10 Ways You Can Save Big Money Right Now on Health Care with Marshall Allen

With you all today. As I said my as Christy said, I'm Marshall Allen. I'm a healthcare journalist. I've spent the last 10 years at ProPublica, which is a large investigative news organization based in New York City. And for the last 15 years I've focused exclusively on doing investigative stories about our health care system. And I look primarily at patient safety issues, quality of care issues, and also why we pay so much for health care in this country and get so little for our dollar. And so I'm going to share with you today 10 tips. It's actually going to be more than 10 tips that you as individuals could apply right now to save money on your healthcare. And when I say save money, I mean saving big money. With every healthcare interaction, you could be saving hundreds or even thousands of dollars for you and your family if you know the right way to navigate the system. I'm going to share with you 10 ideas. But also I know for this group in particular, a lot of you are executive level people working in finance for different employers. And so you may have had the experience of participating in an employer sponsored health plan from the point of view of the employer. And so my book is for individuals, but it's also for employers. I have eight chapters for individuals. I also have three chapters for employers. And I really believe I'm going to put a link to the book right there in the chat. So if you want to pre order it, you can. If you want to share it with others, I urge you to. And I'm going to share my screen here.

Let's see here. And then I'll go into my presentation.

And I'll go through these money saving tips and then we can have time for questions. So I want to be sure and leave time for you all to ask me anything specific that you might be encountering, whether you're in transition right now or whether you have an insurance plan right now or even if you are from the employer point of view. And I'm also easy to find. I'll give you information about how you can follow up with me afterward if you're interested. But anyway, thank you for having me here. So as I said, I have two decades in journalism as an investigative reporter. I'm also an educator. I teach at the CUNY Graduate School of Journalism. I've taught there for about a decade. And what I found was I'm really using and teaching a lot of the tactics that I use as an investigative journalist. I'm teaching that to consumers in my book and prior to journalism, I actually Spent five years in full time ministry. So I have a little bit of an unusual background for a journalist, but I care a lot about people and I write about healthcare from the point of view of the patient who's engaging with the system and actually paying for it. So my mission with the book is to equip and inspire people. I want to equip them by giving them how to tactics. And so each chapter talks about challenges people have to face in the system and then I want to inspire them. If you look at the subtitle, the subtitle is, it's called Never Pay the first Bill and Other ways to fight the Healthcare System and Win. I want to focus on that winning part. And when I say winning, I mean we should be spending less money on our healthcare and getting better benefits in return. There's been this trend that is completely unjustified of our healthcare costs going up year after year after year by 5, 10, 15, 20% while our benefits are being decreased. And if you look at the data, if you look at the research, what it shows is that we should actually be spending a lot less and getting more for our money. So the book breaks it down into different things. I talk about how to identify errors in your medical bills. Most medical bills have some type of error in them. They have all kinds of charges for things that didn't ever happen. They have upcoding that means using a more complicated medical billing code for things that were actually simple so that they can charge more. And they have incredible price variation. I mean, price gouging is what I call it. Basically making you as a consumer pay more than you should for something that you could get for a lot less money somewhere else. I also have a chapter on how to deal with medical debt collectors because unfortunately one in six Americans right now has medical debt in collections. And I walk people through how to use small claims court to protect yourself. I think small claims court is one of the greatest things we can use as a consumer to protect our dollars. And we haven't been doing this in the healthcare system. I think most people just don't think about it. But I'm going to show you how to do that with the book. The book has led me to launch a new company called Allen Health Academy. And that's really to promote what I'm bundling with the book, a series of videos which I'm putting together this healthcare education curriculum. And the videos, you know, you realize when you write a book that probably most people are not going to read your book. You know, as much as people say, oh great, cool, you wrote a book, you know, people probably aren't going to read it, right? And that's especially true for employees who are working for all these companies. They're busy, they're trying to manage their families. So I'm in the process of producing a series of short three to five minute videos that I'm bundling with the book and selling as a curriculum for employers to roll out to their companies to equip and empower their employees to make better healthcare decisions. My vision here, and I've had a lot of employers and healthcare brokers and advisors ask me to do this actually. So what they're saying is if employees can learn how to save hundreds or thousands of dollars for themselves, well then the employer sponsored health plan, many of them which are self funded by the company, can save exponentially more. So that's the vision with what I'm calling the neverpay Pathway Curriculum project. And for more information on that, go to my website, marshallallen.com you can pre order the video curriculum and the book. You can sign up for my newsletter. And when you sign up for the newsletter, you get the introduction for free. So I encourage you. Usually you'd never tell people, look away from my presentation and go do that right now. But if you want to go do that right now, feel free to let your mind wander over to marshallallen.com okay, let's get into 10 Ways to Save. And if anyone has questions, by the way, while I'm speaking, I would welcome you to go ahead and ask the questions. It's just let me pull up the chat if I can so I can see it. But someone might need to flag me, Christy or Nita, if, if you see a question, just turn off your, your microphone and ask me a question about anything at any time during this presentation. And then I am going to leave time afterward for, for questions. Okay, So I think we will have time afterward, but feel free to make it a conversation. Ask me what you want to know. Let's start with some principles. Okay. Price variation is extreme. As I said, you can go one place for a knee replacement and it will cost 20,000 doll. You can go another hospital in the same town, same quality knee replacement and they will charge $80,000. So just by knowing that fact and that price variation, hidden price variation is built into the system. That's a principle you need to understand. Number two, you may be able to negotiate. So if a hospital is coming after you for a bill, don't assume that you're required to pay the sticker price on that bill. In fact, you might want to get prices up front. When you negotiate up front, you can also negotiate. So these are things that a lot of people don't realize with our health care system. But like anything in business, it's negotiable and there may be a better path to what you need. So you can try these different tactics. Often they will work, but they might not work. But you may need to find another way to get the care you need. And I'm going to talk about some of those things specifically. So tip number one, check the prices. This is a game changer, folks. On January 1st of this year, the Hospital Price Transparency Rule went into effect. The federal government now requires all hospitals to post their prices, their cash prices, their Medicare prices, and their negotiated rates for each insurance company they contract with. That information is required to be posted on their website for their services. So you can now go. If you say, I have a UnitedHealthcare plan and I know I need a certain procedure, you can now go. And you can see how much the charges are for that procedure.

