Negotiating Medical Bills? Prep for More Patient Payment Conversations

May 23, 2017 by Antonio Arias, MBA, CHBME

Topics: Meaningful Use Stage 2, Practice Management, Medical Billing Company

How does your organization feel about patient financial responsibility?

For some providers, the itemized total on an EOB is the last word – it’s essentially here’s what the payer covers, here’s what the patient owes, end of story. For others, the patient payment amount is a little less firm… and perhaps open to negotiation.

Naturally, all physicians want to receive fair compensation for their efforts (and be able to compensate their staff members appropriately as a consequence). But the question of value comes into play when or if patients take issue with the number on their invoice. Are you committed to your contracted payment rates in a hard-and-fast way, or is there wiggle room in what you expect a patient to pay?

In today’s evolving U.S. healthcare system, many providers are grappling with that very question. As deductibles continue to increase, patients are becoming increasingly price-conscious about care and treatment – expecting increased up-front transparency and pursuing a greater amount of treatment options when cost is a concern.

In light of the changing dynamics, it isn’t just the pre-encounter information patients may take issue with financially; it’s also sometimes the amount on their final bills. A wealth of articles online today provide guidance to patients with tactics for potentially lowering their healthcare payment requirements or even paying third-party experts to negotiate on their behalf.

Of course, haggling with patients is not an entirely new phenomenon; after all, some people – regardless of the setting – simply refuse to pay full price for anything. But negotiating medical bills is increasingly being seen by some financial experts as a best-practice effort among price-savvy consumers.

In an article on Fox Business, for example, Christina LaMontagne (vice president of NerdWallet Health) espoused how "medical bill professionals often negotiate bills down $10,000, $20,000 or $30,000,” and said "it’s possible for consumers, patients or caregivers to get the same results."

Or is it? At our medical billing firm, we understand that those negotiations are often between provider and payer (rather than provider and patient). We also understand that negotiations should ideally be a rarity, in response to a patient’s undue financial hardship.

But in a more price-conscious environment, negotiating medical bills may no longer be all that rare of a practice. As your practice enters a potentially more ‘negotiable’ financial future, start drawing mental lines around what you are and aren’t flexible about.

Is preventive care on the table for negotiation, or only expensive procedures? Are you willing to offer a “cash discount” in any circumstances? What’s your threshold for financial hardship? Do you prioritize patient loyalty as a consideration for potentially lowering costs? By answering these questions, crafting smart negotiation policies (or even loose guidelines), and collaborating with your medical billing service when necessary, you can enter a more negotiation-friendly era of healthcare with confidence.

Are you interested in learning more revenue cycle management tips? Visit our blog! 

5 steps to successful insurance negotiations

Subscribe to Our Blog

Stay in-the-know on trends, best practices, and news affecting the medical billing industry!