My son's pediatrician referred us to an occupational therapist for an assessment. The pediatrician was concerned about the way my son was holding a pencil with both hands. The details aren't that important. We spent 30 minutes with the therapist. The therapist advised that he did not need ongoing therapy and gave us a suggestion to correct at home. Three weeks later, I get a bill for $475 (after the group insurance adjustment). After doing some research, I've come to the conclusion that the typical cost is $90-170 for an evaluation. That seems reasonable. I appreciate any advice on how to negotiate with them.

  • Have you called the office yet to get more information or is this a "pre-call" question?
    – Troggy
    Commented Jun 16, 2011 at 0:31
  • Calling the office tomorrow because they were already closed for the day. I did already speak to the insurance company though. I was mainly looking for advice on what strategy to take to get a reasonable fee adjustment.
    – kakridge
    Commented Jun 16, 2011 at 2:59
  • I spoke to the billing office. I offered to settle with them for $175. The lady said they could offer me a 20% discount, bringing the total to ~$380. I told her that wasn't good enough. She said they would take any payment I took, but they need $50 a month to stay "in good standing". She also said they would turn me over to collections after 120 days. I'm shaking in my boots. Honestly not sure where to go from here. Considering letting the hospital know about it and that I am notifying everyone I know via social networking to use one of the other providers in town.
    – kakridge
    Commented Jul 22, 2011 at 17:51
  • What is the source of your conclusion that $90-170 is the going rate? Was the provider an out of network provider? If that's really the rate, you're being defrauded -- let the billing person know that you believe that they are attempting to defraud you and your insurance company and intend to report them. Commented Jul 23, 2011 at 1:58
  • Medicare rates as well as other provider rates. Example: akrongeneral.org/portal/page/portal/AGMC_PAGEGROUP/Price_guide/…
    – kakridge
    Commented Jul 27, 2011 at 19:15

4 Answers 4


I think your first step is to be asking for an itemized billing as to exactly what services they claim to have rendered in the half hour that would result in that sort of charges.

These days a lot of medical providers have outrageously high rates if you are not a member of a medical plan that has negotiated rates with the provider. I've heard of instances where someone without insurance was being charged anywhere from 5-8 TIMES more than someone covered by a health plan would be billed. (this seems to be the new tactic to make up for the expenses of covering those without coverage or a means to pay.

Once you have some kind of accounting for the charges, if you can't get them to reduce it to a reasonable level, it might be time to contact a consumer advocate at a local paper or news station.

If you were recommended specifically to this OT by your primary provider, I'd also let them know about these insane charges, and you might want to suggest it would be in the best interests of their patients for them to find someone else (with less egregious fee schedule) to refer patients to for such services in the future.

An important lesson here is to ask about charges and insurance coverage IN ADVANCE and don't be afraid to shop around and check multiple providers. There is very little transparency of pricing in the healthcare industry at the moment, and prices for the very same procedure (such as a consult, or medical imaging) can vary widely (e.g. three maybe even four digit percentage differences) from one provider to another. You really need to be an informed consumer when it comes to health care these days to avoid being taken to the cleaners.

  • +1 for ask in advance. When it comes to our children, we tend to avoid this question. But for non-emergency referrals, ask (about fees). Commented Jun 16, 2011 at 11:22
  • thanks for the advice. That is definitely a lesson learned. I guess I usually thought that my medical bills in the past were fairly reasonable (yes, I know that's an unpopular position). I think I will do better to ask in the future. I know our pediatrician is well intentioned and she is focused on prevention. In this case, I probably should have done some more research before even considering the OT. The itemized bill is a just a single line item: Occupation Therapy Evaluation. I am calling the hospital today and asking what they would take for an immediate cash payment.
    – kakridge
    Commented Jun 16, 2011 at 12:51
  • Hospitals tend to fleece people who don't question them: nrecursions.blogspot.in/2012/11/pore-in-retina.html
    – Nav
    Commented Nov 27, 2012 at 10:18
  • @kakridge The itemized bill is key. If there's something there that wasn't actual performed you can definitely get that dropped. Sometimes if a price for a commonly available product (i.e. asprin) was unreasonable you can negotiate that down. Sadly the medical profession seems to be very hard to get itemized bills from, and sometimes the itemized bills are inscrutable as well...
    – C. Ross
    Commented Nov 27, 2012 at 15:41

Personally, I have not had much luck fighting bills that felt excessive but were not incorrect. In my case it was "external surgery" for a sore shoulder, where the doctor did nothing except gave me a sling, and charged $1000 or so. It seems like the doctors separate out the billing operation from the treatment operation in order to make it hard to fight.

