Episode 18: Special Guest: Marshall Allen

Did you know that 7 out of 10Americans who have medical bills say that they have to lower their spending on food in order to avoid a medical bankruptcy? Navigating our highly complex world of healthcare and health benefits leaves many people feeling.

Like a snowball in.

Well, you know where.

I'm Josh Butler, healthcare consultant and advisor to more than 150 employers around the country. And this is A Snowballs Champion in Healthcare, a show about restoring hope in healthcare.

Join us as we discuss ways you.

Can lower your healthcare and benefits costs, how companies are winning the health care and benefits battle, and how hope is being restored to this community and communities across the country.

Hello, everyone, and welcome to another episode of A Snowball's Chance in Healthcare. As you can see, I'm out of the studio today. I'm here in my office, the home office. And this is episode number 18 today. I'm super excited today because it's always easier to do an episode when you have a guest and a friendly face and a friend that you can just have a conversation with. My name is Josh Butler. I am the president of Butler Benefits and Consulting located here in Amarillo, Texas. And this show, I'm also the host of this program, the Snowball's Chance in Healthcare. And, and this show really is about restoring hope in health care and giving people resources and helping people solve problems, and not just people, but employers, and to reduce the cost of health care, to improve access for hardworking Americans. Because, you know, health care is one of those things that people are increasingly frustrated with and they don't really know how to navigate our very convoluted and complex healthcare system. And we've said it many times, it's the leading cause of personal bankruptcy in this country. And today I'm super excited. I've got a friend and I've got a guest and a best selling author of this book right here. Never Pay the First Bill and other ways to Fight the Healthcare System and win, ladies and gentlemen, and when.

Yes.

So my good friend Marshall Allen. Welcome to A Snowball's Chance in Healthcare.

Hey, thank you so much, Josh. It's an honor to be here with you.

Absolutely. I've been, you know, just kind of looking forward to having you on the program. You're a very busy guy. So am I. And our calendars finally synced up. So I'm super excited to talk to you today and for you to share some information with our audience and our guest and you know, our, our guys that followed this program. But as we get into, we're going to Talk a lot about the book and we're going to talk about a lot of initiatives that you have going. But for those of you that don't know you as well as you know, some of us do, give us a little intro and some in your background.

Well. So, Josh, that's a. Thank you so much for having me here and for the great introduction. So I actually am best known as a healthcare journalist. I mean, I've been doing healthcare journalism, investigative reporting about health care for 17 years. And the stories that I do, most recently, I was at ProPublica for 10 years. They're in depth stories where I usually feature a patient trying to navigate our healthcare system. I have the patient waive their HIPAA privacy rights so that I can get all their records. I can share their records with doctors, I can call their doctors, call their hospitals, call their billing departments. I've been doing this for a long time. Hundreds of case studies really holistically and independently looking at what's going on in our healthcare system. What I found really surprised me, Josh, as I discovered this and unveiled it over the years. What I've learned is that our healthcare system often is not set up to really help the public in the way that the public expects. I say that because they market our healthcare system one way. They promote as a healing healthcare system, a healthcare system that's set up for the benefit of the patients. And I'm not saying that's not always the case. I mean, obviously in the case of taking care of people, I think they're doing their best, typically to actually provide good health care to people. But on the billing side, on the cost side, unfortunately, it's often a quite predatory system where there has been a lot of profiteering that has inserted itself between the healthcare practitioners, the clinicians and the patients. And they're trying to use, frankly, some unethical business practices to wring as much money out of the employers and out of the employees. The working Americans are the ones hardest hit by this. They're trying to wring as much money out of the working Americans and employers as they possibly can. And it's causing a tremendous amount of harm. We now have about 100 million Americans with medical debt. About 1 in 5 or 1 in 6Americans has medical debt in collections. This is causing a great amount of damage to people. My book and the healthcare literacy videos that I've launched that are based on the book, they are a how to guide to help people and employers navigate the healthcare system so that they can get better healthcare for a lot less Money.

