By Michael Kaplan | New York Post

When Larry Nolan decided to fix his deviated septum — so askew that his nose was visibly crooked and airflow was almost nonexistent — he knew he needed to find a skilled plastic surgeon. He also knew he wouldn’t be paying retail.

The 34-year-old Californian, who co-owns the Hardcore Fitness chain of gyms, sought a price quote from the office of Dr. Robert Kotler, a highly regarded facial plastic surgeon in Beverly Hills. The initial estimate: $16,500. Nolan suspected he could negotiate a better deal.

More people than ever are haggling to reduce the cost of health care, spanning everything from annual physicals to major lifesaving surgery. And for good reason: A poll, co-conducted last year by the find-a-doctor site, found that 55 percent of respondents had been hit with at least one medical bill they couldn’t afford to pay.

Abbie Leibowitz, founder and chief medical officer of Health Advocate Solutions, a company that advises consumers on health care and insurance needs, explains that out-of-pocket expenses are rising. Average deductibles for family plans came to $8,232 in 2017, according to eHealth Insurance. As a result, patients are devising creative ways to save cash. “If you are not attempting to negotiate, you are missing out,” Leibowitz says.

It helps to have a bargaining chip, experts tell The Post. Common points of negotiation include flexibility in scheduling, the ability to satisfy a bill quickly and — depending on your digital clout — a promise to promote the provider on social media. An expression of need can sometimes help, too.

Nolan negotiated a break by accepting a last-minute appointment when another patient canceled, agreeing to go under the knife with just five days’ notice. When the office manager asked what he’d be willing to pay for the spur-of-the-moment surgery, he said $12,000.

“They said they could do it at that price,” Nolan says — a savings of more than 25 percent.

For his part, Kotler tells The Post that he also considers markdowns for patients who sign on for multiple procedures at the same time or piggyback with another patient for what he calls “the friends and family plan.”

“If someone and her sister want work done and we can do it all in the same day, we offer a discount that can be 20 percent,” Kotler says.

Wheeling and dealing also works for dentistry. When Nolan needed crowns on his four front teeth, he scored a 50-percent-off deal in which he agreed to promote the dentist to the 150,000 Instagram followers and 5,000 Facebook friends he shares with his wife. “By posting pictures of me smiling on Instagram and tagging the dentist on Facebook, I brought the price down to around $4,000,” Nolan says. “And [the dentist] posted before-and-after pictures of me on her Facebook page.” Nolan estimates that his endorsements drove at least 20 new patients to the practice.

Ed Brodow, author of “Negotiation Boot Camp” and a negotiation consultant to Fortune 500 companies, says courage is half the battle. “It’s all about having the guts to ask,” he says.

Such was the case when he received a $2,000 quote for a dental crown. “I flinched and said, ‘That seems very high. I can’t afford that. Can you help me out?’ ” The dentist lopped 25 percent off the price.

“I knew he would rather get $1,600 from me than have me not do it or look for another dentist,” Brodow says.

Researching market rates can further empower patients in price discussions, says Derek Fitteron, CEO of Medical Cost Advocate, which aids clients in getting value out of health care. He suggests looking up average procedure costs on sites such as and and using those numbers as a starting point.

And don’t hesitate to negotiate if your bill doesn’t align with typical fees. “Call [the provider] and say, ‘You are charging me more than the going rate,’” Fitteron says. Doctors’ offices often acquiesce in hopes of securing payment more quickly, he notes.

In many cases, haggling after care actually gives you an edge. “That’s when you are in a position of power,” says Diane Mullins, a registered nurse with an MBA in health care management and the author of “Health Care & You: A Guide to Navigating the Health Care System and Becoming Your Own Best Advocate.” After all, the hospital can’t exactly take back your artificial hip.

Another gambit for getting a price cut after the fact: Offering to pay a smaller lump sum immediately as opposed to a larger amount in billed installments. This often results in a 15 to 20 percent discount, Fitteron says.

It can work even when your bill isn’t in the thousands. Leibowitz says that patients can haggle over co-pays, offering to pay a smaller amount on the day of their office visit. “You can offer to pay $20 on the spot rather than them billing you for $30,” he says. “The idea of getting paid right then and there is appealing [to doctor’s offices].”

As an entrepreneur himself, Nolan believes that health care is a numbers game like everything else. “Because doctors provide a medical service, people think that their prices are set in stone,” says Nolan. “But ultimately, they are also running businesses. And like all [businesspeople], they benefit from negotiating.”

Dr. Raffi Terzian | BenefitsPRO

As health care continues to grow increasingly complex, the repercussions can be especially apparent during open enrollment season. Whether organizations are changing their plans, adding new offerings or switching their approach, open enrollment can often best be described as controlled chaos for those leading the charge.

