was going to shop around. She lives in a small town but there are 2 other hospitals there.

I instructed her that if at any time during the negotiation she felt like she was going to lose it and cry or yell she was to look at her watch and say “I am so sorry, I just realized that I am late to pick up my daughter. Please accept my apologies and let me reschedule”. And dash out of the room.

We practiced this many, many times. Sigh. But it worked. She kept her cool, the hospital agreed to accept the amount her insurance was paying only and actually by the time she got out of the hospital this time she found out that they had written off the rest of the $50,000 she owed from the first visit.

It works. I’ve done it on several occasions when I had insurance but not the huge deductible or 20% of $100,000. Once I even managed to schedule my hospital stay for the first of the year so not only did I not have to pay any out of pocket, I met my yearly deductible with that stay.

That was the good old days when I had insurance – crappy scam that it was. Now, with no insurance I use a city/public hospital, a few great clinics in town and negotiate with all my doctors.

Have you ever negotiated your fee? How did it work? What advice do you have for others?

Monday Night Cancer Club is a Daily Kos group focused on dealing with cancer, primarily for cancer survivors and caregivers, though clinicians, researchers, and others with a special interest are also welcome. Volunteer diarists post Monday evenings between 7:30-8:30 PM ET on topics related to living with cancer, which is very broadly defined to include physical, spiritual, emotional and cognitive aspects. Mindful of the controversies endemic to cancer prevention and treatment, we ask that both diarists and commenters keep an open mind regarding strategies for surviving cancer, whether based in traditional, Eastern, Western, allopathic or other medical practices. This is a club no one wants to join, in truth, and compassion will help us make it through the challenge together.
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Comment Preferences

  •  Thanks! (12+ / 0-)

    It's criminal that Americans who are facing potentially catastrophic illness have to "negotiate" their medical bills. Citizens of any other advanced country do not have to face bankruptcy due to illness or injury. Bless you for sharing these valuable tools. Let's work to make single-payer, universal care a reality.

    Zen is "infinite respect for all things past; infinite service to all things present; infinite responsibility for all things future."--Huston Smith's Zen Master

    by Ree Zen on Mon Jun 16, 2014 at 05:34:50 PM PDT

  •  Hi ZenTrainer. (8+ / 0-)

    Did you see the diary posted by Ole Texan that is a message to Monday night Cancer Club?  Here is a link.

    He was asked to join because he is currently going through a very recent cancer diagnosis.  He might need some help with how to hook up with the group.

    Thanks for the great information you have provided for those who need it.

    "Just because your voice reaches halfway around the world doesn't mean you are wiser than when it reached only to the end of the bar." ~ Edward R. Murrow

    by CJB on Mon Jun 16, 2014 at 06:10:47 PM PDT

  •  I've followed a couple of links from your tip jar, (6+ / 0-)

    and they do indeed have good information.
    I am still paying down my own bills, left over from my hospitalization and chemo in 2011 (with a few others since then). I wonder if they'd give me any kind of a discount if I said I could pay it off all at once?
    Might be worth asking. All they can say is no. But if they say yes, I would be gaining something.
    Thanks for all these resources, ZT!

    Support Small Business: Shop Kos Katalogue If you'd like to join the Motor City Kossacks, send me a Kosmail.

    by peregrine kate on Mon Jun 16, 2014 at 07:05:58 PM PDT

  •  Another thing to keep in mind when negotiating (5+ / 0-)

    is the laws in your state.

    Now pretty much everywhere in the US no one cares if they pull up your credit report and it has medical debt. They just assume the insurance company is dragging their feet.

    But some states are better than others. In TN where I live they can take your house to cover your medical debt. I don't think they can do that in MI. That was one thing my sister was not worried about.

    Tracy B Ann - technically that is my signature. I scroll with my middle finger.

    by ZenTrainer on Mon Jun 16, 2014 at 07:31:10 PM PDT

  •  asdf (6+ / 0-)

    I love when they suggest price shopping before your procedure. There are over 50 hospitals in our local "tri-county area" listed on Wikipedia, not counting outpatient centers and clinics and the better-equipped doctors' offices. One should call up each of these? And how exactly is the layperson supposed know the exact technical name of the procedure or treatment, or to guess what all will be needed during a visit or surgery?

