Plan Hacks: Negotiating a Free Market Price

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We’ve established free market providers and facilities charge far less than non-transparent facilities and hospitals. What if you want to stay with your current provider but save yourself (or your health plan) a lot of money?

Here are tips for negotiating with your local provider who does not have bundled, cash pricing.

  • Find out the price from your provider.
    • If the price is not bundled, you will need to find the price of the surgeon, facility, anesthesia, and any labs or pathology that is needed. At minimum, try to find out what the “charge master” price is.
    • If the provider/facility/anesthesiologist refuses to give you any price for whatever reason, make sure your physician or surgeon is aware of this, and that you are considering leaving their practice for a transparent, high quality, provider.
  • Find the free market price.
    • To find a bundled cash price for a procedure, there are some options:
      1. Go to www.fmma.org and search.
      2. Use a free market facility’s price from their website.
      3. Go to HealthCareBluebook to find a ‘fair price’.
    • Can’t find a bundled cash price? Call FMMA at 1-866-901-FMMA (3662) we can help!
  • Print out the cash price for the procedure and show it to your local provider.
    • Take this to your provider and show it to them.
    • If applicable, find out the cost of a plane ticket or gas, for travel.
    • Let your provider know that you are willing to leave them to save money, while still getting a high quality procedure. This method is effective whether you are a cash pay patient, have a high deductible health plan, or a self-funded health plan.
  • Get A Written Consumer Cash Price Agreement
    • If your provider (and all of the ancillary providers if necessary) agree to price match and compete, get a Cash Price Agreement in writing!
  • Be prepared to call their bluff.
    • Many providers have no interest in competing with their peers. You must be prepared to travel for your procedure if they refuse to negotiate.
    • It is common for a provider to relent after losing a few patients to a free market facility.

“A man in Georgia needed a prostate operation and was quoted $40,000 by the local hospital. Our price online was $3,600, so he took a plane ticket to Oklahoma City in one hand and our price list in the other hand to this hospital administrator. The administrator caved and said ‘we’ll do it for $4,000’ so we saved that guy $36,000 to get his surgery.”

~Dr. Keith Smith, Surgery Center of Oklahoma