Ask the grumpies: worth fighting insurance company?

L asks:

My employer switched health insurance companies/networks recently and a service that used to cost $75 with the old network’s discounts now costs $175 with the new network, apparently there is no discounted price. It’s the exact same service and a month apart, so it’s not like prices went up in the meantime. I told the benefits department at my company this and they gave me a bunch of bullcrap about how the new network is supposed to save us money and unfortunately my case is one where it costs more than twice as much. There’s a distribution list and I asked and there are other people seeing similar increases in service costs.

While I can absorb this, it is rather annoying and I now have the high deductible plan, so it is 100% my cost. I did finally get the bill in the mail from the provider and sure enough, it is $175 like the insurance company’s website said it would be. Do you think that I can call the provider and try to negotiate my own discount since there was such a large discrepancy between back to back visits? I really wish my employer would do something like this since we as individuals have no pull with the insurance company, but they have enough employees that they probably would…



Well, the only time we’ve ever had luck negotiating with an insurance company is when we’ve been in the right. And even then it has sometimes taken multiple phone calls. Still, it’s always worth a shot, if you think your time is worth it– you can report back to us.

What do our readers think? Have you ever had any success negotiating with an insurance company? Any thoughts for L?

25 Responses to “Ask the grumpies: worth fighting insurance company?”

  1. Thisbe Says:

    In a general idealogical sense, an expense that happens monthly and is in the hundreds of dollars order of magnitude seems exactly like the kind of thing I’d prefer go towards my deductible. (In my imaginary dream world, that kind of stuff isn’t covered at all at my high-deductible insurance plan is way less expensive as a result, but that’s not really either here or there.) It can be budgeted for, and then in the event of an unexpected health-related incident there’s that much less of the deductible I have to shell out to meet all at once.

    • L Says:

      I like your imaginary world! It’s mine too!

      Last year, my birth control costs equaled my deductible (I had a lower deductible plan), so really anything other than birth control cost me 10%. Not bad! So I really went from this service costing me $7.50 last year to $175 now, which is even more of a sticker shock…

      I think I’m going to follow PoP’s advice below.

  2. Kellen Says:

    I think you might have more luck finding a different service provider than convincing the insurance company of anything. In my experience, the health care providers can be your best bet for negotiating the waters of insured healthcare. Either talk to them, or ask the insurance company where/how you could get this service cheaper – but I wouldn’t bother negotiating an already-occurred bill.

    • L Says:

      I would, except that finding the right service provider is really hard on a personal level :( I’m going to go to the provider this time like PoP suggested below. I really don’t like that our healthcare system means that I have no idea what something will cost me until I get the bill a month later.

  3. Comradde PhysioProffe Says:

    Private health insurance is the best system possible, because freedom. This letter writer is obviously an America – hating socialist who should move to some socialist hellhole like Sweden. USA! USA! USA,

  4. Cloud Says:

    This sucks, but I don’t think there is anything you can do about it, except for shop around for a different provider, as @Kellen suggests. You don’t mention anything about premiums. If your employer is paying those, it may very well be true that the new plan is cheaper overall and you just don’t see the savings because it is occurring in the part of the coverage that your employer pays. This is one of the (many) reasons I wish we’d get our health care decoupled from our employment. The people comparing plans and negotiating with insurance providers may have quite different priorities than the people who are going to use the service.

    • L Says:

      My premiums are really cheap (~$25/month) and didn’t change with the insurance company switch, so it’s quite possible that the new insurance company costs my employer less in premiums.

      Agreed. Your employer knowing how you use the health care is almost as bad (or maybe worse?) than your parents knowing.

      • Ally Says:

        Or the premiums on the old plan were about to go up, and your employer switched in order to maintain the same premiums for them AND your portion… Not that I’m convinced employers always have our best interests (ha!), but they know employees will be upset if they have to raise the employee portion of the premium, so they’ll generally try anything else first it seems…

      • L Says:

        @Ally LOL That seems like a pretty big jump just to save on employee portions though! The family people might notice, but single employee health insurance premiums are so cheap compared to what people make that I don’t think anyone would really notice – this bill is pretty close to what my premiums cost annually.

  5. Holly@ClubThrifty Says:

    I wouldn’t waste my trying to fight it. Your insurance company is a for-profit business who wants to pay as little as possible on your behalf. I’ve endured my share of disputes with health insurance companies. Trust me, they don’t care. And they never will.
    I now have a $5000 deductible and my husband’s employer (my former employer) only chips in for about 33 percent of the premium, so my thoughts are coming from an entirely negative perspective. I try not to think about it.

    • L Says:

      Eeeek $5,000 deductible! Mine is definitely lower than that. My employer subsidizes employee health insurance premiums quite heavily. So as a single person, my employer pays probably about 95% of the premium, but if I had a spouse/family/children on my insurance, they don’t really subsidize that person.

      Thanks for your realism – I’m still partially in this fantasy world with my parents’ magical health plan in my head that covers every 100% at no cost to us…and dealing with insurance companies and medical bills is a surprise every time. This one more so than any other one.