With this year’s open enrollment just around the corner for most organizations, now is the time to think ahead. Brokers and consultants can play an integral role in reducing the burden for their clients by helping them stay abreast of both ongoing and emerging trends and issues facing HR professionals. Here are nine trends and common issues to be aware of:

  1. HDHPs – The continued adoption of high-deductible and other consumer-driven health plans are driving employees to look for options that make the most of their health care dollars. Helping employees understand their options and how their choice may impact costs can help avoid issues later on.
  2. Plan changes – Between policy updates, mergers and cost shifts, the plans available to employees frequently change. This can adjust their level of coverage, premiums and cost-sharing responsibility, and provider network, making it critical that they have resources to help determine the best fit for their needs.
  3. Prescription coverage changes – As part of other plan modifications or new offerings, yearly changes to prescription coverage can also have a big impact on employees (especially those on long-term medication for chronic conditions, etc.), so it’s even more important to communicate these changes effectively to avoid issues down the road.
  4. Diverse workforce – Employees represent a span of generations, lifestyles and backgrounds, so one size plan does not fit all. It’s important that open enrollment options provide for this variety of needs.
  5. Digital options – From online platforms that help employees select plans to plan offerings like telemedicine, digital technology is playing a growing role in open enrollment as well as benefits in general.
  6. Multi-channel outreach – In addition to utilizing technology, many employers are looking to diversify their benefits communication in order to reach more employees in the ways they seek information. This can include mailers, posters, emails, small meetings, and much more.
  7. Concierge services – Due to the increasing confusion of open enrollment, more and more organizations are offering resources and services to help employees navigate the complexities. This can help reduce the burden on HR as well as ensure employees make more informed decisions.
  8. Addons – Many employees have a wide variety of additional options to consider adding during open enrollment, which may lead to confusion about what is best for each individual and their family. Effectively explaining these options, their costs and their benefits can make a big difference.
  9. Overworked HR team – As benefits continue get more complex, HR teams field an increasing number of questions and concerns from employees, especially during open enrollment.

Addressing some of these key challenges or issues in advance can help make this year’s open enrollment process smooth and successful. Open enrollment may be challenging, but working together with clients to plan ahead can enable organizations to overcome issues, leading to a more effective benefits year ahead.

Dr. Terzian is a board certified Emergency Physician with nearly 20 years of clinical and administrative experience. Before joining Health Advocate, Dr. Terzian led educational programs at a number of the country’s top teaching hospitals.

Episode 17: Addressing Opioid Misuse and Abuse in the Workplace

The inappropriate use of opiodis is a fast-growing public health issue nationwide, and the impact is also being felt in the workplace. In this episode of Health Advocate’s Ask the Expert series, we’re joined by Dr. Raffi Terzian, Health Advocate’s Senior Medical Director, to discuss strategies to address prescription drug misuse and abuse in the workplace.

By Ada Brainsky, M.D., Medical Director, Health Advocate

Skin cancer and the hazards of sun exposure—its major cause—typically gains awareness as the warmer months approach. But skin cancer is a year-round concern, and a growing one for everyone, including employers. Skin cancer is the most common type of cancer in the U.S., affecting more people each year than all other cancers combined. One in five people in the U.S. will develop skin cancer by age 70.

Each year, nearly 5 million people are treated for skin cancer, at an estimated annual cost of $8.1 billion. Furthermore, the National Institutes of Health (NIH) reports that skin cancers cause a significant loss of productivity in the U.S. workforce. Fortunately, most skin cancers can be prevented and, if found early, can be cured.

Employers can play an important role in helping protect workers from becoming a statistic.

Getting the Message Across

Incorporating sun-safety messages and programs in the workplace can improve health outcomes and save money. These messages should underscore that skin cancer is a year-round concern for everyone, no matter where you live or work, or what your age or the color of your skin.

The main emphasis should be to reduce the overexposure to the harmful ultraviolet (UV) radiation, which comes from sunlight, sun lamps and tanning beds. The damaging effects of the sun build over time. The more exposure to UV radiation over a lifetime, the higher the risk of developing skin cancer.

The most common type of skin cancer, non-melanoma (squamous or basal cell), tends to occur in areas of the body exposed to sunlight and can usually be cured because it grows slowly. However, if left untreated, the cancer can become large and spread inside the body.

The second type of skin cancer, melanoma, accounts for about one percent of all skin cancers in the U.S., but it causes most of the skin cancer deaths because it is aggressive and more likely to invade nearby tissues and spread to distant parts of the body. Risk factors include having a history of many blistering sunburns as a child or teenager, having several large or many small moles, and having a family history of unusual moles or melanoma.

