The art of negotiation in an abusive relationship

Negotiation.

It's a skill that I didn't think I had, but recently I proved myself wrong.

When presented with a financial arrangement that demanded 100% payment in advance of a purchase, I managed to talk the seller into accepting 25% down and agreeing to 10 monthly installments for the balance--interest-free! Not too shabby. So why do I feel dejected and angry? Because I was negotiating the terms of paying for use of the surgical center where shoulder surgery was scheduled.

Call me crazy, but setting up a payment plan was the last thing I wanted to think about a few weeks before my rotator cuff repair. Yet, in the U.S., we have come to expect it. When you check in with any health care provider, what is the first thing they ask for? Your insurance card and/or payment. Maybe that's why I hear Cuba Gooding Jr. yelling, "show me the money!" whenever I walk into a doctor's office.

Experts speculate about how we got to this point and who (or what) is to blame, but I agree with Wendell Potter, author of Deadly Spin. Fault can be laid squarely at the luxuriously appointed doormat of health insurance companies and, for them, it's all about the money.

So let's think about this. If the insurance companies only care about making a profit (and they do), how confident can we be that our health and well-being will take priority when making health care decisions? The sad truth is, we can't. And, to add insult to injury, our access to health care is shrinking, as costs increase, as noted in Steven Brill's comprehensive story about "Why Medical Bills are Killing Us" for Time magazine.

Caught in the crossfire of the health insurance companies' quest for greed, health care providers have been forced to "game" the system, increasing fees to net a somewhat reasonable contracted payment amount [note the difference between the "amount charged" and "allowable charge" columns on your next EOB (Explanation of Benefit payments) statement]. Recently, my family learned the hard way (via our checkbook) that the cost for an MRI can be almost 40% cheaper at a radiologist other than the one my husband's doctor referred him to. He could have gone to the less-expensive facility, but didn't think to ask. Likewise, it was almost twice as expensive to have my shoulder surgery at a hospital, versus a free-standing surgical center just down the street from said-hospital. Lesson learned!

I liken the whole debacle to an abusive, dysfunctional relationship. We know on some subconscious level that it's wrong--not to mention unhealthy--but we accept it because we don't know any other way. Except to negotiate.