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Comment by thisisweirdok | Hacker News Reader

Get this though: if you have insurance and your insurance doesn't cover something, you often can't negotiate. I had a $10,000 procedure that insurance didn't cover (i.e., I hadn't met my high deductible yet), and I had no choice but to pay the insurance's agreed-upon rate (which I feel was higher than what I should have been paying out of pocket).

So it was kind of negotiated, but through insurance and their negotiated rates not an individual's out of pocket negotiated rates.

This was also a service where I wasn't informed that a second doctor was out of network, which also screwed me me (and there's literally nothing I can do about this after the fact).

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You can always negotiate and threaten to not pay. They might send you to collections or even sue you for the debt, but often they'll agree to a smaller number to avoid the hassle.

really? I've been told by different hospital billing departments that they will put me on a payment plan, but will absolutely not negotiate beyond an insurance provider's agreed upon rate.

Of course, that stance is in their best interest and not mine... so maybe I wasn't being forward enough?

This all feels quite ridiculous.

It is all ridiculous.

It honestly depends on the individual hospital. They almost always have a contract with insurance that they can't accept less, but nobody's checking and it's common for them to do so. Some hospitals are reasonable and especially if they see if you have low income/assets, will settle with you. Others don't care at all and will not accept any less and just send you to collections or sue.

Well of course the hospital billing department is going to tell you that you have to pay the entire bill. What did you expect? Ask to speak to a manager, make a specific counter offer, and threaten to pay $0 if they don't accept. It only takes a few minutes and even if they refuse you won't be any worse off than before. (I agree this is a ridiculous system.)

I've said things like "really? there's nothing you can do about the cost?" but that's a really weak push for it... I just hate kind of being a dick about it (asking for a manager and making a counteroffer makes me feel pretty shitty, but I'll give it a shot).

I would think it depends if they think you have money (or future earning capacity). If I'm the hospital, and I think you have or will have money, then why not pursue you. On the other hand, if you're poor and having nothing to pursue, then I'll settle for less.

Sure, but the people in the billing department have never met me? So unless they're doing a credit check or doctors are taking notes on suspected financial situations... I doubt they're doing this.

Employment status, Medicaid status, and zip code you live in are all pretty good proxies. Someone who doesn’t offer employer provided insurance is probably not worth pursuing unless they have some other indicator of wealth.

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