    What if oxy is cheaper than dilaudid at one hospital but vice versa at another? At the first hospital, maybe the meals and housekeeping are more expensive... How do you tally up the list? It's not like groceries, where you can buy your milk at the one grocery store and your bread at another. Once you've committed to a medical facility, you're pretty much stuck with it throughout your treatment, unless they're unsanitary or abusive or some other horror.

    My husband had a PEG tube insertion. I wasn't back there, but apparently it went something like this:
    "There's going to be a poke, that's the anesthetic."
    "I can still feel everything."
    Lather, rinse, repeat.
    And the third shot finally made it tolerable, if still noticeable.
    How does one plan for something like that? There's no way. What did the second and third shot cost? Could we have gotten that sourced in from a different place? Not bloody likely.

    Taking the kid to the doctor, or the walk-in clinic for a fever and general malaise. There will be labs, you know there will. Which lab will the facility choose to use? What will be done in-house? What if the walk-in place doesn't disclose ahead of time that they have higher rates for evenings, weekends and holidays? It's not really proper to use the ER for something mild like that, but what if you know there's a much cheaper copay on an ER visit?

    These are things that the average person shouldn't have to think about, ever. Placing the onus on the presumably stressed and ill patient to price shop is flat out impossible. Penalizing a person financially for choosing to go to any particular facility or provider is not fair either.

    We were charged $25,000 for one procedure. The insurance had negotiated a rate of $4,000 for that procedure and the hospital agreed to take it. We split that equally with the insurance company. Someone uninsured paid $25,000 for that same thing, while someone else without insurance may have negotiated to pay half that, if they thought to try.

    Three people. $25,000, $12,500, $4,000. The hospital got $40,000 when they wanted $75,000 and could have gotten by with $12,000. Random chance, privilege, whether the billing coordinator is having a good day... Anything could change the outcome of any of these scenarios. It's shockingly unfair.

    We need single payer now, with standardized Medicare rates for all!

    Please help support my husband Unit Zero in his fight against cancer.

    by jennifree2bme on Mon Jun 16, 2014 at 07:56:14 PM PDT

    •  Excellent comment! (3+ / 0-)

      One of the links talked about patient advocates that will do this negotiating for you. I bet with as many hospitals as you have there are some advocates you can find.

      My doctor charges me $37 a visit instead of the $75 insurance would be billed (I doubt they pay that though do they?)

      I think we really only have one lab here in town and my oncologists office negotiated a discount from them. My oncologist charges $172 a visit for someone with insurance. I pay $60.

      I have no insurance so I don't go to walk in clinics and I would probably have to be close to dying to go to an ER.

      Which is just bullshit you know? We do need single payer.

      Until then I am getting very good at negotiating. ;-)

      Tracy B Ann - technically that is my signature. I scroll with my middle finger.

      by ZenTrainer on Mon Jun 16, 2014 at 08:13:59 PM PDT

      [ Parent ]

  •  Friends of ours had a serious accident (4+ / 0-)

    Somehow he managed to run himself over with his own tractor and among other things badly smashed his pelvis. He had to be airlifted to Harborview in Seattle 180 miles away (they specialize in major trauma), spent a couple months in the hospital with surgeries and who knows what else.

    They didn't have health insurance, but they regularly put away a sum of money every year for medical expenses, and it had grown to a fairly large amount.

    The guy's wife offered every provider 25% of the bill in cash if they'd write off the remainder. Nobody turned her down. They had money left in their fund when all the bills were settled.

    You can do that, but then you're shifting some of your costs to other people - sometimes to people who can afford it, but often to people who can't afford it and don't negotiate. It goes on their credit cards, their home equity line of credit, or they carry the debt for years. Insurance companies negotiate rates and do the same thing.

    No matter how cynical you become, it's never enough to keep up - Lily Tomlin

    by badger on Mon Jun 16, 2014 at 08:36:50 PM PDT

    •  I don't think it should be thought of as shifting (4+ / 0-)

      some of your costs on to other people. The hospitals negotiate with the big insurance guys for lower rates. They stick the rest of us with the big bills, but they are able to negotiate with us too. I sure wouldn't want someone who has been able to talk them down to feel guilty about it.

    •  How're you doing, badger? (2+ / 0-)
      Recommended by:
      ZenTrainer, jennifree2bme

      Always good to see you here. Hope all's well.
      Good thing your friend was able to get treatment and not bankrupt himself in the process.