So check the prices. Also check fairhealthconsumer.org, fairhealthconsumer.org is a website that has price estimates for each community, and it's based on insurance company data that gets shared with fairhealthconsumer.org and then they post it. You look up the code or you look up the procedure you need or that you had, and you can see whether or not you're getting a fair price or not.

Tip number two, always, always ask for the cash price. If you're getting a drug, if you're getting a lab test, if you're getting a procedure done, ask how much it might cost. If you pay cash instead of running it through your insurance, you might be surprised. It might be a better deal. This is a young woman named Gabby, who's now a friend of mine. She emailed me because she was getting an unfair bill from her hospital after she had an emergency room visit. We looked at using the hospital price transparency. We were able to see that the emergency room visit that she had had, she only had three stitches in her finger. It was a very minor procedure. Well, the UnitedHealthcare negotiated rate for that emergency room visit and the exam alone was about $5,800. $5,800. That's almost $2,000 per stitch. Well, I was able to show Gabby, if you look at the cash price on the website, astoundingly, the cash price for that Same exam was $256. So in other words, if she would have gone in as an uninsured patient or even told them, you're not required to tell them you have insurance. You're not required to give them your insurance card. If she would have gotten the cash price up front, she would have paid $256 for that exam. Instead, UnitedHealthcare had negotiated with the hospital to require her and her employer sponsored plan to pay 5,800. So her plan paid about 3,100. Then the hospital was coming after her for $2,700. And because she knew those cash prices and she could see that she was getting ripped off, she was able to successfully contest that bill. She didn't have to pay that 2,700.

Tip. Number three, avoid unnecessary treatment. Did you know that studies show between 25% and 33% of all the health care provided in this nation is unnecessary? We have an epidemic of unnecessary medical care that is plaguing working Americans. We are paying for so many things that we don't even need to do. I think about things like mammograms, other types of preventive tests. Those things are often recommended to us and our doctors or our nurse practitioners or whoever is steering us that direction when it's not necessarily the most appropriate treatment for us. So consult the US Preventive Services Task Force. Their website is online. They're an independent group of experts that our government funds to provide guidelines that are based on independent analysis of independent research. Those are the most sound guidelines when it comes to preventive tests and screening. But also, I think about a friend of mine named Jeff who thought he needed a back surgery. He went to two different surgeons. They both told him, we have to operate right now. If you even go play golf right now, you could be paralyzed if you don't get this back surgery. Well, Jeff, I told him a lot of back surgery is unnecessary. Jeff went to physical therapy for six sessions. He also did some physical therapy exercises that he learned. He changed his diet, he changed the way he exercised and trained because he's a black belt in taekwondo. He's 50 years old. So he reduced the intensity of his training. His back pain went away. And now Jeff just shakes his head thinking about how he almost underwent this operation that could have caused him great harm, even complications, and it would have cost him and his health plan tens of thousands of dollars. It was not necessary for him to do that.