  6. plantingourpennies Says:

    The provider might be willing to eat the cost difference at least the first time if you ask a billing manager. I’ve had some luck with that when the cost of a service increased dramatically to me as a result of their switching labs. They ate the cost and promised to either use my preferred lab or eat the costs in the future as well. (It’s cheaper for them to eat the costs of those who complain and use a lab where they get a kick back than to use a lab that is cheaper all around for everyone. Screwy incentives which they have blamed on the ACA, though I can’t confirm whether the ACA is a convenient excuse or actually related to the issue.).

    Either way, definitely ask. In all likelihood as long as its not an Rx and is a service, they’ll grant it.

    • nicoleandmaggie Says:

      If I had a way to box this comment, I would. Looks like there’s an example of it working at least once. Go for it!

    • L Says:

      This is basically what I was thinking of doing. Thanks! Yep, it’s definitely a service.

    • Ally Says:

      The other thing I found out once at my primary care doctor’s office is there was an automatic discount for paying your bill in full if it was over a certain amount at my office… Rarely did things come through on the same bill in order to be able to do that (I really kind of felt it was unfair because I found this out in a year where I pretty much had a bill from them every month, it just was often not high enough to get the discount applied! I was tempted to ask them whether I could let a bill run over into being late in order to get the discount, but I couldn’t stand the thought of purposefully paying my bill late!)

  7. chacha1 Says:

    My solution for the rising cost of healthcare is to consume as little of it as possible. This is not germane, I know. But I’m seeing above that the monthly premium is roughly $25/mo. That is insanely low. Mine is just under $200/mo and I have a $4500 personal deductible. It costs me $100 to see a doctor in my high-deductible Kaiser HMO plan.

    I’ve carried health insurance my entire working life and only twice has it been “worth it.” But it’s one of those things we are conditioned not to do without … because *what if* there’s an accident?

    One of my coaches broke his arm and got a concussion in a furniture-moving incident. Without insurance he would have owed $85,000 for the hospitalization, CAT scan, surgery to pin the humerus so he could get back to work in three days vs six weeks, etc.

    Anyway, my unhelpful response is, if your total out-of-pocket healthcare expense per month is averaging under $300, count your blessings and don’t waste time arguing about it with the insurers.

    • L Says:

      Your chosen medical value is to use healthcare as little as possible. My chosen medical value is to use it as necessary and accept the costs where logical. It’s just hard to accept the cost when it is that much more than what I expected it to be. I’ve done some more research online and it looks like this insurance provider simply allows significantly higher rates than the previous one and that’s the way it is.

  8. amy Says:

    [caveat-I’m in the medical field] and yes, rising premiums (total cost for employer and patient portions) are rising. Everyone is trying to minimize the rise (so far the trend is that the rate of health expenditure acceleration has slowed, but the overall slope is still quite positive). Anyways, I’m sorry in your case swapping plans made your service more expensive. It is unfortunate that for most people with employer based plans that folks stay in one plan for average of 18 months, and thus, insurers do their best with their provider negotiations to keep the insurers’ near term costs low, but possibly at the expense and inconvenience of patients.

    • L Says:

      It seems that they’re raising the patient cost of services rather than premiums to keep the people who never use the medical but pay into it anyway since my employer only lets you opt out if you have other coverage happier. I also get that prices are going up – but I would expect it to be a more gradual shift rather than an abrupt doubling.

  9. oilandgarlic Says:

    I think in this case you will have more success negotiating with the vendor since the insurance co-pay is not really negotiable.

    My best tip: If you’re fighting insurance, and they do routinely deny things that should be covered, always do it in writing, mail it certified, and back it up by quoting their benefits guide. Employers are required to supply a detailed benefits booklet but many don’t unless asked and most employees don’t read it. I don’t bother calling and I’ve won 100% of my battles against insurance.

  10. L Says:

    An update for any of you who are interested:
    I called the provider and they said that they billed the exact same amount, but that the insurance company allowed a different amount. I started crying because the service was worth $75 to me, but there’s no way it was worth $175 and I honestly would have canceled the appointment had I known it would cost that much. In fact, I’d tried to schedule it before the plan switchover in case billing was wonky, but the scheduling wouldn’t allow it. (Caveat: I will pay the bill in full – I’m not going to cheat the person who rendered the service. I hope this means that the provider gets more out of it, but somehow I doubt that.)

    So then I did some more research online. My insurance company makes it super easy to find how much a particular service costs with any provider in my area. With the old insurance company, I know it was about $70-90 depending on various factors. Well, with this new insurance company, it is between $90 to $175 depending on various factors, which is a much bigger range. And now I know how to look up how much a particular service will cost! At the very least, it looks like the cost will be the same no matter the provider.

    Thanks for everyone’s input!

  11. hush Says:

    I’ve only had to negotiate with an insurer once – and it was not my insurer, but the insurer of the son of the party with whom my car was in a minor auto accident (in which thankfully no one was injured). The insurer was AllSnake out of Boise and the adjuster was a lying cheater, big time. Luckily I had it in writing (email) that the adjuster told me he was mailing me a check – then flaked/changed his mind. My advice – communicate via email, not phone. Don’t hesitate to report jerky behavior to your state insurance commissioner’s office – that was the only way I got paid, and my claim was 100% legit.

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