by Nate Dallas
Knowledge is power, right? Well, here is some knowledge, and therefore some empowerment for your situation: Most offices and hospitals expect to collect the insurance or entitlement program fees, and little to nothing more. They will attempt to collect as much as possible, but expect not to get much. That means that EVERYTHING is negotiable.
Here’s what I know now, and what I have done over and over since my mistake. These finance hacks have saved me tens of thousands of dollars. Again, this is not just for childbirth. This applies to all healthcare. Here are some valuable things to consider:
#1 - Get an itemized bill. Ask the hospital, the labs, the anesthesiologist, and the doctors for a detailed, itemized bill for all professional services offered to you and your child. Nearly every time the list is inspected, you will find expensive items on it that are inaccurate. It may be $55 for a sanitary napkin package that was never opened, $178 for a disposable bedpan that was never used, or $1,244 for an infusion pump that you have never seen. Ask someone questions about the items that are unclear. Get all charges removed that aren’t legit.
#2 - CASH is KING. The first strategy is to ask for the costs before they happen. Even if you have insurance, ask for the cash fees. Then ask how much those “reduced” cash fees are REDUCED even further if you pay them in full. Most offices offer a discount for paying in full. This could be a 5% to 40% discount. I find that it’s typically around 20%. Remember, it costs the facilities a lot of money to administer payment plans, to chase and collect money, and to file legal collection services. Offices would much rather receive a certain amount, even if it’s less, than chase uncertain money for an uncertain amount of time. Dishonest and desperate people are really good at disappearing, and the medical offices know this. Many organizations will not give you the discounted numbers if they know that you have insurance. Don’t give them the card until you get the information you need. Once you have accurate fees based on having no insurance, then you provide your card and ask for the fees, coverage, and leftover amount if you were to go that route. Then ask how much that balance is reduced if you pay it in full. Now you have two options to consider for whether you even use your insurance or not. Don’t be surprised when these two final balance numbers are thousands of dollars apart. Sometimes the insurance route is better, but I find that usually the cash option is best.
#3 - LIFE is UNFAIR, and the medical industry is too. Medical offices expect different amounts from different demographics. You can say that this is crooked and unfair or that it’s charitable and kind. Your opinion on which side to take will likely depend on one variable: which side you are on. You can make up your mind on where you stand on these issues politically. I mention it just to paint the picture and remind you that there is no such thing as a free lunch. Someone is paying for it. Medical facilities accept state plans and accept fees much lower than standard as payments for services rendered. People who pay their own medical bills are charged much more because those few have to make up the difference. The hard truth is that your hospital payment has to be high to pay for the four behind you that will pay little or nothing.
Most hospitals accept entitlement plans and state sponsored discounted insurance and do not charge the leftover amounts back to the patient. It’s often illegal to charge these patients the remainder of the unpaid portion because the medical practices have contracted to provide the services at the lower rate. However, if you don’t have one of these plans, they don’t always expect you to pay for the entire final balance either. Again, it may seem charitable or crooked, but the truth is that the facility has different expectations for different income levels. If you just write the check, as I did on baby number two, they will gladly accept it and never mention any of their relief programs or discount policies. ALWAYS ask if there is an income-based assistance, discount, or relief program. If you are a high-income earner, you may not qualify, but you must ask to know for sure. These in-house programs typically have a scale based on household income and the number of family members in that household. If you have more dependents and less income, you qualify for a larger discount. Just ask before you pay. You may be surprised at what is available to you. I did not qualify for any discounts on my last three children based on income and household size. That meant that my bill was much higher, but still negotiable. I’ll explain later. Just know that this is yet one more level of possible discount before you get to that final bill.
#4 - Do not sign the first payment plan that they put in front of you. Debt can ruin your life. If you fall behind on paying your bills, default on a loan, go bankrupt, or foreclose on a home, it will affect you forever. In these catastrophes, your reputation, your credit rating, and your trustworthiness are damaged. It may cripple you and take a long time to recover from the devastation. A payment plan is a legal agreement in which, if you default, can cascade into major problems. If you sign it and fall behind, they can send you to collections, garnish your wages, or worse. Do NOT sign a plan that requires more per month than you are able pay.
