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Comment by sokoloff | Hacker News Reader

The greatest leverage is in your willingness to walk away. Being more willing to walk away than your counter-party is an enormous advantage in nearly any negotiation. (Being perceived as more willing to walk away is almost as good.)

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Good point, but makes me wonder how Medical Bill negotiation is on the list at all? How do you walk away from that? I could see some leverage if you're already in collections I suppose. Edit: The list posted by "MerelyMortal" above.

The leverage is – "I will not pay you and take the credit score hit, which I am okay with. You will then have to sell my debt to collections for pennies on the dollar. Instead of that, let's work out a favorable monthly payment plan."

I've always wondered if you can buy your own debt from collections and pay it off there, as some sort of soaring medical cost hack albeit tanking one's credit score.

You can offer to settle, which is similar. A "settled in full" note goes on your credit report.

if you’re going to tank your credit score why bother paying at all

Not sure, but you can definitely negotiate with debt collectors. They have been known to withdraw things from people's credit reports in exchange for payment. Especially if you play hardball and insist on seeing paperwork to prove they they have the right to collect.

It appears you can. At least searching for "buy your own debt" gives results for entities who claim to help you do so, without tanking your credit score. "You're certainly not going to take legal action against yourself".

Why can't they just sue you if you fail to pay? Surely if someone doesn't pay for your services there must be some legal means to get the money that you are owed.

They of course can, and through small claims it's monetarily inexpensive, but it's both time and effort, and for more than small claims will handle, it's expensive. Some businesses won't show up personally at small claims and will get counsel involved, which is expensive.

Depending on the debt, getting most of the difference between the legal expenses and the debt itself is in reach, given a creditor who is a rational actor.

If someone doesn't have the money to pay a debt then suing them isn't going to magically produce it.

This submission is about getting a discount when you otherwise wouldn't have. If you can afford to pay in full. You have the money to pay.

Why do that, when they can sell the debt to a collections agency that's willing to pay:

(probability of recovery) * (1 - profit margin) * (amount owed)

today, for the right to sue on you behalf?

Note: I think the current debt collection system in the US is terrible, especially for medical debt. I suggest looking at the charity "RIP Medical Debt" if you do too.

At the very least, when selling a debt to a collections agency, the (re)seller of the debt should be obligated to first offer the same price to the person that owes money.

> At the very least, when selling a debt to a collections agency, the (re)seller of the debt should be obligated to first offer the same price to the person that owes money.

That seems reasonable at first glance, but it would lead to an explosion of people simply refusing to pay and waiting for the 'debt collector price' offer to arrive.

If you ever ask a lawyer to sue a person with not much money, you might get a proverb in response: "you can't get blood out of a stone". Literally, if someone doesn't have the money, you won't get it.

Suing people who don't pay their bills is a losing proposition. You will be paying lawyers and getting very little to nothing in return.

The difference is that we are talking about a case where you can pay bills but you just want a discount so you threaten not to pay.

I'm on the same page. But, the hospital doesn't choose their collections strategy just because of one person. They can't see inside your bank account. Most people who can pay, pay. Most people who can't, can't. If they started suing people who couldn't pay, they'd lose money overall, so they don't.

I didn't think of it that way. Thanks. So as long as most people don't try to do this then the negotiating strategy can work.

> They can't see inside your bank account.

In the "of course that exists" category, there are services that give a score about somebody's ability to pay.

I really hate how every business process can be (and frequently is) optimized to the nth degree at the cost of privacy.

https://www.equifax.com/business/product/ability-to-pay/

Getting paid today (or a payment plan starting today) is probably worth a discount over getting paid after a lengthy court process; even if you'll get compensated for legal fees and time value of money.

How much of a discount that's worth depends on the likelyhood of collecting after the legal process as well as how much of a reputational hit going through the process would be.

I wouldn't negotiate with most things after the service was performed (unless it wasn't to my satisfaction), but most services will have a firm quote before the service (sometimes that's legally required). A mechanic can keep your car until you've paid, but a hospital can't refuse to discharge you until you've paid, so they don't have the leverage to get immediate payment.

My first son was by cesarian and we did not have insurance. The bill was $15,000. After some various payment plan discussions I asked if there was any other way to pay. The lady said yes, if you pay cash before you leave the hospital is is $2000. I since have used the pay cash method to pay a fraction of various medical bills.

The more I read about the American healthcare system the less it makes sense.

I just read all three credit bureaus removed medical bills from their report.

Where did you read it?

Check out my reply above

I was curious and found these details.

https://www.businesswire.com/news/home/20220318005244/en/Equ...

> Effective July 1, 2022, paid medical collection debt will no longer be included on consumer credit reports.

In addition, the time period before unpaid medical collection debt would appear on a consumer’s report will be increased from 6 months to one year, giving consumers more time to work with insurance and/or healthcare providers to address their debt before it is reported on their credit file.

In the first half of 2023, Equifax, Experian and TransUnion will also no longer include medical collection debt under at least $500 on credit reports.

>leverage if you're already in collections I suppose.

What about before you undergo the medical services? Why is it so damn uncommon to ask for a price before seeing the doctor?

> Why is it so damn uncommon to ask for a price before seeing the doctor?

The main reason is that, often, the doctor is choosing the specific procedures after you show up, not before. There's not a price for "stomache ache".

For the elective procedures where it is known what is involved up-front, there is some price shopping that does happen.

There is a price for office consult. And when the doctor says, "I'm going to order a blood test," or "I'm going to clean your ear out" or whatever, you can ask them to have it priced out before they do it. People ought to know that.

Insurance has driven a market where the pricing is opaque. The doctors are trained to req services without concern for money and the billing office reconciles it with the insurance bean counters.

Imagine choosing doctors like plumbers. Do you go with the one with the low initial exam fee? How about the one your family member recommended? Or the one with good reviews on the internet? Then, when they tell you the plan, do you go to another one and pay their exam fee to find out their plan?

I have some experience at this from the veterinary side. Some people do treat us like plumbers. They know there are several points of leverage in the pricing. However, it is a two edged sword. If you decline the plan and renegotiate it, the vet is liable to stop recommending the expensive options because you are more focused on money than health. This happens unconsciously. If you decline a $20 diagnostic after a half hour of haggling I won't have time or energy to try to convince you to spring for a $100 monthly treatment when an inferior but acceptable treatment is available for less. I'll present both options and you will probably choose the inferior one as part of your haggling strategy.

Haggling makes lots of sense when the quality of the commodity is not under control of the salesperson, it is easy to determine, and the salesperson pads your price with lots of margin. In medicine, everything is opaque and haggling is rarely able to take a broad cut on price without sacrificing quality.

Elective surgeries.

Need a hip replaced? Having a child? These things can negotiated in advance at a substantial discount.

In negotiation theory, this is known as your BATNA.

https://en.wikipedia.org/wiki/Best_alternative_to_a_negotiat...

Tried this buying a used car a few weeks ago, but didn’t work. Still spent money on some stupid crap (pre installed lojack, door edge protectors) to get the car I wanted.

With supply chain issues, cars are not very negotiable right now. Supply chain issues notwithstanding, used cars are trickier to negotiate because you can't go to another dealer and buy the exact same item like you can with new cars.

It sounds like it didn't work in large part because you actually weren't willing to walk away (which makes sense in a lot of cases; if you need something and don't have a good alternative, you may reasonably choose to accept a worse deal than if you were indifferent).

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