      Support Small Business: Shop Kos Katalogue If you'd like to join the Motor City Kossacks, send me a Kosmail.

      by peregrine kate on Mon Jun 16, 2014 at 08:56:46 PM PDT

      [ Parent ]

      •  Counting down (4+ / 0-)

        In between the last treatment and chemo drugs (which didn't work) and hospice care. I still feel pretty good though, but blood tests and CT scans disagree.

        You win some, you lose some, some get rained out.

        No matter how cynical you become, it's never enough to keep up - Lily Tomlin

        by badger on Mon Jun 16, 2014 at 09:54:34 PM PDT

        [ Parent ]

        •  Oh, badger. Oh, badger. (4+ / 0-)
          Recommended by:
          badger, ZenTrainer, Sara R, 2thanks

          Is there no other option? Any other treatment modality that you are willing to try?
          This is such distressing news to me--I can only imagine how it is to those who know and love you. Let alone to you!
          Please keep connected as long as you can. You matter to me, to us.

          Support Small Business: Shop Kos Katalogue If you'd like to join the Motor City Kossacks, send me a Kosmail.

          by peregrine kate on Mon Jun 16, 2014 at 10:00:31 PM PDT

          [ Parent ]

          •  No other option (4+ / 0-)

            There are more new tumors on my liver and the right hepatic portal vein is slowly getting blocked. The embolisation procedure did take out one tumor, but the larger original tumor has also gotten bigger, as has the liver.

            My oncologist did offer "hair-falling-out, nausea, debitating" IV chemo, for about an extra month of life. Neither of us thought it worth it, though.

            I have plenty of support from friends, family and community. A bunch of guys from a church I don't attend are going to come up and cut a load of logs I bought into firewood for us and the widow next door. We have hospice already in place - even though I can still drive to town, they'll even come up and do blood draws, and provide all the equipment, drugs and care for when I've really gone down hill.

            The only hard part for me is the sadness of those who are close to me and the fact that if I could stretch it out a few years (highly unlikely, but what I was shooting for originally) my wife would be in much better shape financially.

            It isn't exactly what I'd choose, but it seems to be the only choice available. As I've said before, I'd rather go out laughing than crying or raging about it.

            No matter how cynical you become, it's never enough to keep up - Lily Tomlin

            by badger on Tue Jun 17, 2014 at 07:08:33 AM PDT

            [ Parent ]

            •  Oh Badger, my heart hurts reading this. (3+ / 0-)
              Recommended by:
              Sara R, peregrine kate, 2thanks

              You are such a beacon.

              What can we do to help? Do you want tickets to the movies? A trip to Disneyworld? Some really good wine?

              You are so kind to come and post and share with us, how can we return the favor?

              much love,

              Tracy B Ann - technically that is my signature. I scroll with my middle finger.

              by ZenTrainer on Tue Jun 17, 2014 at 09:18:50 AM PDT

              [ Parent ]

              •  It's just nice to occasionally talk to someone (4+ / 0-)

                somewhat more anonymously, and get caring replies like yours and Kate's. It's kind of like telling it to the world, without having to stand on a street corner shouting.

                I don't really have a bucket list. Maybe I set my sights too low, but I've done most of the things I wanted to do. Not necessarily perfectly or even well, but I got to do them. So really, I just want to fade away and have some good laughs with the people around me as I do. I get out of having a couple of root canals this way, too.

                I think the wine might be bad for my liver :)

                My wife is planning ahead, and she'll be on a tight budget, but will probably be OK. My daughter finally brought her new boyfriend home to meet the parents and he's a nice guy, very smart and funny. She just finished her second master's and I wish I could tell you who she interviewed with yesterday - it was kind of a hoot, but in a good way. She has another interview for a great job later this week. My wife's roommates from Colorado in the 70s live nearby here in WA State and they keep in touch, her sister lives next door, and she's made a lot of other friends in town who will help her out if needed.

                I'm sure some of this won't be a lot of fun - I already don't like looking in the mirror - but I'll have a relatively easy a pain-free demise, just as my illness and treatment have been nothing compared to what most cancer patients go through.