What are you supposed to do? You let them know that you are doing the best that you can and that you will pay as much as you can per month. They may try to intimidate you, scare you, or strong-arm you into signing a payment plan. You do owe them money, but the amount and the schedule have not been legally assigned yet. If you are making payments every month, even if they aren’t much, you will not likely be harassed. They just need to know that you are actively and consistently paying. If you cease making a monthly payment or two, then you will certainly start getting letters and phone calls. If you don’t have an extra $400 per month, don’t agree to pay that for the next 24 months. Assure them that you will pay them everything that you owe but that it will take some time. Tell them that you will send as much as you can every month, and do it. ?One reason to approach paying the bills in such a reserved way is to protect your family moving forward. But another reason to pay it slowly is that they will probably offer you a much better deal in a few months. It’s crazy, but true. Many organizations will offer you a settlement to close out the account after a few months of bills trickling in. They will cut the bill by 10% to 50% if you agree to a payment plan, or give a more substantial discount to pay it in full. If you do sign a payment plan, I suggest a simple rule. This strategy applies for car financing and home mortgages too: only agree to a plan that you can easily afford to pay in half the time. In other words, get a monthly payment that is half of what you know that you can afford to pay each month, and plan on paying double each month to speed it up. That way, if there is any hardship or financial change, you know you can pay less and not get in trouble.
#5 - Kindness makes a difference. Appeal to whomever you talk to in the billing office, as a kind and compassionate person. You will want to cuss, call names, and burn the place down on numerous occasions, but you must resist, and keep your cool. Be patient and kind. Stand your ground, but don’t be a jerk. They get two reactions in the office from people like you with an outstanding balance: One is bitter rage, and the other is a pity party followed by a sob story. Don’t give them either of these, and you will be noticed and treated differently.
Talk to the same person every time, and build rapport with her. If she is out to lunch or out of the office, leave a message, and get back in touch when she returns. Do not work with another employee every time you call. Sticking with the same person will allow you to build the relationship and create personal accountability. There is still a human element to this process, and having a friend in the front office will prove to be very beneficial.
#6 - If you use the right language and delivery, it works. I want to give you a few lines to use that are proven effective when negotiating. But first, please know that most of these people are paid on a commission basis. Yep! They get bonuses for how much they collect and how much they successfully secure into a payment plan contract. This means that working out a deal with you to get something, is much better than getting nothing. If they think the full amount is out of re
ach, they will work to get you a deal because they want a piece of the pie. Simple human nature comes into play when dealing with collections officers.
These are the quotes that you need to have in your bag of tricks. Use with your discretion based on where you are in the process.
“How does this really work? How do regular people do this?”
“I tried to save money ahead of time, but I had no idea it would be this expensive.”
“Does this eventually cause people to go bankrupt if they can’t pay it?”
“I am so grateful for my child being here, and I want to pay what I owe, but this is going to take a long time to pay for.”
“I don’t know if we can afford this right now.”
“If I only have ‘x’ amount of dollars for this, what are we going to do?”
“Someone told me that you give huge discounts if you pay in full. How much is the discount?”
“If I could borrow the money from a family member or my bank, or put it on a credit card, what is the discount for closing out the account in full?”
“I have a friend that got a 50% discount for closing his account. What is that program called?” (It’s not a lie, I am your friend, right?)
These lines help communicate that you are responsibly concerned, but not a crook or a beggar. I have used these tactics with amazing results, saving my family (and others) tens of thousands of dollars. Do not let them know that you have an HSA account or how much money you have saved. They will want to know how much you can pay today. Negotiate, and then leave the discussion in a time of silence for a few weeks if needed. Allow them to provide a creative solution that works for you. Don’t take the first offer. Let them think that you are going to pay $40 per month for eternity instead of agreeing to pay the $450 per month that they recommend. The deal will likely get better with time, especially if you play your cards well.
The last thing that you must do after you agree on a settlement amount is very important: verify that all charges have finished in the billing cycle and that nothing else will be added later. Ask for a formal letter stating that once the specified amount is paid, you, your baby, and his mother are cleared from all services up to the date of the letter. Get it in writing. After you pay, you may get a few late bills that have been “in processing” for some time and show up weeks later. Do not pay these late bills that come after your agreed date. Your letter states that these are not your responsibility. Your agreement closed all your accounts for all services rendered up until that point. You certainly should not pay for anything else later because of their billing and filing inefficiency. This is an all-inclusive, one-time deal. Once it’s paid and you have a letter saying that your debts are satisfied, don’t write another check.
A Father’s Perspective
If men were solely responsible for carrying a child for nine months and delivering a baby, the human race would be extinct.
Stop for a minute, and think about the last nine months. Your special lady lying in the other room, attached to a pneumatic breast pump, sitting in a diaper full of ice has been through war. The magnitude of the hormonal changes, the surrender of personal privacy, bodily mutations and mutilations, pain, exhaustion, emotions, fear, and confusion have been an insanely grueling process. You and I could have never done it, much less done it that gracefully. Women were built for this and men most certainly were not. Her role is something in which you should marvel. Your role, my friend, is just beginning. Your role is of vital significance, though it doesn’t have the same public spotlight or the fanfare.
