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I will share my recent experience with negotiated rates. Went to the hospital recently to have a kidney stone removed, at pre admission they told me I owed 1200 on my deductible and co insurance and how would I like to pay. I asked if I could pay installments, she said if I paid cash now she could reduce the payment to 800. I countered with an offer of 600, like a car salesman she said she needed to run it by her supervisor, came back and said ok. My son in law did the same thing when they had their child last year. In addition, you get credit from the insurance company for the entire amount. Negotiations work in my area, even with coverage.