Absolutely. And we're going to talk about your curriculum in your videos here in just a second. But I want to go back to something that you said, because I find it very, very intriguing, is that you can, like you said, you have hundreds and hundreds of case studies. I've got a ton of case studies. I've provided you a couple of case studies. One of them is in this book. You know, you and I have shared stories for a lot a long time. But you know, what I find very intriguing and interesting is that doctors and nurses are still literally the most admired professions in this country. So the American people are. They're smart. I mean, we're smart people and we got it. And it's pretty much they understand that this, what you're talking about, this collateral damage that's being wrought on our society when it comes to the financial aspect of health care, it's not doctors and hospitals specifically that are doing it to them. And that's why I find it very intriguing that the American public still views doctors and nurses, our health care clinicians, the people that actually deliver health care to us. That's not where the problem is, is it, Marshall?

No. In fact, sometimes people will ask me who's to blame for this problem. And I certainly believe that there are some doctors who are exploiting the system. There's no question that that's the case. But generally speaking, clinicians that are the issue. But what you do see is the billing departments for hospitals are taking advantage. The insurance companies, the pharmaceutical companies, unfortunately, some in the broker community are also taking advantage.

Right. Our industry.

I've written about that. You've helped me understand that. And so there are a lot of these non clinician types who are using, again I mentioned unethical business practices. Let's start with one that's just the most basic. The prices are all hidden. What kind of a business is being run when the prices are hidden? Even now, the hospital Price Transparency final rule, which went into effect at the beginning of last year, this is a rule that the federal government put out that requires hospitals to post their prices on their websites. And the adoption has been slow. So most hospitals in the United States right now are out of compliance with the federal government's hospital price Transparency final rule. That's not ethical behavior. I mean, what other business as a consumer do you go to where you're paying out, you're shelling out a lot of money for a new car, for an airplane ticket, for a meal at a restaurant, for anything you do, where you're paying your Money, where do they not show you the prices? And now the prices are required to be available by the federal government and they're still not showing us the prices. So I do show in my book how to get to the prices. We can, we can often get the price or close to the price, but still it's hard. They're expecting the employer sponsored health plan to build that into their benefits or they're expecting the consumer, the patient to go out and find those prices. They're not just providing the prices up front.

That's right. And so let's talk about the book a little bit more. You know, so I want people to just stop and imagine. And some people don't have to imagine this at all, Marshall. This is a very much a reality for some people. But you know, I want you to imagine what it feels like to receive a $50,000 medical bill in the mail or $100,000 bill or an 80,000. It doesn't matter. You may, it could be a $10,000 bill, could be a $500 bill, could be a $500bill. I mean you, you cite a lot of statistics, we cite these statistics as well, is that the majority of the country doesn't can't afford an unexpected $1,000 bill in a given month. So you can imagine the stress and you know, the anxiety that's created if you get an unexpected $50,000 bill in the mail. And I know that the thought has to be from the beginning, what on earth do I do with this? Where do I even start? And that's why I love this book is because it is actually a step by step, it is full of tips, it's full of resources on how to request a medical bill. But a itemized medical bill, never pay the first bill. Marshall, you're not telling people not to pay their medical bills, are you?

No, I'm telling people never pay the first bill until you check it to make sure that it's accurate and to make sure that it's fairly priced. I love. Josh, you post some examples on LinkedIn of this. I love when you do it where you'll dig into a health plan and you'll start showing some of these prices that you're seeing that are again, unreasonable prices because a lot of the prices are mistaken. There's tons of mistakes on medical bills and they're overpriced and people don't realize how much price variation there is. Can you think, I know you posted on this stuff recently. Do any of them come to mind to you that you've seen.

Yeah, absolutely. So I'll just tell a real quick story. I mean, we got a client one time, I had been prospecting this client company here in the area for about two or three years and you know, he just never would, you know, commit to giving us a chance and things of that nature until finally they're a self funded employer so they could get access to data. And we had had a couple of conversations about, you know, who's really monitoring your healthcare utilization and your, and your bills and I mean, this is your company money and it's your employees money that's paying literally for these healthcare services. How do you know you're getting a good deal? And he just kind of looked at me quizzically. And after I asked him that question, I said, would you be willing to share your data with us and just let us do a little bit of analysis?

