Yes. Your hospital bill is negotiable.

What hospitals accept for payment is not set in stone. There's the hospital's list of charges and then there's what they actually collect. Hospitals are required to offer discounted or free care to patients who meet financial eligibility guidelines. And most will negotiate with any patient having difficulty paying their bill. It's best to have such discussions before care takes place. It can enable the hospital's billing office to help find some assistance, such as Medicaid, Medicare or private and hospital charity assistance if the patient is eligible. Uninsured patients have the right to negotiate even after hospital care has been given, with the best deals often offered to people who agree to share their financial information and show a willingness to start paying the bill. Here are 7 tips to help you save money on your hospital bill.

1. Let your doctor know your financial circumstances

Get a full picture of what will be done during your stay, as well as any related tests and follow-up visits. If you're worried about paying the hospital bill, ask whether it's safe to delay the treatment or procedure. Perhaps you need surgery for a sinus condition that's bothersome but not life-threatening. A delay, if approved by your doctor, is an especially good idea if you or a spouse is in line for a job that will pay health benefits or if you've maxed out your flexible spending account for the year. Also ask if there are tests that can be avoided safely, such as for cholesterol and glucose if you've recently had those checked.

2. Choose a non-hospital if possible

One way of saving money might be to avoid the hospital for some procedures. Consider having tests and procedures, such as colonoscopies, MRIs and CT scans, done in independent surgery or imaging centers, or at an accredited doctor's office. This can save hundreds of dollars. Hospitals have far higher expenses, including a large physical plant, a larger staff and the need to write off millions of dollars in care for people who don't pay or who pay at a reduced cost. Your doctor should be able to recommend independent.

3. Shop hospital costs

Some websites, like Healthgrades , can tell you what many area hospitals charge. Healthgrades charges about $8 for a report. Finding the least expensive hospital can lower your out of pocket costs greatly. For instance, costs for a caesarean section in Southern California vary from $18,000 to $30,000, excluding doctor costs, depending on the hospital selected.

4. Check out financial assistance

Meet with a financial counselor at the hospital as soon as possible. Hospitals are required by law to let patients, insured or not, know about the availability of charity care, discounts and government programs that can cover all or part of their bill and about any other programs that can help take care of hospital charges. You may qualify for free or discounted care if your income is below 350% of the federal poverty or your medical costs are more than 10% of your family's annual income.

5. Be prepared when checking in to the hospital

Expect hospitals to ask for payment for the deductible and any other patient share of the bill before service. You don't always have to pay the deductible or your share of the hospital bill immediately, but you do have to come up with a plan to pay it off. Don't use a credit card to pay a hospital bill, unless you're sure you'll be able to pay it off in full by the due date. Letting the credit card bill go past one cycle adds interest fees and could increase your interest rate. Also, it's virtually impossible, to negotiate charges once they've been paid by credit card. A better idea is to ask the hospital for a no-interest rate payment plan. If you can't foot your share of the bill, hospitals might be able to discount your deductible, copay or coinsurance if you qualify under its financial screening process.

6. Get an itemized statement

Insured patients will typically get a summarized billing statement; the insurer gets more specific cost information. Request an itemized bill and ask the hospital for deciphering help if needed. Hospital bills often have errors in them, including misplaced decimal points, charges for tests or procedures not done, even care on days you weren't in the hospital. Look for charges you think were unnecessary. For example, if you recently had a cholesterol blood test, but the bill shows another one you were not told about beforehand. If your bill is huge, you may want to hire a medical billing advocate.

7. Don't ignore your bill

A bill for cancer surgery or an appendectomy or a meniscus repair has to be paid. Ignoring it will simply result in it being turned over to a collection agency. You cannot negotiate with the hospital to lower your bill once it's been turned over to a collection agency.

Hey people, wake up. When faced with the choice of buying groceries or your prescription medications, it's time to get smart. There are plenty of ways to save money on your prescription drugs if you're willing to educate yourself and put in a little effort. You'll also have to learn about pharmaceuticals, know your health plan, become a savvy healthcare shopper. So, before you skip a dose, read on to learn 7 ways to score cheaper prescription drugs.