Billing side:

Me: This is excessive.

Them: We just bill the set amount for the treatment the doctor code, and have no discretion. Let me transfer you to the doctor.

Doctor side:

Me: This is excessive.

Them: We coded what we did, and it would be fraud to change that. We also have no idea how much things cost on the billing side, so we have no way to warn you before having something done that is so expensive. Tough luck.

I recognize this is an example of being unsuccessful, but it's useful to know the script they follow.

  • I would suggest that this separation is deliberate on the part of the insurance companies. They get more, the doctors don't have a clue, and you get scrooged.
    – Andy
    Commented Dec 30, 2014 at 17:37
  • Me: Would you like to find out if a jury considers it excessive?
    – Joshua
    Commented Jan 8, 2018 at 17:36

For typical insurance, there's a co-pay, e.g. $15 for primary care doctor, $25 for specialist. So long as the doctors you use "accept" the insurance, they agree to accept the insurance company's payment. When you were referred, did you ask if they were on your plan? In my case, the doctor or hospital can charge whatever, but I'm paying $15/$25 (10% for hospital visits) and that's it. If the therapist was "off plan" you can appeal it, but be careful, if you don't get some agreement, they can turn you over to a collection agency.

  • To be clear, I am not debating the insurance coverage. The bill that I received claimed that the total bill is $1180. $2400 per hour for handwriting evaluation? The hospital probably writes off most of that $1180. My insurance company told me that the provider is allowed to collect up to $475 from me. I looked at the Medicare fee schedule and Medicare allows collection up ~$90. I'm just using that as a comparison. $475 seems completely unreasonable.
    – kakridge
    Commented Jun 16, 2011 at 2:57
  • That's an outrageously high copay. I'd call and try to talk them down. Commented Jun 16, 2011 at 3:02
  • @kakridge: Taking Medicare loses money unless your on-staff physicians would otherwise be idle. That is no way to get a fair amount anymore.
    – Joshua
    Commented Jan 8, 2018 at 17:37
  • @Joshua : I don't disagree. This is why I offered them roughly double the Medicare fee schedule. I gave a range in an earlier comment with medicare being at the low end of that range.
    – kakridge
    Commented Jan 9, 2018 at 19:41

Scenario 2 is exactly what happened to me. Company took on new insurance provider, I took my daughter to our 19 year long pediatrics office with potential strep and a sore belly button (pierced). PA cultured her for strep and looked at bellybutton, said it looked infected and suggested she take the ring out. Asked my daughter if she wanted to take it out herself or would she like the PA to take it out. My daughter told her she could do it since she had a better angle. The PA unscrewed the belly-button ring and removed it (surgical procedure #1 $196.00). After she removed the belly-button ring, she pressed the area and said yes it is infected and swiped away some pus (surgical procedure #2 $350.00). With that she cultured the belly-button area for strep too (positive for strep in both areas-keep hands away from piercings if your sick!). Strep culture costs and office visit added another $173.00 (no problem with that) to total $719.00. I am contesting but the response is exactly as smackfu has outlined. Our new provider requires us to absorb the first 7k in deductibles before they kick in, Great! But I had no idea our long standing and trusted physician would be ripping us off on basic health care.

  • If your deductible is $7K - you should consider HSA, and look for a plan that is not a high-deductible. Take it to your company HR, why did they switch to such a horrible plan? For $7K a year you might get a private insurance with better terms. I would look for another job.
    – littleadv
    Commented Jul 23, 2011 at 4:27

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