Yeah, I love it.

He agreed. And so in there we found multiple opportunities to drive down their, the unit cost of care for them. But there was one that stood out that was pretty egregious. And I dug into it. I did all the research, I called the facilities, I called the tpa and I verified that I had my information correct where they had paid. And the TPA didn't, you know, didn't want to really have this conversation because they're the one that approved and paid the claim. But that employer paid $17,000, Marshall. For a single CT scan. Wow. One CT scan. Now, Marshall, I'm not going to tell the audience. You tell the audience what you what, what? In your research and what you see, what would you consider to be a fair price for an abdominal CT scan?

That's what I mean. It would be in the hundreds of dollars, right? I mean, you, you see these prices way more than would it be 300.

$400, between 3 and $500. But his organization had literally paid.

This is 17,000.

17,000. And when I pointed this out to him and said, now listen, Mr. Owner, this is what I'm talking about. Was this a mistake? Was this an error? Was this fraud? What we don't really know. All I know is you should never be paying $17,000 for one CT scan. And at that point he said, you're hired, buddy.

Wow, that got you the business. That's amazing. But that's a great example. And I think this, this is happening on the employer level. It is where the employers need to have savvy advisors and other solutions providers. Right? There's all these data analytics companies, there are medical management companies There are a lot of companies that exist, pharmacy benefit managers that will help people do this pharmacy provision in an honest way, not a dishonest way that saves tons of money. So these solutions exist. And so the employers need to redesign their benefits so that they're engaging with these independent advisors who will stand up for what's right for the sponsored plan, not what's right for their own bonuses and commissions they're getting from the vendors. And then it happens also on the individual employee level. This needs to be a partnership. And so my book is really challenging, really.

I'm trying to reframe the way people look at this from the employer level and the employee level so that they get engaged, so that they understand, oh, wow, there's a lot of games out there where they're causing me to pay more than I should. But we're not helpless. There's actually a lot we can do. And so employers get with a savvy advisor and then individuals check your bills. I mean, I have eight chapters in the book that show different ways that you can apply different steps. Just some basic principles to look at your medical bills. If you get denied by an insurance company for care that you should get, there's a way to fight that. There's a smart way to appeal that. Sometimes it's better to ask for the cash price. People don't realize it, but the cash price is often lower than what your insurance company has negotiated on your behalf. So there's little tricks of the trade about navigating the system. And that's really what the book and my videos are trying to show people how to do. But your example is a dramatic one.

Yeah. So I love what you're. The term you're using is engagement. So let's talk and shift a little bit because you didn't just write a best seller, you didn't just write a book. You're engaging with your audience and you're engaging with communities and with employer groups in a more virtual way as well. So talk to us a little bit about the Never Pay pathway and the employer solutions and the curriculum that you've generated outside of for those people that don't necessarily like to pick up a book and read it.

Yeah, well, so this actually came to me from some advisors who recommended to me that I create videos based on my book because most employees aren't going to read a book, which is true. Most people aren't going to read a book. And so I've translated the book into 16 short videos. Each one's about five minutes in length and the videos in a really engaging and fun way with really great graphics, really great animations, really cool visuals, show employees and individuals what they can do to navigate the system. So I have a video on how to get an itemized bill, and I have a video on how to ask for the cash price, how to price a bill once you get it, how to avoid treatment you don't need. So all of these videos show the problem and they show an individual person who has taken these steps that I recommend and then solve the problem, and then the action steps that an individual can take themselves. So they're really built to equip and empower employees to navigate the system. And so the videos are one way I'm doing that. People can go to allenhealthacademy.com for that information. And these videos, by the way, were supported by, by you and others who either pre ordered or crowdfunded this curriculum. So this was actually a movement of advisors, brokers, solutions providers who came together. I ran a crowdfunding campaign, raised money to produce these videos, and so now I'm really proud to launch them. The the other way I want to point out that I'm helping people is people can reach out to me. MarshallAllen.com is my website. I'm getting emails and messages from people every day and I'm showing patients how to do this. And it's really fun for me to help people kind of navigate the system and achieve these victories. So they're victory stories, what I call them, when people save a lot of money on their health care while still getting the care that they need.