1. Insist on Generic Prescription Drugs

A generic drug is a pharmaceutical no longer under patent protection. An example of a generic drug, one used for diabetes, is metformin. A brand name for metformin is Glucophage. (Brand names are usually capitalized while generic names are not.) A generic drug, one used for hypertension, is metoprolol whereas a brand name for the same drug is Lopressor. Generics are sold over the counter or at low cost as a generic prescription. Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. In other words, their pharmacological effects are exactly the same as those of their brand-name counterparts. They are every bit as safe and affective. Some people become concerned because generic drugs are often substantially cheaper than the brand-name versions - generally at least 70% cheaper. They wonder if the quality and effectiveness have been compromised to make the less expensive products. The FDA requires that generic drugs be as safe and effective as brand-name drugs. So there's no truth in the myths that generic drugs are manufactured in poorer-quality facilities or are inferior in quality to brand-name drugs. The FDA applies the same standards for all drug manufacturing facilities, and many companies manufacture both brand-name and generic drugs. In fact, the FDA estimates that 50% of generic drug production is by brand-name companies. Another common myth is that generic drugs take longer to work. The FDA requires that generic drugs work as fast and as effectively as the original brand-name products.

Sometimes, generic versions of a drug have different colors, flavors, or combinations of inactive ingredients than the original medications. Trademark laws in the United States do not allow the generic drugs to look exactly like the brand-name preparation, but the active ingredients must be the same in both preparations, ensuring that both have the same medicinal effect.

Over the next three years, drugs with $100 billion of annual sales will become generics as their patents run out, including the cholesterol-lowering statin - Lipitor, asthma medication - Advair and antipsychotic - Seroquel. That means big savings for you.

Some big retailers like Walmart and Target take drug savings to the limit. Walmart's $4 Prescriptions Generic Program has been a groundbreaking success. Target followed with their own version. They offer hundreds of prescription drugs and more than 1,000 over-the-counter medications at only $4 per 30-day supply, or $10 for a 90-day supply. The list of eligible drugs in the $4 prescriptions represents up to 95 percent of the prescriptions written in the majority of therapeutic categories.

2. Shop Online for Brand Name Prescription Drugs

If you must fill a prescription for a brand name drug, always ask your doctor for a written prescription for a 90 day supply so that you can fill your Rx by mail order. With that prescription, you'll be able to shop for the lowest rates possible. I strongly suggest you begin by shopping online even if you eventually buy from a local pharmacy. Start your shopping at PharmacyChecker.com. where you can compare prices from a long list of mail order suppliers. You'll be amazed at the wide range of prices for the same product. For instance, recently posted prices for Lipitor 20 mg tablet ranged from a low of $1.24 per pill to a high of $4.78 per pill. All of the suppliers with the lower prices are foreign suppliers, most are based in Canada, the United Kingdom, New Zealand, and Singapore. The lowest price from a U.S. supplier was $3.80 per pill, so you can see there is a strong financial incentive to buy from a foreign supplier. Do I recommend that? I can't because I don't have enough proof that it's 100% safe to buy your brand name drugs outside of the U.S.. Personally, I feel comfortable doing it. I guess because I view these countries - Canada in particular - as trustworthy. I have ordered prescription drugs from foreign suppliers for years without incident. Even if you are uncomfortable doing so and end up buying your prescription from an online supplier in the U.S., you will be getting the best U.S. price available.

3. Split Pills to Double Your Savings

The pharmaceutical companies price their pills pretty much the same regardless of dosage. For example, a 20 mg dose costs the same as a 40 mg dose. So if you buy the 40 mg pill and cut it in half you'll cut your drug bill in half. What could be simpler? Critics say the practice can lead to uneven dosing, but that can be minimized with a simple pill splitter that you can purchase at the drug store for a couple of bucks. Don't try cutting pills with a knife or razor blade. You'll never get it exactly right. Round pills are the easiest to split. Oval or elongated pills, like Lipitor, require a somewhat more elaborate splitter.

Many Lipitor users and many physicians do not realize that the cost to the individual is around $1,300 per year regardless of whether they need the 80 mg tablet, the 40 mg tablet, the 20 mg tablet or the 10 mg tablet. (The 10 mg tablet is slightly cheaper.)

• Splitting the 80 mg Lipitor tablet into quarters will save $1,001 per year.
• Splitting the 80 mg Lipitor tablet in half will save $668 per year.
• Splitting the 40 mg Lipitor tablet in half will save $655 per year.

Not all drugs can be split, including time-released medications, capsules and gels.