All right, let's talk emergency room costs. Okay? You can't help when you go into the emergency room. You can't control what type of treatment they're going to give you. It's a lot harder if you're undergoing an emergency. Right. Well, this organization called Quizify, which is a health literacy organization, recommends and I think this is a great idea. I've seen this done successfully, what I call and what they call the battlefield consent. So, you know, when you go for services, they make you sign that financial document that says, I agree to pay whatever the charges are that I get charged for this care. Alter that contract. That is a legal agreement you're entering into. You have a right. You're a party in this legal agreement. They don't have a right to just have you sign and agree to charge whatever they want. So this language says, essentially, I agree to pay up to two times the Medicare rate, including what my insurance company pays for these services. The Medicare rate is almost always the cheapest rate at a hospital. And so by saying I agree to pay twice Medicare, that's actually a very generous payment. But you're also protecting yourself because these charges folks, they can be 2 times, 3 times, 5 times, 10 times the Medicare rate. So you're putting a ceiling on what you agree to pay. And so I urge you to try the battlefield consent. And the battlefield consent also then creates the legal agreement that you have entered into with that hospital. So if you need to, like I recommend suing in small claims court. If you ever need to go before an administrative judge in small claims court, you to need, you now have a legal document that you signed that shows what you agreed to pay. And the hospital, by providing you services, also entered into that agreement. And so that's one way that you can protect yourself from this extreme, like, surprise out of network billing and all these other problems we can encounter. Okay, tip number five.

Do we have any questions right now? Let me get. Let me pause for a minute. It's okay if we don't. How are we doing, Christy?

I think we're doing okay. There was somebody who said, how can I find the price? Sarah gave the website health fairhealthconsumer.org fairhealthconsumer.org.

And also all hospitals, if it's a hospital service, are now required to post their prices. Many are not complying, sadly, they're violating the federal rule. But it's now our right as a consumer under the federal government's rules for us to have these prices. So we need to tell the hospital, we might need to tell them, hey, to comply with the federal government's rule, you need to give me prices. So if it's a hospital based procedure, get it from the hospital. And I would also use that for leverage with other providers, Doctors, labs, places you're going to get MRIs or CT scans. It's actually a lot more common now for people to pay a cash price or to be self pay. And those cash prices are sometimes a lot lower than what you're going to get from your insurance plan. So that's how you get those prices.

Okay. And then Victoria says the receptionist will not let you see the doctor if you don't find everything.

Yeah. So you still sign it, but you write in that you put your limit on it. Now with emergency rooms, it's also different because there's a law called the EMTALA law, the Emergency Medical Treatment and Something Act, Mtala E M T A L A. That law says that if you're having a medical emergency, hospitals are required to treat you whether or not you sign any financial consent form. So they can't tell you at an emergency room if you're having an emergency, that they won't treat you until you sign the form. And you have every right to alter the contract. And if they want to have a conversation with you about it, they can have a conversation with you. But typically what happens is you sign that form. And by the way, a lot of times they'll give this to you on an iPad. They'll give it to you in an electronic form, ask for it in a written form so that you can write it in, take a picture of it, so you have that for your own records and then give it to them. But typically they won't even look at those documents. I mean, once you've signed it, they're not scrutinizing that big stack of forms that you turn in. And if they do want to have a conversation about it, then you can have a conversation about it.

