I am pulling back the curtain and showing you how I negotiated discounts on my hand surgery.

Back at the end of last year, I needed to have a medical procedure. It wasn’t urgent, so I chose to wait until work slowed down and my out of network deductible was met and I had vacation time to use. I wanted to use my doctor, whom I know and trust. We have been patients of the practice for years, and he has done a few surgeries for the family, but he was out-of-network. 

I have admit that insurance sometimes baffles me, but I was bound and determined to figure it out. After discussing the details with my doctor, I chose to have the procedure at the hospital’s surgery center – which that cost was in-network. First step done easily and I wouldn’t have to pay for anything.

Next, I contacted the surgeon’s business office to discuss the fee. I knew I would have to pay something and the 80/20 isn’t really 80/20. I had a lot to learn here. I learned that an out of network provider doesn’t have to get prior approval from my medical insurance, so they couldn’t tell me what I would owe ahead of time. They could only tell me the surgeon’s cost. Then to understand this better, I spent well over and hour on the phone with a really helpful person at the insurance company. I found out what the insurance would probably cover – that was actually about 58% of the cost – not really close to the 20%. I was now two business days before the surgery and still trying to figure out if I have the money to pay my part or was I going to cancel the surgery at the last minute.

Lastly, I learned from my insurance company that I could be responsible for the anesthesiologist as well, if they were out of network. I contacted the surgical center and was given the number for the anesthesiologist and contacted them. Since they were in network, this step was fairly easy. But, they did bill me for the full amount after the surgery. So back on the phone with the insurance company to straighten out this bill, that I wasn’t supposed to pay for.

Now I still had to deal with the surgeon’s fee. I decided to contact the doctor’s office and explain my situation. I really wanted to the have the surgery and I wanted it with that doctor, but I was struggling with the portion of the fee that I would have to pay. (My portion would have been a couple of thousand dollars) After 24 hours, the office got back to me, and the surgeon reduced his fee to a number I was comfortable with and that I could afford. Yes, this took a lot of effort on my part but my budget said thank you.

Bottom line, you can negotiate with all types of services and possibly come to an understanding. I did it this time, with several calls and a few hours of my time. For me this was worth the time and effort, to end up paying a few hundred dollars, a number my budget liked.