Dealing without health insurance

Be upfront with providers about your situation. When time allows, talk to providers in advance about your insurance, employment and financial status so that you know before incurring fees how responsive they are.

Apply for charity help. Hospitals, in particular, have access to foundation and state funds to cover care for the uninsured. When Dotty Scott's husband of Vancouver, Wash., ended up in the ER with what turned out to be kidney stones, the $6,100 bill astounded them. The hospital requested financial forms and a copy of tax returns, and Scott explains, "They said we qualified for a charity grant, so we didn't pay for any of the hospital bill."

Ask targeted questions. Negotiations fall into two categories: lowering the bill total and asking to pay over time. Usually, it is easier to ask about payment terms than it is to ask about discounts. But, says Hana Rubin, CEO of The Maxon Co., a third-party administrator for health insurance programs, "when you ask for help, it's hard for them not to do something."

"Talk to the doctor," she says. "I would talk to the people at the desk as well, but they are the gatekeepers. They are not the ones who are supposed to be sympathetic necessarily. They are there to do their job and to run the business."

Be reasonable. Smith credits a collaborative tone for successful negotiations. "Our people are trained to walk through that conversation without losing focus, without losing their temper," he says. "We don't accuse the provider of wrongdoing -- 'You've sent an erroneous bill!' or 'I can't believe you charged me these rates!' We just deal with the reality of the situation, which is here is this bill, here is how much this person makes, and we need to come up with a resolution."

Smith considers a negotiation successful if providers agree to a 30 percent discount or more. "That's assuming that the charges weren't rock bottom to begin with," he adds.

Don't agree to aggressive payment plans. Make sure you can live up to amounts you agree to pay each month.


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