Okay, tip number five. Check to see if your bills are inaccurate or unfair. So every time you get a bill from a hospital, it is a lump sum, aggregate cost. They might show medical services, pharmacy services, lab services, but they're aggregating this. They're combining the services you receive in a way that doesn't allow you to see the cost of each individual procedure. Asking for an itemized bill requires them to itemize each charge and make sure they include the billing codes that they use to bill your insurance plan for each of these charges. Because what you're going to do then is you're going to look at those billing codes. They're Easy to Google. They're easy to find online. Again, my book has a how to and examples on all of these things. So I lay all this out in the book. You can look up the billing codes, you can read the description of the billing code and see does it accurately describe the services that you received. If it doesn't, then you can contest it. Or you'll often see charges for things that you didn't receive at all. It's very common for hospitals to either make mistakes or upcode or just insert charges. I don't know how they do it, but fraud is rampant in healthcare and so these charges often get added. And if it's something you didn't receive, you should not be paying that charge. You also want to see if your insurance plan processed the bill properly. I got a bill for $250 just last year for an urgent care visit my son had. I knew something was wrong with it because I have great insurance. I have very expensive insurance. I pay a huge premium, but I actually have good care. Good. You know, I'm paying up front, but I have a low deductible. So I knew something was wrong when they sent me this bill for $250. I called my insurance company and insurance companies are really good at telling you what the charges are, what the claims are. They're not going to help you a lot if you can test things, but they will help you at least understand what you've been charged for. I called my insurance company and they said that the bill had not even been submitted to them by the urgent care. So I called the urgent care, I said, hey, you need to submit this to my insurance company. They submitted it, no problem. I saved $250 in about five minutes. And so you just have to have that assumption that there might be something wrong with this bill. I need to check it. You want to also consider getting your medical records. It's every patient's legal right to have their medical records in health care. They have a saying if it's not documented, it didn't happen. So anything that's not documented in your medical record, whether it happened or not, they are not legally allowed to bill for it. So see if your medical records start there, see what type of care they describe, and then see if the billing codes and the bills that you're receiving align with what the medical record says. That's a great question.

Asks, how do you know if they have charged for a higher level of service when you're not familiar with what you should provide it at? Either at each level of service.

That's a great question. So let's go back to my friend Gabby. When you go to an emergency room or a doctor's office, they can bill a level one to a level five examination for just a typical doctor examination. Level one is low complexity. Level two is a little more complex. Level three is mid complexity. Level four and level five are the highest level of complexity. So when Gabby went in with three stitches in her finger or a small cut on her finger that needed three stitches, that's not a medically complicated case. But they billed her at a level three emergency room visit. Well, the codes, they call them CPT codes, common procedural terminology.

You can Google. She was able to google the code and you can see a description of the CPT code that she had. The description she read said a level three code is for a case of moderate complexity where there's an extended physical exam of the patient and moderately difficult decision making. Medically. Three stitches on your finger. She had no exam. She had zero exam. These characteristics have to be in place in order to, for them to bill at level three. They really should have billed that at a level one. It required no complex examination and it required no moderate complexity of medical decision making. So they build, they up coded that. They build the wrong code. So when you look up these codes online, there are lots of websites that have descriptions of what service is required for that code and the patient is the one or the patient's, you know, let's say it's your child, you know best what type of care was actually provided. You might see charges on there for a doctor, but you know that you never saw a doctor. Or you might see charges for multiple doctors and you know that you only saw one doctor. So you as the patient know, hopefully, you know, unless you're unconscious or something, obviously it's much more difficult then. But I hope that answers the question in terms of how to look things up.

Yes. And there's another one.

Thank you for answering about doc signing an emergency. What about regular doctor visits? Assuming sign change, what part an initial.

With your regular doctor visit, this is much less of a problem. In fact, your typical doctor visits, you can get your charges and the costs up front typically. Because what you can do is say, okay, hey, I'm going in for.

Like my wife goes to an endocrinologist routinely that she knows what type of exam she's going to have. So you can call the billing department for your endocrinologist and say, hey, I'm coming in for my, my wife Goes, I think like every six months, you know, I'm coming in for my six month checkup. I just want to know, how do you guys, what do you guys bill that with? I have United Healthcare, I have Cigna, I have Aetna. I just want to understand my cost before I go in. And they always have someone in their office who can help with billing and they're usually pretty responsive. And if it's a simple thing like that, you're able to get those costs up front. So I don't think that the language is quite the same when you go to just a typical scheduled doctor visit. Really. It's the emergency rooms that I think are the danger zone. Right? That's the time when you might not know exactly what they're going to do and they're not going to be able to easily give you the costs up front.

