How to haggle with your doctor

In this month's 5-Minute Consult column, John Santa, M.D., director of the Consumer Reports Health Ratings Center, explains how to negotiate prices with your doctor.

It's hard to listen to the news these days and not wonder whether you, like so many other Americans, could end up drowning in doctor bills. Sure, you're probably insured. But more and more folks with health insurance are facing large deductibles, plus paying an increasingly large portion of the rest of the bill. So it's important that you become a savvy health-care buyer—and even be able to haggle if you have to. Here's advice for three possible scenarios.

This is the optimal time to talk with your doctor about costs: before you've incurred any. Having a practitioner you trust is key. Physicians, nurses, and other providers have a professional obligation to take your financial resources into account when recommending and delivering care. But you might have to let them know that doctor bills are important to you, especially since some practitioners are liable to suggest the most aggressive—and usually most expensive—options first. (The reasons for that are complicated, ranging from a patient's preferences to the fear of malpractice suits to pure financial motivation.)

Once you let your doctor know that cost matters, you might be surprised by the reasonable, more conservative options he or she comes up with, such as recommending a different drug regimen that involves fewer brand-name prescriptions or choosing watchful waiting over a costly diagnostic test that's not likely to affect the course of treatment. Having a good relationship with a doctor can also be helpful if you wind up in a dispute with a hospital or other health-care provider, since your doctor can go to bat for you to dispute the costs.

You went into the hospital for a coronary angiogram and expected to pay a few thousand dollars; now you've been slammed with a $15,000 bill that's way beyond your resources—and your insurance is only covering a portion. If possible, sit down with the doctor who ordered the procedure and go over the bill together to see how the costs ran so high. Make sure all the hospital services were needed and reasonably priced; you can look up the going rate in your area for many medical services at www.healthcarebluebook.com, a free resource that provides information on health-care costs and advice to consumers. Examine hospital bills closely for errors, which are common.

Don't assume the price on your bill is set in stone. Providers often discount rates substantially to insurers and others, so why not ask whether you, too, might get a reduced rate? Dispute any charges you think your insurance company should cover, and don't pay until you have exhausted all your options. Do make clear to the hospital's billing department that you're willing to work toward a resolution, and consider making a discounted offer that you can manage within a set period. You can also consult one of the reputable groups that, for a fee, can help to reduce the size of doctor bills, such as INSNET or Medical Cost Advocate).

This situation is a bit less daunting, since you have some time to research the best device, doctor, hospital, drug, or other option, and should have the funds to cover the procedure. Do the research. Variations in health-care costs can be stunning, and plenty of providers will gladly let you overpay for a service that you could get for less.

As with any purchase, beware of shortcuts, too-good-to-be-true offers, and providers you've never heard of. Don't hesitate to ask for the price up front and get it in writing. Request an itemized list of all potential charges—not just, say, what the cosmetic surgeon will charge to do your eyelids but what you'll pay at the hospital or outpatient clinic where the procedure takes place (which often far exceeds the doctor bills). Shop around, talk to providers, and bargain for what you think is a fair price.