Over the next few days, months, and even decades, be appreciative of your wife and her contributions. You need her for many roles that you simply cannot carry out on your own. You need her, and so does your precious new child (and future children). Be grateful that she is here. Praise her. Encourage her. Support her. Show little signs of appreciation. Do it verbally with compliments, and non-verbally with gifts and thoughtful gestures. Leave her notes, treats, and flowers. Make her coffee, prepare her dinner, and tuck her in at night. You know what she appreciates; do those things. Hopefully, you will want to do these things and will get satisfaction from showing your wife how appreciative you are of her. Reaffirm your love for her as often as possible. All of these little things matter and will continue to matter even more as life moves on. If you aren’t a thoughtful person, set reminders on your phone, or put it on your calendar.
I know you’re tired now and have a lot on your plate, but now is when you start showing her what you are made of. I know that there is a heavy load on your back and a lot of pressure, but now is when you reassure her that you aren’t just acting like someone else, you are becoming someone else. Blow her mind, and show her a true man. Your heart can grow. Your endurance can grow. Your sense of self-worth can grow. Your abilities can grow. Your success can grow. If you give it all that you have and apply the lessons learned in this book, you will grow as a man, as a father, and as a husband. Remember, only thing that you can control in life is your effort. Be sure that your wife and child always know that you are maximizing that. You are a new person. You are a father. Your priorities have changed. Your heart will follow your head after you ingrain new habits and practices. Repetition is key. Stay the course. Do the hard work.
You and your wife now have a newly joined role. You are parents. You are a team and have been tasked with the most important of vocations. You will be battered and tested. You will lean on her strength at times, and at other times, she will lean on yours. Build your relationship now to grow the team resilience that you will certainly need later. Your spouse and your child come first, forever. Your comfort and happiness are no longer the top priority.
Don’t just do fatherly things. Be a father. Be a man of character. A large portion of being a good father to your child means being a wonderful husband to your wife. Place both of their needs ahead of your own, and know that it’s going to try you to your limits. I am convinced that most people give up when they are at about 40% capacity. Your body will tell you to quit way before you should. There is always more gas in the tank than the gauge reads. We are all capable of more than we think. Push through that limit with an intense will. Quitting is not an option. Take divorce off the table now, and eliminate it as a plan B. It’s not the easy way out. Fight for your marriage. Remain faithful to each other, and make a commitment to work on the relationship continuously, whether you think it needs work or not. Communicate with each other, and don’t let little things go on undone. Never go to bed angry. Talk things out, and constantly work on your love for each other. It is a process that requires constant, intentional attention. Schedule date nights, vacations, and time to play together. Everyone needs counseling, and everyone needs grace. Find mentors and professionals that can help. Plan ahead, and prevent problems. Build the foundation that can withstand the impending storm. It will come, and it may return more than once.
Saying that we are committed to a fruitful and harmonious relationship is easy, but cheap. Agreeing with my advice may be no problem for you. It’s another thing entirely to pull it off and maintain a strong family through difficult times. Most every man intends to be a good dad and a good husband. He, at minimum, doesn’t desire to be terrible at the jobs. As Mike Tyson said, “Every man has a plan until he gets punched in the face.” So, what happens to all of the men with good intentions? They get tired. They get caught off guard and get disoriented because they weren’t ready for what was coming. Getting knocked off your feet is natural and should be expected if you don’t have a game plan and haven’t prepared properly. Men get bored. They get needy. They get greedy. They place themselves first and think that they are entitled to a “better life.” The grass is not greener on the other side. The world is lying to you about that. We must do the work. It will always be challenging, and it will take everything that we have to succeed.
The secret is profoundly simple: you have to believe that this child is more important than your own life and happiness. You
r family deserves all of your love. Your sacrifice is worth it. They cannot thrive as well without you. You must believe that the marriage is worth fighting for because stable parents are worth so much to the children.
The amazing thing about love is that when you are willing to give up your happiness and faithfully make sacrifices for others, that’s when you start to be truly happy. Please hear me clearly. The only way for you to be happy in life is to do this job well. That is, to be the best version of yourself and keep working to be better. Be the man that you were designed to be. You know that you are not average. If you love with everything that you have, you will be satisfied. Regret and guilt will swallow you if you don’t leave it all on the field. I think I’ve said enough. The rest is up to you. Go do your thing, Dad.
Author Bio
Dr. Nate Dallas is a devoted husband of fifteen years and an energetic father to four boys. He is a dentist, a serial entrepreneur, and a lifelong learner. He has helped many people build products and businesses over the years, but his true passion is helping men grow and transform into the strong leaders that they were designed to be.