So the next thing on the what kind of the pathway here of analyzing your bills is look up the fair price. So once you have those medical billing codes, you can go to fairhealthconsumer.org you can go to those hospital websites and you can see whether the charge that you were priced was fair or not. And then if they are charging you exponentially more than they should or more than they should, you can challenge that price gouging. You can tell them, hey, why am I paying 5,800 when a cash pay patient is paying $256? That's not fair, that's not acceptable. And as consumers, we shouldn't be accepting that. So we have got to be pushing back and making it inconvenient for them to rip us off. That's where small claims court comes in. So small claims court is creating the most inconvenience and expense we can for hospitals that don't treat us fairly or other medical providers. This is a picture of some friends of mine, Josh and Jennifer, and their two kids. They go to my church and they were having a billing dispute with their dentist. The dentist didn't run their bills through their insurance plan properly and instead just charged their credit card about $300 more than he should have. They spent years arguing with this dentist, calling the billing department, trying to get them to rerun those bills through insurance. The dentist refused, just gave them the runaround. I told Josh, like, hey man, like small claims court, you can file a case for about $30 and you can protect yourself and you can require them to treat you fairly. They will have to defend themselves in front of a judge for what they're doing. Think of what this does, when you sue a dentist or a doctor or a hospital in small claims court, you take it out of the playing field where they can keep giving you the runaround. And you take it to our American judicial system, which has determined that consumers have a right to protect themselves against people who are billing them abusively. And it also creates an expense for, let's say it's a hospital or a dentist. They probably will have to hire an attorney to defend themselves, spending hundreds of dollars an hour. It's very expensive and very inconvenient for them and that will incentivize them to come to the table and treat us fairly. It costs almost nothing to file a case in small claims court. It's easy for anyone to do. You don't need an attorney. I've done it myself. In fact, I did it myself when I was 16 years old with an employer who stiffed me when he closed down the business while keeping another branch of the business open. He told me he wasn't able to pay me. I filed a case. My mom told me about small claims court. I filed a case in small claims court. The owner of the company and his attorney had to show up to the hearing against me. A little 16 year old. The judge heard the circumstances of the case. The judge told the guy to write me a check and he wrote me a check on the spot. It totally transformed the way I look at these consumer conflicts. We're too passive as consumers. We need to use the resources we have to stand up for ourselves. Did I see we have a question at all or how are we doing on questions?

We're good. Okay.

So in, oh, in Josh's case, I don't remember if I said this or not. The dentist has had his attorney call him within a couple weeks of filing the case and they wrote them the check for the $300 that they had been withholding from them this whole time. It got easily settled.

Tip number seven. And this tip might especially come into play for people who are between jobs in transition, like some of you might be. See if you qualify for financial assistance. Nonprofit hospitals in this country are required by the IRS to provide financial assistance, especially for anyone who's under 300% of the federal poverty level. Your bills will be wiped free according to the federal law. But you have to know this. They won't tell it to you. They don't volunteer this information. And so you need to see if you qualify and even for profit. Hospitals also provide financial assistance. Many doctors groups provide financial assistance. So always check to see if you qualify, sometimes the numbers right on the back of your medical bill where you can call and find out if you qualify. They're also required to post their policies on their websites. They might be hard to find, but if you know to look for it or ask for it, you can get it. And you can go to this website, clinicpricecheck.com and you can look up financial assistance policies there. But again, you can also go to the medical provider, get it from them. And I've even looked for even people who make up to six figures. You can qualify for some type of a discount at a lot of hospitals. So make sure and check that option. You do have to verify your income, but especially if you've been out of work for several months, you might not have a lot of income to show. And then you can show them, I don't have the money to pay for these bills, and they waive them.