Targeting All Workers Is Essential

Sun protection messaging is especially important for outdoor workers, but all workers should be made aware of the risk of overexposure to the sun. For example, employees who work in direct sunlight through windows or who drive regularly as part of their job are at risk of overexposure to UV rays through glass. Additionally, indoor workers may be more likely to have intense, intermittent sun exposure during recreational time on weekends or during vacations. This puts them at increased risk of melanoma.

Messages should encourage employees to visit a dermatologist for a full-body skin exam to check for any abnormalities, as well as teach them how to self-check for unusual changes in the color, shape or size of moles or skin spots. For best protection, the year-round use of sunscreen with an SPF (sunscreen protection factor) of at least 30 should be encouraged, combined with wearing long sleeves and a broad-brimmed hat, and avoiding sun exposure as much as possible between 10 am and 4 pm when the sun’s rays are most harsh.

Sun Safety Protects Everyone

Keeping employees safe from skin cancer makes good business sense. Workers who develop skin cancer miss work and cause claim costs to rise. It’s also an employer’s legal responsibility to keep employees safe, according to OSHA guidelines. Employers already address the dangers of working in extreme heat, and sun safety can easily be incorporated into these efforts. For example, they can allow for breaks to apply sunscreen or rotate the schedule of workers in in UV-intense positions to reduce exposure.

Some forward-thinking employers provide workers with sunscreen and protective clothing and even offer skin cancer screenings.

No matter what sun-safety strategy an organization chooses, policies designed to support sun protection practices have been shown to be effective, the NIH reports. Employers who encourage behavioral changes and communicate well with their workers can increase the success and adoption of new policies.

Contact Us

Health Advocate provides clinical coaching, resources and a vast array of timely, year-round employee communications to help employees prevent health problems and/or connect with interventions that can detect diseases in their earliest, most treatable stage. Find out how we can help you put the right program in place to help keep your employees and organization healthy and safe.  Contact us to learn more.


Next Story >> Product Spotlight: Financial Wellness







By Norbert “Bert” Alicea, MA, CEAP, Executive Vice President of EAP+Work/Life Services

Despite the nation’s improving economy, fear and anxiety about money is a leading stressor for today’s workers, and this stress negatively impacts both health and productivity. In fact, 7 out of 10 American workers say finances are their top cause of stress, with 80 percent reporting that it affects their productivity. Furthermore, surveys show an increase in the number of employees who say their financial woes are negatively affecting their lives and are worried about their future financial situation.

The issue is compounded because many employees lack budgeting skills and are ill-prepared to handle current financial responsibilities or future risks. For example, 68 percent of Americans have no emergency funds, let alone money left over for unexpected injuries or illness. Nearly half do not save any of their annual income. Another third have no retirement savings.

When coupled with student loan debt and other financial burdens, it is not surprising that these issues create stress. And financial stressors can change throughout the course of an employee’s life, from college debt to mortgage payments to retirement planning. Unstable finances and the resulting stress can negatively impact relationships, productivity, and mental and physical health, all while lowering profitability for employers.

Creating an Effective Program

No matter what their financial struggle, it’s important to offer employees the right online and personalized support and tools to help them learn how to manage their money, reduce debt, and save for the future, all to lower stress and increase productivity.

An effective financial wellness program includes a variety of components to engage and prepare employees to meet a spectrum of financial needs, including but not limited to:

  • One-on-one consultations with financial specialists to discuss financial planning or more complex matters on a range of issues, from IRS matters to divorce financial planning. This is a great first step for overwhelmed or confused employees who prefer access to a “live” resource for help getting started with specific issues or general planning.
  • In-person workshops and webinars on topics such as estate planning, managing life transitions and paying for college.
  • Online calculators to determine a plan for loans, credit payoff, mortgages and taxes.
  • Articles and worksheets with information on a variety of relevant financial issues such as identity theft, budgeting, investing and more.

Integrating a financial wellness program with other programs can maximize its effectiveness by raising awareness and increasing convenience, making it more likely that employees will know about and use the program.

Value of Financial Wellness in the Workplace

With access to financial wellness programs, employees are able to effectively address the issues creating their financial stress, leading to higher productivity. Further, these programs guide employees toward related benefit programs and resources, maximizing engagement in tuition reimbursement, health spending accounts and retirement plans.

Most importantly, incorporating financial wellness into workplace well-being programs can have a positive effect on employees’ physical and emotional health. By addressing one of the primary causes of stress, it’s possible to mitigate issues like high blood pressure, poor eating and more, leading to better overall health and well-being. When employees are healthier and less stressed, they can re-focus their time and energy on other matters, including work.

Contact us. We can help.

Learn more about how Health Advocate can help you develop an easily accessible financial wellness program through a single portal that guides employees to financial solutions that work for them. You benefit by having more resilient, productive workers and an improved bottom line.



Next Story >> Clinical Corner: Skin Cancer Protection: A Growing Concern for Employers