Only your doctor can do that, which is why he or she needs to know your situation.

Q. What can I do to prepare for these conversations?

A. Your physician may be just as uncomfortable with these conversations as you are. That’s because  and I can tell you firsthand  doctors are simply not trained for this.

I was trained to give the very best care for my patients, regardless of cost. And many doctors are still laboring under the illusion that most people have good insurance that pays for the bulk of their care, even though out-of-pocket health care costs have gone up for everyone, and the number of uninsured is high.

With that in mind, if you can get a good handle on the tests, medicines and monitoring you will need for a health condition, as well as a clear idea of what, if anything, your insurance will cover, you’ll be able to ask your doctor and the billing staff specifics about ways you can save money.

Q. Why do patients who pay the bills themselves get charged more than patients who have insurance? Can they do anything about this?

A. What’s happening is that people without insurance are paying full price, while insurance companies, with their high volume of patients, can negotiate steep discounts. For patients paying for care out of their own pockets, it’s important to let everyone you encounter know that. The next step: ask for the discounted rate.

The reality is, you may not have as much leverage as the big insurers. But it almost always pays to ask.