Everything Changes - The Guide to Young Adult Cancer

The first step to reducing your medical debt is asking your doc or hospital to reduce your bill. This takes time, chutzpah, and smarts and is worth the work.

Asking for a discounted bill can sound impossible but it’s not.  Here’s why:  The cost of medical procedures, doctor’s time, and hospital services are not set in stone. In fact, different patients are even billed different prices for the same services. Walking into a doc’s office or hospital is not like walking into McDonald’s where a Big Mac costs the same for everyone in line.  With medical care, different people get charged different rates and your rates can be negotiated.  After all, negotiating rates is exactly what insurance companies do and you can do it for yourself too!

The National Endowment for Financial Education has a great brochure ‘Avoiding and Managing Medical Debt’.  These tips on how to ask for a reduced medical bill  are based on their expert advice:

1.  Have a positive attitude. Your odds are good: 50% of people who ask for reduced costs get them, plus using these strategies give you an extra advantage.

2.  Talk to the right person, face-to-face: Don’t do it by phone or letter. Talk in-person to your doc, your doc’s or hospital’s office, business, or billing manager.

3. Honey goes farther than vinegar. Be polite. Kill’em with kindness.

4.  Be persistent. Don’t take no for an answer.  (I never do!) Many hospital staff don’t know the correct policies and will say ‘no’ when they should say ‘yes’.  Work your way up the ladder.

5.  Build your argument. Find a copy of the hospital’s free and discounted care policy.

The American Hospital Association has a Billing and Collections Practices Policy.  4,200 hospitals have signed on agreeing to: a.) assist patients who can’t pay for all or part of their care, b.) make these policies accessible and written in clear language. Visit this link, click on ‘more than 4,200′. If your hospital is on the list, present this info in defense of your request.

6.  Contact your State Attorney General. If you’re at a non-profit hospital, many state AG’s will help ensure they provide charity care.  Find your State AG here.

7.  Compare costs. Conduct research to find out what patients with insurance or Medicare are paying for your same procedure codes. Demand the same rate.

8. Offer to pay part upfront.  Billing departments need cash from patients who often can’t paying anything at all.  Bargain for a discount in exchange for paying something upfront.  Will they cut in half a $15,000 bill if you give them $800 upfront?  Maybe.

9.  Get it in writing. When they agree to your request, get it in writing!

Does haggling for reduced costs excite or intimidate you?  Have you ever done it?

For grants, financial assistance, and money saving tips download for free the first chapter of Everything Changes: The Insider’s Guide to Cancer in Your 20s and 30s.  Scroll down on the right side of this page for the yellow highlighted download link.

I was interviewed in the Chicago Tribune this past Sunday about when you know it is time to ditch your doctor. For me the answer hinges on what kind of doctor it is: primary care physicians (PCP) versus a specialist. I’m actually much more stringent about my PCP, and much more lenient on my specialists. Here is why:

My PCP is the gatekeeper of my health. If they don’t ask the right questions, don’t investigate a symptom, don’t remember who I am or if my body has changed over the years it’s a big problem. In the myriad interviews in my book Everything Changes, it was most often the PCP who neglected the signs and symptoms of young adult cancer. Dana’s PCP suggested her back pain was caused by the sexual positions she was using. Mary Ann’s PCP told her she was anorexic and a hypochondriac. Both of these women had blood cancers that were littering their bodies with tumors.

I also want my PCP to connect me to the best specialists. I don’t want them randomly cracking open a pocket-guide listing of docs in my hospital system. My PCP should know who a great is gynecologist is and tell me hands down Dr. X is the best otolaryngologist on staff. If my PCP isn’t hitting these marks it is time for me to move on. I have fired my PCP and my new one rocks.

So, am I conversely forgiving of a rude specialist, who doesn’t remember my name, my medical history, isn’t as communicative? Yes. I search damn hard for top notch specialists. Top docs have access to medical knowledge years before it trickles down to the likes of an average specialist. If my specialist has horrible bedside manner – and some of mine do – I dawn armor and enter my appointments ready to access their life saving knowledge. Can their lack of communication increase the risk of medical error? It might, so I am hyper vigilant. I check my records, repeat information, ask good questions, and develop good rapport with their assistants.

Mozart was an ass but people kept him around because he created some of the most beautiful music ever written. I don’t mind if the same comparison can be made to one of my specialists. As for a PCP…YOU’RE FIRED!

Have you ever ditched your doctor? What made you fire them? Did you tell them why you were firing them? Was your next doctor an improvement?

For tips on doctor-patient communication, check out Everything Changes: The Insider’s Guide to Cancer in Your 20s and 30s.

I loved Michelle’s response to my post Fashionable Hospital Gowns? It begs the question: How do we take control in a doctor’s office when our tits’n ass are hanging out? Here are some of my tactics.

When the nurse hands me a gown to change into  - I don’t.  Instead, I wait fully clothed in a chair until the doctor enters. (I often work at their desk, which is productive and beats sitting half naked in fear on a vinyl table.) When the doc arrives, we talk about my symptoms/concerns and review labs or scans. Then they leave and I change for the exam.

Some docs hate when I eat up their time with these extra entrances and exits. Frankly, I don’t give a damn. The more comfortable and in control I am at my appointment, the better we will communicate. Good communication reduces the likelihood of phone tag or extra appointments to clear up misinformation.

After the exam, I always get off of the table. I sit in a chair, walk across the room, or if there is no space I just stand up in front of the table rather than sitting on it. I’m a professional choreographer and believe that where you stand in space can manipulate the focus, power, and control of a scene.

Also, if I walk over and pick up my underwear and start putting it on, male and female docs usually bolt for the door and return in a minute or two for conversation when I’m fully clad.

Do you ever think about where you sit or stand and your body language or eye contact during conversations with your docs? How do your docs react when you change up the routine and try to approach things more on your own terms? Are these suggestions practical for your situation?