                I would have preferred much later than sooner, but it's still inevitable and I don't have a choice. Or I do have a choice, and that's about the way I handle it. I haven't really given up, but I don't want to fight futile battles that have very little effect on the ultimate outcome when I can enjoy the time left with some quality of life for most of it.

                No matter how cynical you become, it's never enough to keep up - Lily Tomlin

                by badger on Tue Jun 17, 2014 at 10:46:36 AM PDT

                [ Parent ]

                •  badger, (4+ / 0-)

                  I am so sorry to hear your news - Kate wrote to me and let me know.  Would you like a community quilt?  We can put one on the fast track for you...and it would be our pleasure to do that for you.

                  •  I hope you say yes, badger. (3+ / 0-)
                    Recommended by:
                    ZenTrainer, 2thanks, Sara R

                    You have many fans here, and it would be a kindness to let us salute you.

                    Support Small Business: Shop Kos Katalogue If you'd like to join the Motor City Kossacks, send me a Kosmail.

                    by peregrine kate on Tue Jun 17, 2014 at 11:49:08 AM PDT

                    [ Parent ]

                  •  Thank you (2+ / 0-)
                    Recommended by:
                    Sara R, peregrine kate

                    but while I appreciate the offer, it really isn't necessary. Even on a fast track, I certainly wouldn't have much time to cherish or appreciate it, and we want to keep this whole process very low key - there won't even be any funeral or memorial (though perhaps a few bottles of good Scotch will be consumed along the way) - I'm donating my body to science, and my wife will get the ashes back.

                    We just got beef stew and some chicken dinners from a friend tonight, we have a crew coming next week to cut firewood for us and the widow next door who I used to cut wood for, we've had offers of free massages from a therapist friend, offers to help replace the front porch steps which my wife really wants to do herself. The Lutheran minister from town stopped by today - we don't even go to his church and he knows we're not at all religious, but just wanted to visit.

                    But in general, we're rather private people and a little overwhelmed by all of it. The offer is very touching and greatly appreciated, but I think we'd rather your efforts went to support someone who perhaps needs or deserves it more.

                    I can't tell you how honored I feel by the offer, and how highly I think of the people who do the quilting.

                    No matter how cynical you become, it's never enough to keep up - Lily Tomlin

                    by badger on Tue Jun 17, 2014 at 09:41:39 PM PDT

                    [ Parent ]

                    •  I can appreciate your perspective, badger. (2+ / 0-)
                      Recommended by:
                      Sara R, badger

                      So then I'll just tell you here what my message would have been for your quilt.

                      Your serenity and calm shine like a beacon for us all who will eventually, from cancer or not, face what you do now. I salute your equanimity even as I regret you will be passing sooner than you or anyone would have hoped. Peace and blessings to you, dear badger, and to all those who love you.
                      But please don't take this as a farewell. As long as you are willing and able to keep commenting, we will all welcome your presence. Speaking with the royal we, you understand.

                      Support Small Business: Shop Kos Katalogue If you'd like to join the Motor City Kossacks, send me a Kosmail.

                      by peregrine kate on Wed Jun 18, 2014 at 11:44:07 AM PDT

                      [ Parent ]

                      •  Apparently the good wishes of all of you (1+ / 0-)
                        Recommended by:
                        peregrine kate

                        have elevated my karma level.

                        I'm going to leave my wife with some financial challenges, but today we got a good offer (application not approved yet, though) for a re-fi of what we owe on our home equity line of credit. She got an offer on a car we want to sell from a car dealer (where we bought the car and have had it serviced) for only slightly less than retail Blue Book, even knowing the few problems the car has. It's enough to get her to the end of the year comfortably.

                        This morning a friend called and offered to keep our tractor running. He knows tractors, and my wife will need it for snow blowing. A neighbor stopped by to take our garbage down to the bottom of the road (2.5 miles) where it gets picked up.

                        When I tried to take a nap, about 1/2 hour in, a friend who does massage called and offered free services if I needed it (and she's a cancer survivor, too). Another try to take a nap, and the satellite internet installer for our area called and offered us an upgrade to the company's newer system. We were planning on cutting back to a lower plan on the system we have now, which would have been slower, but the new system is about 8X faster than the downgrade with some other benefits, and only $3 a month more and $50 for installation.

