How does one do this? Where do you learn it? Is there a book you suggest? The fact that I'm even asking this feel weird (I'm insured).
You can't do this if you're insured, because then the terms of your insurance apply. You can still get bills reduced, but the reasons are different and it's a bit more involved.
If you're uninsured, it's simple. You literally just tell them, "I have no insurance. I can't afford $45,000. It would take me years to pay that, and I'd probably default on the bill beforehand. However, if you reduce the billed amount to $500, I can pay that in full today, in cash.".
Substitute appropriate values in as needed, but that's the general idea. It's actually not all that different from what private insurers do, except they do all this up-front in bulk, so their rates are set in long-term contracts.
I've known people to successfully negotiate to 40-50% of original bill, usually with proof of (lack of) assets.
Maybe if you really are basically broke, they'll write you off rather than carry it on their books until they sell the debt. On the other hand if your bill is 45,000 and you have even meager assets : say a couple of cars and equity in a house, I'm guessing their going to try hard to see a good chunk of that.
In general, they only negotiate hospital bills because they are the only bills large enough. I would say that the typical final negotiated rate they get from the hospital is about 3-20% of the billed amount. It depends on how high the original bill is, and it also depends on whether you need to make payments and how long the series of payments is.
Hospitals will certainly claim that you need to send in the proof of assets, usually you have to refuse about 6 or 7 times and they will relent.
However, things have changed in the last few years and professional medical bill negotiators have told me certain hospitals are completely unreasonable and refuse to negotiate. They advise these people to file bankruptcy.
You're wrong either way. I've seen some bills my insurer pays around 2% of what is billed, but not most things. Hospitals will ofter sue, and they are aggressive about judgements. If you can pay something, they will take more.
I have never had health insurance. Where I live many people don't have health insurance. I have never heard of this happening. I've seen peoples, my own included, wages garnished before this will happen. I currently have a $20k bill for an emergency appendectomy I had 4 weeks ago. The hospital will seriously take payments for 30 years before they'll lower any cost. If you want to negotiate, you'll have to wait until the collection agency has their account removed from your credit report 7 years after the first reporting. Any time before that you are in no position to negotiate with anybody.
EDIT: Unless your income is less than 1.5x the poverty level. In which case you qualify for aid in paying your bills.
But having to play that damn game when you life is on the line is inhumane. There's no time out zone.
What? No, that's not how it works.
Good luck finding a 90% off coupon for a surgery prior to the event.
It doesn't. It's not a debt yet. You don't have to pay taxes on the difference.
A large bill which, if you're uninsured, you can almost always negotiate down to 10% or less of the original.
Of course, most people don't know this, but those large bills aren't what the hospitals expect uninsured patients to pay. They just legally have to present them the same initial bill that they present private insurers.