Tip number eight, avoid hospital imaging centers. Okay, so your doctor who is affiliated with a hospital, when she tells you to get an mri, she might just say, hey, go right down the hall here. Go down to our other hospital affiliated imaging center. Well, research has shown hospital based imaging centers cost exponentially more than independent imaging centers for the same thing. This story I did here is of a guy named Kevin Vincent in Amarillo, Texas. He needed two MRIs before he got a back surgery. The hospital told him he had a high deductible. He had a $10,000 deductible, which just means he had to pay the first 10,000 before his insurance plan kicked in. So Kevin asked the hospital imaging center, how much is this going to cost? They said, well, it'll be $11,000. We're going to charge your insurance. Well, he would have to pay the first 10 grand of that. He said, what if I pay cash? Which is a good question, right? They said, well, it'd be 9,000 if you pay cash. He learned about a company called Green Imaging. A friend of his referred him to Green Imaging. You can look him up greenimaging.net what they do is they do direct contracting with independent imaging centers. He got both of those MRIs for $950. So boom, just like that. By going to an independent imaging center through a direct pay contract, a vendor, direct pay vendor. He saved $8,000 on his two MRIs. And the imaging centers were about half a mile away from each other. He also got copies of the images and they were read by a radiologist for that fee. $8,000. I mean, this will tell you a little Bit about my financial situation. I don't even have. The combined value of my two cars is not $8,000. So $8,000. I have two kids going to college next year. That's half of a tuition payment for one of my kids to go to college next year. $8,000 is big money.

Tip number nine. Okay, let's talk prescription drugs.

Everybody, almost everybody has some type of a prescription they need. You may have heard of Goodrx. I think Goodrx has been shown to have the lowest prices. Often it's cash pay, it's a coupon system. So go to goodrx.com, look up the drugs you need, look up the prices in local pharmacies and see if it's a better deal for you to pay cash through Goodrx than it is to go through your insurance plan. Also check out if you, if you also have ongoing need for drugs, check out a pharmacy called Good shepherd pharmacy in Memphis, Tennessee. They have a member program where it's $5 for members per month for whatever drug you need. They have about 300 common drugs. They send the drug to you 90 day supply. Check it out. And then if you need specialty drugs, we're talking about the high dollar stuff, the really expensive things. This is how crazy our healthcare system gets. This is how inexplicable and absurd the pricing is. This company called drugstoreunlimited.com imports the same drugs that we would buy here in the United States from Canada, the uk, New Zealand and Australia. And they give you massive discounts on specialty drugs if you purchase through them versus buying them here in the United States. It's the same drugs by the same companies. But because of all the middlemen and markups in our pharmacy payment system, it can be cheaper to get your specialty drugs imported from New Zealand. That's bonkers. That's our American healthcare system at play. And a lot of people just don't know that these workarounds exist. They also do it for employer sponsored health plans too through one of their other companies. So check them out if you're interested in that.

Tip number 10 eye drops. Now, if you just use the occasional Visine for some red eyes, it may be no big of a deal to you to waste your eye drops. But did you know I did a whole story about this. The eye, the human anatomy. Our eye can only hold about nine microliters of fluid. But a typical eyedrop by a drug company is between 25 and 50 ML in size. When you put in an eye drop and A little bit of it runs down your face. It's not because you missed. It's because it's like if I took too much fluid and I poured it into this cup, it's just overflowing your eye. It's wasting your eye drops. It's not more therapeutic to do a bigger drop. It's just wasteful. Drug companies know this. They have been still producing massive eye drops. And so especially if you're on like a glaucoma medication or some other type of more expensive eyedrop, you may want to consider the nano dropper. I did this story that talked about this problem and these super industrious medical students and design engineers created this product called the nanodropper. It's about $15. It screws onto the top of a typical vial or bottle of eyedrops. And what it creates is a micro drop. So it creates a small 10 microliter drop out of the massive drop that comes out of your bottle and it extends the life expectancy of your bottle of drugs. You don't waste medicine. And if you're on a budget and you're paying for expensive eye drops, that can be just a massive savings for you. So I encourage you, if you have a need for this or know others who do, check out the Nanodropper.

So these are my top 10 tips. I know I kind of had some of them had more than 10. So whatever, 10 ish tips. I hope that you have enjoyed this presentation. I hope that you will.

Very, very informative. There's another question. So what if I go back and audit bills? How likely and easy would the hospital and doctor office refund over billing?

Well, I don't know that it would be very easy, but if they will not cooperate with you, you could file a case in small claims court. So in my book I have a template that you can use. A letter that you can send to your doctor or to your hospital where it's a 30 day warning letter basically where you could show, hey, I went back and I looked at my bills and I realized that there were errors or that there were things where I was overcharged. I need to be refunded that amount of money. So you may need to press them. You know, they might. It's funny, with these things, sometimes it can be very difficult. Other times it can be incredibly easy. I mean, you all know how this is. Like sometimes you talk to the right person on the right day and they have decision making power and they're in a good mood and they approve what you're saying. So I think you can go back and do that. I also know, by the way, with financial assistance policies, there have been cases where. Look up the website $4. It's a charity that has started to help people work through their financial assistance policies. It's $, like D O L L A R for F O R. That's a nonprofit that has started to help people with their financial assistance policies. They have helped people get refunds. They have helped people get checks by retroactively applying for financial assistance and having the hospital imagine that you paid the money to the hospital, you got the money refunded. So I think.

