How to negotiate lower costs for out-of-network care

February 11, 2020 in Health finance  •  By Miles Varn, MD

While seeking care within your health insurer’s provider network costs less, there are situations when you may decide to seek care outside of the network. For example, if you’re diagnosed with a serious, rare, or complex condition, the physicians and hospitals that have the most experience treating your condition and the best outcomes may not be part of your insurance network. If you or a family member need mental health care or treatment for substance misuse, you may need to go out of network since many providers in this field don’t accept insurance because of low reimbursement rates. If your children attend school in another state and your insurance network is geographically limited, they may need to use providers outside your network. Or if a doctor you’ve seen for years is dropped from your network, you may prefer to continue seeing him or her in spite of the extra cost.

If you do decide to seek out-of-network care, these strategies can help you lower the cost:

  • Check your insurance benefits: Many insurance plans do offer coverage for out-of-network care, though you’ll still pay more than if you stayed within the network. Check to find out if you have coverage for out-of-network care and what you’ll need to pay out of pocket.
  • Plan ahead: Before receiving care, talk with the physician, hospital, or other provider and ask for a written cost estimate that includes the billing codes for the services you need. You can then research what other providers charge for the same services on a site like Healthcare Bluebook or Fair Health and ask the provider to lower the cost of your care based on the data you uncover. If you are successful negotiating a lower cost, get a written document that outlines the cost reduction agreement.
  • Look for discounts: Some providers will discount the cost of care if you pay the balance in full within a set time period, pay cash, or pay via phone of through their online portal, so ask if there are any discounts available.
  • Consider a payment plan: A study published in the American Journal of Managed Care found that the patients surveyed negotiated 19% of out-of-network healthcare bills and had success lowering the cost of their care 56% of the time. If you’re in the other 44% of patients who weren’t able to lower their bills, talk with the provider’s billing department about setting up a plan that allows you to pay smaller amounts over an extended period of time. If you’re faced with an exceptionally high hospital bill, find out if they have a financial assistance plan and whether you qualify.
  • Don’t wait to negotiate: It’s more difficult to negotiate with providers if you’re already delinquent on your payment, so start the process immediately when you receive your first bill.
  • Get professional help: If you’re facing large bills, consider hiring a medical billing advocate to negotiate on your behalf. For a fee, advocates work with the providers to cut the cost of your care and check bills for errors, which are far more common than you may realize.
Topics: ,