It works pretty well, though I've never had to use it. There is a private forum for members to discuss tactics on getting the biggest discounts. A member will typically ask for a self pay discount as we don't have "insurance". In many cases that knocks 25%-50% of the bill off right there. But you are still dealing with the normal hospital or clinic billing department at that rate.

If you continue to decline this "discounted" rate and push to be transferred (in person or over phone) to the billing department's higher ups, you might even be able to get the bill lowered even more... but you must reject these as well. Eventually you will be turned over to a collections company, and right before they file against your credit score you will actually have the most bargaining power. Typically you will be able to knock another 50% off of the bill.

There are many testimonies on the forum of people getting heart surgery or chemo and having bills in the $100k-$150k range and yet in the end, and after lots of phone calls and added stress... they walk away with paying only $20-30k.

So basically, "insurance" does this bargaining for you.