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The price is right: When patients want to haggle

If you don't know the answer to "How much does this cost?" you'd better find out, because more patients want to negotiate the price of care. But how do you set that price without getting into financial -- and legal -- trouble?

By Myrle Croasdale, amednews staff. May 6, 2002.

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As Priceline pitchman William Shatner might tell you, a lot of people like the idea of naming their own price for services, whether it's for airline tickets, hotel rooms -- or a visit to your office.

More often, doctors are seeing patients who want to negotiate the price of care, with the increasing popularity of defined contribution plans and the increasing preponderance of high deductible plans. According to a recent poll taken by Harris Interactive Health Care News, 13% of consumers have asked their doctors for a discount in the last 12 months.

"In the last three to six months, I'm seeing more patients coming in with defined contribution and medical savings account plans. I'm seeing big momentum in this direction," said David McDonald, DO, a family physician in Renton, Wash.

These people aren't coming in unprepared, either. There are Medicare fee schedules on the Internet for the public to peruse. And while doctors know most Medicare fees don't cover their costs, consumers don't and they may not care.

So what do you do if a patient starts to haggle with you? What would you charge? How do you even get started figuring that out?

Fortunately, analysts say, most doctors have time to figure this out. But eventually, they say, physicians are going to have a lot more patients asking them, how much does this thing cost, anyway?

"I believe when this reaches critical mass, in, say, three or four years, there will be whole new set of equilibrium pricing on routine care," said J.D. Kleinke, a Denver-based health economist. "Physicians haven't been in a free market before. A lot will be offended by this, and a lot will jump right on it. With the lack of hassles, it's cash on the barrelhead." [...]