PERSONAL HEALTH : A Reducing Plan for Medical Bills

Ann Fagan needed a dental crown but couldn’t spend the $650 charged by a Santa Monica dentist. So the Pacific Palisades woman started shopping.

A Westchester dentist recommended by friends wanted $495. “Still too much,” Fagan said. He came down to $425. She made an appointment.

Meanwhile, in Beverly Hills, facial plastic surgeon Francis Palmer III is offering a 50% fee reduction for the next three months to patients unable to pay full price.

It’s a new twist on an old tale, says Long Beach internist Richard Wigod, president of the Los Angeles County Medical Assn. In bygone days, cash-short patients shared the harvest. Today, patients seek a discount or installment plans.

Such negotiating--which Wigod finds perfectly ethical--is more likely in specialties such as dentistry and cosmetic surgery than in gynecology or internal medicine. Patients with fee-for-service health plans are more likely to bargain hunt.

How best to broach the subject?

* Be humble. “Say something like, ‘I am sorry to bother you with this, but money is tight right now,’ ” Fagan suggests. Then negotiate a comfortable fee.

* Ask if your doctor will accept the insurance payment as payment in full, Palmer suggests. If a discount is impossible, see if you can pay in installments.

But don’t get overly fixated on fees, Wigod warns: “You can get inferior services if you secure health care strictly by fee.”