You can get the money refunded, but it might be a fight. But it depends on how persistent you are. Right. And how. I think it's important to be polite. But then this kind of enters that phase of negotiation, right, where you say, hey, look, I looked back at this, I saw errors. I need you to please correct this by refunding my money.

Okay, Another question, and this is actually my question. So, you know, we pay the deductible, and then we get a bill, and my husband has some kind of complicated medical issues. And. And then there's a coinsurance charge, so the deductibles all paid, but then we get this coinsurance. What the heck? What do we do about that?

Well, so coinsurance. This is why these prices really matter, right? The negotiated price your insurance company has set with the doctor or the hospital has huge implications for us because typically you do have a coinsurance, it's usually like 80, 20, or 70, 30. Or if it's like an emergency room visit and you don't have great insurance, you might have a coinsurance rate of like 50%. So all of a sudden, the insurance company and the doctor have worked together to create a price that they're now saying that we have to pay, but we've had no say in the setting of this price. And by the way, the insurance companies, I have documented this over and over again, and I write about it in the book. The insurance companies care more about the doctors and the hospitals. They see them as their customers. They need to keep the doctors and the hospitals happy and in their networks so that they can advertise their massive networks to the employers. And so as the patient, your insurance company is not really on your side. They're not really protecting your money. So they might negotiate a rate that's more in favor of the hospital than it is you. And now you're stuck paying that coinsurance. And so that's what my friend Gabby had found herself in, in that situation where she was like, what is the deal here? My insurance company negotiated a massive price and now I have to pay it. That's ridiculous.

So in that case, I think that's why you want to know that price. And then you are obligated under your plan to pay coinsurance. And my argument is, I'm fine paying these bills. We all should be willing to pay our bills, but only if they're priced fairly and if they're accurate. So that's, that's. I hope that answers the question, Christine.

Well, it begs for reevaluation when you get that coinsurance part. So there's another question. Do you still recommend people getting supplemental insurance after 65 in addition to Medicare?

You know, I haven't done a lot of reporting about Medicare, so I would, I don't want to go kind of outside my area of expertise. Like, the real focus of my research and my book is the 180 million or so people that are working Americans or their families.

So I can't tell you enough about Medicare to say. And also, I know everybody's situation is a little different. So some people might feel they don't need extra insurance, some people might feel they do. So I'm sorry, I just don't have a good answer.

And then any quick tips for the self employed?

Self employed, meaning? Well, so let me throw out some other things that you might want to look into.

It depends on your income, but let's get really radical, okay, let's get really radical. Let's say you have a very low income. Let's say you're at under 300% of the federal poverty rate, and you say, look, I care most about saving money and I'm healthy, okay? Let's assume that you're also very healthy and you're youngish, okay? If you go to a hospital and you're under 300% of the federal poverty rate, you qualify for financial assistance. They're not supposed to bill you. Now, this is a risky way of looking at things, okay? This is the most extreme radical. So I'm not necessarily recommending this, but one option you might want to think about is saying, wow, these ACA plans are extremely expensive and cover a lot of things that I know I'm not ever going to need. I'm going to pay a direct care primary care doctor, which could be 100, $200 a month for you and your family. So look into direct primary care, and then maybe you have an extreme catastrophic plan that will cover something on the very high end. Or you go, you know what, I'm going to roll the dice and I'm just going to try and rely on hospital financial assistance plans. I wouldn't personally recommend it, but you could do that. You could also look into some of the health sharing plans. So a lot of these are faith based. A lot of them are not. They also have non faith based ones. These are plans that are not insurance. You want to make sure and research these plans. You want to make sure and check references on these plans. It's just a collective of people that's agreed to pool the bills for the group and share each other's medical costs. But it takes out all of these deceptive middlemen who are marking things up each step of the way. And the health sharing plans are way less money to cover an individual and a family. The thing is, they might not cover things like the faith based ones, might not cover things like.

