Negotiating Your Costs: Using FAIR Health Cost Estimates to Negotiate the Costs of Care
Summary
Since providers are able to decide how much to charge for out-of-network care, sometimes that charge might be higher than you expected. Did you know that you can use cost estimate information—available for free through this website—to discuss and negotiate the cost of care with out-of-network doctors, dentists, hospitals or other healthcare providers?
That cost information can help you make educated healthcare choices—and may even save you money. Providers do not have to accept a lower fee for a service or procedure. But, some may do so if asked. Or, they might offer payment plans that allow you to pay for the service over time. Keep reading for tips on planning and negotiating the costs of your healthcare.
Before you have a medical or dental service: Know what you will owe
- Talk to the healthcare provider you intend to see—or the provider’s office staff—to ask about the service or procedure that you will receive, its billing code and price.
- If you have insurance, find out if your insurer will cover any of the costs of your out-of-network service or procedure.
- medical and dental cost lookup tools on this website to estimate the cost of your medical or dental service and compare it to what your provider is charging. Use the
- Start a conversation with your provider about your payment options.
- If you have a flexible spending plan, use it.
- Build confidence.
After You Get a Bill: Compare Your Costs with the medical and dental cost estimates from this website and Discuss Differences with Your Provider
- Review your medical bill closely.
- If you have not already used the website’s cost lookup tool, use it now.
- Contact your provider’s billing office and discuss the difference between their charge and the FAIR Health cost estimates.
- Ask if the provider can match either one of the cost estimates from this website.
- Be open to discussion.
- Find resources that can help you to dispute your medical bill such as Healthcare Path Finders and the Patient Advocate Foundation.
Step 2: If you have insurance, find out if your insurer will cover any of the costs of your out-of-network service or procedure.
Some types of health plans will pay part of out-of-network costs and others will not. Some plans may also help with unique situations, such as if you have a rare condition and need to see a doctor with a specialty to treat the condition, but none are available in your network. Some plans may allow you special permission to receive care from an out-of-network doctor and pay the same amount that you would for an in-network doctor. For more information, call your plan’s member services number (on the back of your insurance card) or review your summary of benefits.
Step 4: Start a conversation with your provider about your payment options. Is the out-of-network/uninsured price lower than what the provider charges for that service? What about the in-network price? If so, ask if the provider would consider offering a price that is closer to one of these estimates. You also may wish to ask about other types of discounts, financial aid or a payment plan. Those steps are especially important if you are not insured or have not met your plan’s deductible. In such cases, you will be paying your entire bill out of pocket.
Step 5: If you have a flexible spending plan, use it. With a flexible spending plan, you can save by using pre-tax dollars to pay for healthcare services. For more information, see Flexible Spending Plans.
Step 6: Build confidence. Speaking openly with providers about prices can help you build the confidence to shop for healthcare services and make the best decisions for you and your family.