                        Then another neighbor stopped by, brought back our empty garbage can, and also left a pork loin roast, salad, scalloped potatoes, and banana-blueberry bread and jam. We already have almost another week of dinners from another friend.

                        That's all just today.

                        This is all amazing and overwhelming and I don't know if we can take much more of it.

                        No matter how cynical you become, it's never enough to keep up - Lily Tomlin

                        by badger on Wed Jun 18, 2014 at 06:04:04 PM PDT

                        [ Parent ]

                        •  Dear badger and Mrs. badger~! (0+ / 0-)

                          I do hope our positive intentions helped, but I suspect it has more to do with your own karma coming round. I'm very glad to hear your promising news, too, and I hope it will all come to pass.
                          Take it all in. Don't be shy. It is a way for people to be kind. There will be more than enough hard days ahead to get through, even with caring support from those who can provide it.

                          Support Small Business: Shop Kos Katalogue If you'd like to join the Motor City Kossacks, send me a Kosmail.

                          by peregrine kate on Wed Jun 18, 2014 at 06:39:33 PM PDT

                          [ Parent ]

                    •  No worries -- (2+ / 0-)
                      Recommended by:
                      peregrine kate, badger

                      just let us know if you ever need anything or if you should change your mind.  {{{{{{badger}}}}}}}  Wishing you all the best, peace comfort and lots and lots of time in the arms of your family and friends.

                •  Humour I've got. My current fave Louis CK. (4+ / 0-)
                  Recommended by:
                  2thanks, peregrine kate, badger, Sara R

                  I watch about 10 minutes every am.

                  Tracy B Ann - technically that is my signature. I scroll with my middle finger.

                  by ZenTrainer on Tue Jun 17, 2014 at 12:59:07 PM PDT

                  [ Parent ]

    •  That is very good to hear! Thanks for this! (2+ / 0-)
      Recommended by:
      jennifree2bme, peregrine kate

      Tracy B Ann - technically that is my signature. I scroll with my middle finger.

      by ZenTrainer on Mon Jun 16, 2014 at 09:01:42 PM PDT

      [ Parent ]

  •  I am off to bed now. I just walked my dog and (1+ / 0-)
    Recommended by:
    peregrine kate

    watched the fireflies as we went. I'll check in tomorrow.

    Thanks to all, especially you lurkers, you know who you are! ;-)

    Tracy B Ann - technically that is my signature. I scroll with my middle finger.

    by ZenTrainer on Mon Jun 16, 2014 at 09:55:01 PM PDT

    •  Good Morning ZenTrainer. (2+ / 0-)
      Recommended by:
      peregrine kate, ZenTrainer

      You told me yesterday that this diary would be up as usual. I was busy tending to the diary I posted and confused as to whether the group would read it. That was taken care of at a time when I became a bit tired and I closed shop at eight.

      Everything turned out fine at the end and I even was given a spot in the group as a member..Thanks for giving me that opportunity.

      Now to your diary of today. I am greatly impressed by what I have learned in negotiating with hospitals on fees. I have to think that indeed money has always comes first and our health second to doctors, clinics and hospitals. But really I would not know all the details.

      What I mean by this is that I at least feel lucky that I have not fell through those cracks. At my age (old really) I have been covered my Medicare and also have the pleasure to be covered by Medicaid`s QMB`s twenty percent that Medicare does not cover.

      I can only imagine how I would be feeling today if I did not have what I describe to cover me and my wife.

      I decided to post this even though I am calling my doctor this morning. I want specific clarification as to what he meant when I saw him Friday the 13th.

      Exactly what he meant by "small growth" and what he meant by "it looks like cancer" and the procedure that he said the eye cancer specialist would do to correct what was found (small growth).

      Even if I cannot get in touch with the doctor, Notes were taken by his assistant. I will ask to speak with her. She can clarify what the doctor told her to write down and what instructions, if any, he laid out for the eye cancer specialist. Ether way I must get in touch with ether one of these two, today, right after I post this. Will keep in touch.

      I am sorry for coming to the group for this meeting late. I will remedy that in the meetings to come.

      again I am impressed.

      Thanks to those who mentioned me in the comments sections and thanks to  peregrine kate, Lorikeet and anyone who has gotten involved with my plight.

      Old men tell same old stories

      by Ole Texan on Tue Jun 17, 2014 at 07:15:53 AM PDT

      [ Parent ]

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