O ne benefit of our recent hard times is that doctors are more willing to negotiate fees and payment plans than they were in the more affluent past. This is good news not only for those who have no health insurance, but also for the vast numbers who are underinsured. More doctors are offering discounts, sliding scales of payment according to income level, and other accommodations -- but of course, few advertise their willingness to make such arrangements. For practical advice on how to negotiate doctor fees, I called patient advocate and syndicated newspaper columnist Trisha Torrey (EveryPatientsAdvocate.com/blog). As usual, she offered a wealth of practical tips...

Speak Up

Your first step is to take a deep breath and work up your courage to confront the situation. You may feel awkward, but many people are in the same boat today and the only way to get a discount is to ask for it. Torrey advises that you calmly and courteously explain your financial situation and ask about ways to lower your costs.

Though it would seem to make sense to start with the office manager or head of the billing department, Torrey suggests asking your doctor directly. "Doctors might be more open to negotiating than an administrative person, who can use ‘it’s against our rules’ as an excuse -- and this is especially so if you already have a relationship with the doctor," she says. This is also far less frustrating than getting passed from person to person, none of whom are familiar with -- or potentially sympathetic to -- your personal situation.

As part of the incentive to reduce fees, offer immediate payment by cash, check or a debit card. This means less work for the billing department and certain, timely payment. Ask the person in charge of billing if you can get a discount if you pay on the spot. Also, using cash or a check to pay your bill will save them even more money -- all businesses, even doctors, pay fees for accepting credit cards.

If negotiating isn’t an option...

Double Check Medical Bills

A recent study found that as many as nine out of 10 bills from hospitals and providers contain errors -- which, for some odd reason, don’t usually work in favor of the consumer. Since a typical medical bill is an enigmatic mix of technical medical terms and obscure codes, it’s perfectly reasonable to ask a person in your doctor’s office or at the hospital accounting department to go over the bill with you line by line. If you believe there are discrepancies and you aren’t able to work them out yourself, you can find a medical billing advocate to help you uncover savings at www.billadvocates.com. Advocates charge an hourly fee, from $50 to $300, depending on the type of job and the individual advocate, plus a percentage of identified savings. This fee may sound daunting, but can be well worth it for expensive procedures or big hospital bills.

Visit a Walk-In Clinic

For minor concerns, such as colds and rashes, you may be able to reduce your health-care costs by taking advantage of the growing number of convenient walk-in clinics. Though the fees are usually not negotiable, such facilities are typically priced below the local cost for an office visit -- and recent research has found that they offer comparable care for minor medical complaints. However, Torrey cautions that you should not use these clinics for chronic problems, such as diabetes or heart disease, which require more expertise and continuity of care.

Should You Ask For Free Drug Samples?

Free drug samples are great for acute ailments, such as strep throat or flu, says Torrey, and many practices are willing to dispense them at least for the first few doses. Be aware, however, that for people with chronic illness, a free sample can lure you into a treatment plan that is more expensive in the long run. Also, some medications aren’t easy to stop taking once you get started, so proceed with caution. These types of freebies may not be such a smart move -- for your health or your wallet.