4. Ask Your Doc for Free Samples

Big pharmaceutical makers ply doctors with samples as part of their marketing efforts to get them to prescribe their drugs. You might as well enjoy some of their largess. But you should know that using free samples of prescription drugs is a potentially risky practice for several reasons. For one, drug manufacturers typically use free samples to promote the newest and most expensive drugs. When the freebies stop, you'll probably be reluctant to switch to something cheaper. Once you start on a drug you tend to stay on it, even if there is a good generic. That's one reason the drug companies spend billions of dollars on sampling. Secondly, free samples don't show the side effects or precautions on the label, and you might not receive accompanying literature. Also, the medication won't be entered into your pharmacy's computer system, which screens for harmful interaction or duplication with other drugs and supplements you take, allergies you might have, and unacceptable doses. Having said that, let's say you are already taking a maintenance medication for a chronic condition and you can no longer afford to pay for it. Get over your pride and ask your doctor for a month or two supply to get you over the hump. Just one month of samples will reduce your annual expense for a drug by almost 10%.

5. Know Your Health Insurance Plan

If you have health insurance, the first step in saving is to learn how your plan works.
Health plans give members an incentive to choose cheaper medicines through a tiered system of co-payments. The least expensive drugs - usually generics - might have a co-payment of $10 or $15 for a 30-day supply. The next tier is usually for brand name drugs that are on your insurance company's drug formulary list. Each insurance company has its own drug formulary list. Non-formulary drugs are either not covered at all or require that you pay much more out of pocket. Specialty drugs such as injected, infused, oral, or inhaled medications that require close supervision by a doctor tend to be higher in cost as well. Many lower cost health plans have adopted deductibles of $500 or more applied specifically to the prescription drug benefit. Typically the deductible does not apply to generics. You will usually have lower costs if you fill prescriptions through the mail or at particular pharmacies.

6. Look for Discount Programs

Recognizing that costs for name-brand prescriptions can be steep, many pharmaceutical manufacturers may offer discounts or rebates to keep your business. For example, drug maker, AstraZeneca, has a program that limits your co-payment for the statin, Crestor, to $25 for a 30-day supply. A host of programs offer uninsured patients help getting prescription medicines for free or at a discount from pharmaceutical companies including , Merck and GlaxoSmithKline. Some offer discount cards good for their own medicines only. AstraZeneca has one discount card just for Medicare Part D recipients.

Another option is the PS Card, which offers discounts on prescriptions filled at over 56,000 drugstore and supermarket pharmacies nationwide, including CVS, Rite Aid, Walgreens, Wal-Mart and Target. Founder Jim Robbins, a former United HealthCare executive, has negotiated discounts at these retailers, which he passes along to cardholders. Robbins earns his cut by collecting a small referral fee on each prescription. The card is free and anyone can sign up at the PS Card Website. There are many other free prescription card offers. To find them simply Google "prescription drug discount card".

7. Lower Income Patients Should Seek Assistance

There are hundreds of programs nationwide that help low-income patients (usually less than $30,000/yr annual income for a single person or $40,000/yr for a couple, and family) obtain medications at little or no cost. Many are listed with the Partnership for Prescription Assistance, a drug industry-managed clearinghouse. About half the programs are run by large pharmaceutical companies. The rest are sponsored by makers of generic drugs, private foundations and government agencies. The partnership has helped about 5.5 million people nationally. People who apply can get free drugs or low cost prescriptions for just $3 to $5.

To access the drug assistance programs, call the clearinghouse at (888) 477-2669 weekdays from 8 a.m. to 8 p.m. Eastern time or go to the PPARx website. You'll have to answer some screening questions to determine your financial eligibility and medical condition.

For example, here is the information provided by one company - AstraZeneca.

Patient applications are evaluated on a case-by-case basis by the Program. Eligibility is based on income levels and absence of private prescription insurance, third-party coverage, or participation in a public program including the Medicare Limited-Income Subsidy. Income eligibility is based on levels at or below $30,000 for an individual; $40,000 for a couple; $50,000 for family of three; $60,000 for a family of four. The Program requires proof of income and US residency (Social Security #, work visa # or green card #). Patients approved into the Program will receive an acceptance letter and should receive their shipment of product within 1-2 weeks. Patients denied to the program will receive a denial letter if the individual does not meet the eligibility guidelines of the Program. Enrollment is for 12 months with reapplication at month 10.

Product(s) covered by program:

Accolate®
Arimidex®
Atacand®
Atacand® HCT
Casodex®
Crestor®
Faslodex®
Merrem I.V.®
Nexium®
Nexium® I.V. Injection
Nexium® Oral Suspension
Pulmicort Flexhaler®
Pulmicort Respules®
Rhinocort Aqua®
Seroquel XR®
Seroquel®
Symbicort®
Toprol® XL
Zoladex®
Zomig ZMT® Oral Disintegrating Tablets
Zomig® Nasal Spray
Zomig® Tablets

Watch out for scams. If you call a number and they say it will cost you $100 to join, or they ask for your checking account number, you should hang up quickly.