Negotiation pretty much has to occur on the front end. They may accept less if you can’t pay, on the back end, but I wouldn’t account on it.
They need to get back to where they charge the same price for the same procedure for everybody regardless of insurance. Only then will we have some clarity.
If anything it is going in the opposite direction. We will have a two tiered system in a very short period of time. You already see this happening with concierge medicine growing as rapidly as it is. These are doctors who don't take insurance. Some will have assistants help you with submitting bills for reimbursement, but most don't do that. You pay the doctor. If the insurance company reimburses it is you they pay.
The beauty of concierge medicine is no one stands between the doctor and patient. If the doctor thinks tests are needed no one says no. The down side is you pay up front and it can be expensive. However, it pretty easy to see that you get what you pay for. The best doctors will gravitate to this type of practice.
If you can't pay then you go to the other tier. The govt system with long lines, delays and govt making the decisions on what can and can not be done. I really don't care about the liberals who get caught in this system. They voted for it. The problem is all my fellow conservatives who didn't want this that get caught in it. Unfortunately, there isn't much I can do to help them other than financially support Tea Party candidates.