Drug addiction treatment or something, or if you have a baby out of wedlock, they might have these morality clauses in their coverage. So you would have to make sure you comply with that or find one that doesn't have those types of restrictions. So look into the health sharing plans and consider a catastrophic plan with a direct primary care. And that might end up saving you a lot of money and it might be a great solution for you and your family. It's just riskier.

Right. Well, this is really great. Marshall, any other questions? There's none in the chat, so if you.

Well, so all I can say is we need to start thinking about this differently. We have been doing the same thing over and over for decades. We have enough data. So I know everyone here is a data person. Everyone here is a numbers person. We have enough data now to know that the healthcare system is not gonna just suddenly start taking less of our money. And our elected officials are not gonna solve this problem for us. They've made some incremental changes that have been good, but they have not put the brakes on the unjustified high cost of health care. So we need to empower ourselves and equip ourselves as employers and as consumers and patients to do things a different way. And so I urge you guys, please get my book. First of all, I would really appreciate that. Second, please share the book with others because I think other people need to know this. And then third, if you're in an employer sponsored health plan, equip your employees the bulk buy cost on the book. There's huge discounts. Equip them with the book and the curriculum because when those employees save money, your health plan is going to save big money. So I think the return on investment is there. I see some other hands raised.

Yeah, we do. Raj, ask your question.

Yes.

Thank you so much, everyone. And my question actually is very. So much relevant right now. Ten months ago, 11 months ago, I lost my job and I picked up a health share plan. Overall, my test reports before I lost my employment was good, so I didn't really pay too much details around it. And six months later, lo and behold, I had a medical emergency that required me to go into ER and do urgent surgery, basically. And, you know, in that state of mind, I just signed all the paperwork and now I have like $120,000 bill. I'm working with the billing, I mean, with the medical provider and as well as the insurance while this is going on. I don't know what the final outcome would be, but one of the things I even applied for medical hearing from some other friends, recommendation and the income level, they said, you know, based on your. Whatever income for 20, 20, 2020, you don't qualify for it. But, you know, there are other places for financial assistance, too. And I'm wondering what is my options out here right now with. What's the best way for me to go around? I've heard from the hospital, too, about asking for financial assistance, but they're asking for income taxes, paperwork, and recent pay stubs and all. And I've just recently joined a job on a contract basis, so I wanted to.

They should be looking at the pay stubs for the months before that procedure you had to have. So with their financial assistance, they shouldn't be looking at your current income. They should be looking at your income in the. In the months leading up to that procedure. So I would press them on the financial assistance and see if you might qualify. The other thing, everything I've talked about so far is really like the easy stuff. Okay, none of this is easy, but I've been talking mostly about episodic types of care. More of it is planned. So you're talking about something that gets a lot more complicated. And so in Never pay the first bill, I recommend if people can engage a patient advocate. Patient advocates are absolute gurus at handling more complicated cases. And there's one there in California, Raj, that I quote in the book. Her website is called Sol Sherpa S O U L Sherpa S H E R P A. Her name is Lisa Berry Blackstock, and she is super sharp. Now, they're going to charge a fee, but maybe now that you have a new job, maybe you can now afford their fee. But these patient advocates are like ninjas. And so find a good patient advocate. You may have to pay them, but they can help navigate, especially when you're in these really complicated situations where all of a sudden, you got hit with something crazy. But I would say I don't know what procedure you had, but I would look up the cost. It sounds like a pretty high cost for a procedure. It was a surgery, and the bills are 120 grand.

It was a cardiac arrest I had. So it was related to that. They had to put the stent in, and it was like that itself was like $100,000. And then $20,000 on top is other doctors visits.

How long were you in the hospital?

So technically over two, two and a half days.

Okay. But I mean, that's not a long time in the hospital, and that's also a very common type of procedure.

Right.

So those bills do sound a little egregious to me. If you also want to just email me, I'd be happy to take a look. Look at it too, and just see if I can help point out any of the maybe overcharges or errors. But you also, if you find that you've been overcharged, you also might want to hire an attorney, because what you do when you hire an attorney and when you sue them, you create a massive cost for them. You also make this a public dispute where there's a record of it. And so if they're being unfair with you, then I would press them on it. Yeah.

I mean, yeah, great job. And, Raj, reach out to Marshall.