Many consumers — who are either uninsured or left with hefty out-of-pocket medical expenses after their insurers have paid — can successfully talk their doctors and hospitals into lowering their bills. (Note: This does not apply to Medicare patients, or to patients' co-payments and deductibles.)

Thirteen percent of consumers polled by Harris Interactive Health Care News, in a survey published December 1, 2005, say they have asked a pharmacist if they could pay a lower price. A smaller but significant number say they have done this with doctors (12 percent), dentists (10 percent), hospitals (9 percent), and health insurers or health plans (13 percent).

According to Harris, more than half (56 percent) of all those who have tried to negotiate a lower price say they did so successfully.

While there are no hard and fast rules for successfully lowering your out-of-pocket health care expenses, there are a few good guidelines:

• Find out what others are paying: This isn't as easy as it sounds since doctors and hospitals in different areas of the country charge widely varying amounts. The American Medical Association web site has an interactive tool that lists how much Medicare reimburses doctors for certain medical procedures. The AMA warns these are "bargain-basement prices" reserved for 39 million senior citizens and the disabled who need government assistance with their health insurance.

Still, you should never pay your provider more than private insurers pay, says health care attorney Deidre O'Reilly Marblestone. "Insurers never pay more than one-half to two-thirds of the total amount billed," she says.

• Cash talks (so do credit cards): Offer to pay your doctor the discounted amount you both deem reasonable in cash, immediately. If you don't have the cash, offer to put it on your credit card. “It works. Just like Wimpy says in the Popeye cartoon: 'I'll gladly pay you Tuesday for a hamburger today,'" Marblestone says.

• Plead your own case: Nine times out of 10, the telephone won't do the trick and neither will a written request. Meet with your doctor, pharmacist, or hospital billing officer face-to-face and plead your case for paying a lower amount.

• Ask for free samples of medication: If your doctor prescribes a medication that is not on your health insurer's formulary (list of approved prescription drugs), don't be shy about asking for free samples rather than paying full freight at the pharmacy window.

It's a safe bet your doctor has plenty of free samples. The number of sales representatives hired by drug firms rose to 83,000 in 2000 (more than double the number in 1994), according to pharmaceutical consulting firm Scott-Levin. Thousands of those sales reps are responsible for providing physicians with information about their products along with free samples.