Q: One issue I don’t think you’ve discussed about the sour economy is if we can negotiate for health care. A good friend told me he actually asks for discounts from his doctors — and often gets them! I don’t know if I have enough nerve to bargain with such experts. Any hints? — Terry Timid

A: Dear Terry: The first hint is one I learned many years ago as a classroom teacher and with respect to school administrators: as long as I possessed a respectful and professional attitude and my job performance remained such that my students achieved, the principal(s) worked for me. In other words, they weren’t my “boss” in the traditional sense of the word.

The same analogy is true for those in the medical field. Gone are the days (I hope) when physicians reigned as the Supreme Medical Being in whose hands our lives were balanced and whose prognosis and diagnosis were never questioned.

Because much of the population is savvier than yesteryear, we tend to always bring a list of questions to appointments, to quiz what we don’t understand, and even to insist upon second opinions if we feel it necessary.

Don’t get me wrong, though. I have the greatest respect for these good folks, and many have helped me immeasurably over the years. On the other hand, when dealing with health and that of my family, I don’t intend to be passive.

What I’m trying to impart in a roundabout way is: We mustn’t be timid or feel inferior when dealing with health care providers — and this includes bargaining with them about finances.

Those of us lucky enough to hold health insurance know it’s sometimes a real pain to get reimbursed or the doctor paid. Multiply that by a hundred and you have an idea of the hassles a physician goes through with his or her insured patients.

In fact, we’re seeing more and more docs jumping ship and returning to the practice of cash or credit cards. If the latter, the practice must pay a bank fee for each charge. Cash, then, can become its own bargaining tool so offer ready money upfront when you make the appointment. Bypass the receptionist and ask to speak directly with the office manager. If this approach fails, go straight to the physician.

Remember, we’re now savvy about health care, including medications. Research shows that doctors are more apt to prescribe a brand name drug than a generic, sometimes because of drug reps who often visit and leave samples and other times because Doc Feelgood simply can’t keep up with the number of generic medicines covered by all his patients’ insurance plans.

It pays big bucks to check equally effective alternatives with your insurance company. Prices can vary between 40 to 90 percent! (And don’t forget most pharmaceutical manufacturers offer a patient assistance program, for which lower income or uninsured consumers may be eligible for low or no-cost medications. Check with each company as to its requirements.)

OK, you’ve saved money by haggling over appointment prices and by being knowledgeable about generic vs. brand drugs. Don’t think I’ll let you throw out all you’ve salvaged to pay for expensive tests; savvy is still the byword.

If your physician prescribes a routine test, such as a mammogram or a colonoscopy, and wants to arrange the exam in a hospital, dig in your shrewd heels. Tests like these can cost three times as much in a hospital than in an outpatient facility. Once you’ve obtained a short list of reliable sites from your doctor or insurance company, call around for quotes.

Following just a few of these suggestions can save you big bucks for the future. And perhaps even better, you’ll become a model for others to “beat the system” in a wholly legitimate approach.

Ellen Phillips is a retired English teacher who has written two consumer-oriented books. Her Consumer Watch column appears on Saturdays in the Business section of the paper. An expanded version is at www.timesfreepress.com under Local Business. E-mail her at consumerwatch@timesfreepress.com