The Insider’s Guide to How to Negotiate Your Healthcare Costs: Part 3

More and more people are going without insurance for their healthcare—they’re paying cash.

So how do they get the best deal?

They know a guy.


And now, so do you.

We’ve already discussed “top line pricing” and learned a step-by-step approach to getting huge discounts for cash from your healthcare provider, be it doctor, nurse practitioner or health system.

But what if your medical care is unplanned?

What if you, without insurance and forced to pay cash, needed to consume healthcare.

It happens.  A trip to the ER.  An emergency appendectomy. A tubal pregnancy.

You’re going to get a huge bill.  A bill for the maximum amount your provider is able to charge. And you’ll be expected to pay it, or get turned over to a collection agency at the risk of ruining your credit rating.

What to do?  I’m going to show you how, step-by-step, to get you an 85% reduction.

Even though you have already been treated, you still have leverage. In fact, they have already spent the time and money on you— and that gives you have tremendous leverage.

Put yourself in your provider’s place.

The worst-case scenario for them is that you pay nothing.

Then they’ll have to sell your debt to a collection agency, for 3-5% of its value.

Even if they forget the whole debt, it is not deductible from their taxes.  It’s literally worth nothing.

Now, look at it from the perspective of the employee who’s in charge of collecting the debt from you.

They’re graded by how much better they can do than simply selling 3-5% of your debt to the collection company—and (this is the important part) how SOON they can do it.

Time is on your side.  Use it.

Here’s your approach for success

If you needed emergency medical care, you’re going to get a lot of bills.

As you receive each one, immediately call the provider and get the name and address of the business office manager.

Draw up a payment agreement and acceptance letter, modeled below.

The key points:

  1. You will immediately pay, in cash, the estimated Medicaid allowable for the services incurred for the bill you received today. That last part is very important, it underscores your seriousness and the timeliness of the offer.
  2. This offer expires at midnight, the 10th day after your letter is received.
  3. Acceptance only by certified mail-return receipt requested.
  4. If you have a personal attorney, note on the bottom of the letter that you sent a copy to her and insist a copy of the acceptance be sent to her as well. This also demonstrates your seriousness.
  5. Tie acceptance to a positive patient satisfaction survey response. These are like gold to the office manager.

The office manager may respond with a counter-offer but overall she is very, very likely to accept your deal.

If she does counter, tell her you can only accept counters in relation to Medicaid charges. Don’t let her get away with comparing discounts to the top line amount you were billed.

That number is made up out of thin air.

The government’s already done your negotiating for you.  Use it.

If you stick to your guns, you’ll get an agreement in Medicaid dollars, even if it’s 150% of what Medicaid pays.

No matter what percentage of Medicaid you end up paying, you will have successfully negotiated an enormous discount.

Don’t think the office manager will go for it?

Just try.  Give her a chance to say no.

See, it’s not just how much of the debt she collects, it’s how fast she collects them.

And if she doesn’t accept your generous offer, she knows that if your debt has to be sent to collections her boss will see your letter when your file is reviewed.

The manager’s boss will then know that 30% of the debt could have been collected immediately, but now, 90 days later, that same debt is going to have to be sold to a collector for 3 cents on the dollar.

The manager knows that if this happens, her boss is going to be mightily displeased.

In fact, may corporations have policies that they must take payment offers such as I outline above.

But YOU MUST ACT QUICKLY!  Very quickly.

It’s the time-value of money that you’re selling, so the sooner you act, the greater the value you’ll have to work with in your negotiation.

You could be turned over to a collection agency in as little as 90 days of non-payment.

And once the collection agency has you, they will work your debt—your full debt—until either you pay, you declare bankruptcy or you die.

You lose nothing by trying.

And have much to gain.



Here’s an example:

July 1, 2019

Jane Doe

Office Manager

United Surgical Services

1234 Anywhere Drive

Anytown, USA, 00000


Ms. Doe

I’ve received bill #XXXXX today.

To settle this bill in full, I will pay immediately, in cash, the estimated Medicaid allowable for the services rendered.

This offer expires at the close of business ten days from your receiving this letter.

If this offer is accepted, I will be certain to mention my satisfaction at your both your personal service and your organization’s flexibility in my upcoming patient satisfaction surveys.

Please respond with your acceptance by return mail, return receipt requested and send a copy of all correspondence to my attorney below.

Sincerely Yours

John Doe

CC John Doe’s attorney.



(This series is adapted from a post written by someone with an anonymous sobriquet. You can find here. The website is buggy, loaded with onerous advertisement and definitely contains content that many people find objectionable—it’s a place that the average healthcare consumer might not want to go.  A reader brought the post to my attention and asked me if it would work. I responded that, yes, I already had seen it work, many times in my old practice.  I revised the content for better understanding and useability. It’s not obviously copyrighted).