Yeah, it's great. And obviously a lot of the solutions that you share in both your videos and I love the videos, by the way. And if anybody's interested in, you know, sharing these videos through your organization, you can reach out to Marshall directly and reach out to us too. Like you said, we were a part of this initiative early on and we're very proud to and honored to work with you on that project. It turned out great, you know, so it really is impressive. But you know, there's a couple of things in the book. You know, you have chapters and subchapters dedicated to things like don't assume that your health insurance is protecting you. You just mentioned a minute ago about sometimes the cash pay rate is the best way to go instead of using your health insurance. And for millions of people in this country, that's probably very counterintuitive because after all, what's insurance supposed to do? It's supposed to make health care more affordable for us. But I think people are increasingly starting to see that that's not always the case. But there's another chapter in your book that I love a lot and talk about this a little bit is about you were kind of hitting on it about get with a savvy advisor. And not just a savvy advisor, an advisor that will is willing to align their interest with your interest as an employer. And you've got an acronym in the book. Is your broker a bui or is it a broker under the influence? And I think that's very important. But also Marshall, we live in a part of the country where there's a ton of uninsured people. So people that don't even have health insurance, they're going to be self pay all the time. How important is your curriculum is your book and your information that you share to uninsured people?

Well, I think it's essential, Josh, because the promise I make, and this is not an exaggeration, is that patients can save hundreds or even thousands of dollars per healthcare encounter by putting these principles into place. For example, if you're uninsured, it's all the more important for you to know how the pricing works. In hospitals and in doctor's offices they have what's called the chargemaster price, which that sticker price that the insurance companies negotiate discounts off of. Nobody should ever be paying that chargemaster price. It's often it can be 10 times more than the discounted negotiated rates. So if you know that in advance, you can watch to make sure that they're not overcharging you. Another key thing that people need to know is about hospital financial assistance policies. I have a whole video about that. If people are within four times the federal poverty rate for their household income, there's a great chance that they're going to qualify for financial assistance at hospitals. And those financial assistance policies can forgive bills 100%. You can go to the hospital and not pay anything by qualifying for financial assistance. So those are a couple examples. But I mean there are so many that we could go on and on. Like prescription drug programs? Yeah, there are some pharmacies now that are doing membership programs where it's a small, small monthly fee to pay for your, your prescription drugs. And a lot of drugs are available that small monthly fee and even specialty drugs can be obtained at a much lower price than you would expect. So I have a whole video about that. So there is so much in the videos for people who are self pay that I would. I would highly recommend them. And scholarships are available, too, for the video. So if you go on my site, it's again, it's allanhealthacademy.com if you go on my site, there's a scholarship program, so take advantage of it.

Yeah, absolutely. Or reach out to us, too. We're happy to help navigate people to your curriculum. And so you talked about a couple of examples. I want to use one more specific example, as we're kind of getting close to the time here is I don't think you can take credit for this. I certainly know I can't take credit for this. But one specific tip that I wanted to make sure that people, whether you have health insurance, whether you're uninsured, there is one specific tip, and it involves laminating a card in addition to your health insurance card, or just put it in your wallet for when, if people find themselves in an emergency situation in an er. Share with us that little tip, Marshall.

Yeah, so we're talking about the Battlefield Consent. And the person and the organization that gets credit for this one is Al Lewis at Quizify. So Quizify has really mastered this one. And the Battlefield consent, you know, when you go into an emergency room, you sign that financial consent form where basically what it typically says is, I agree to pay all charges associated with this care. And you kind of blindly sign it. You know, because you're in the er, you don't have time to debate these things. But when else do you enter into a contract where you just agree to pay whatever the other party says that they're going to charge you? You should never do that. This is a contract that you're signing. So the Battlefield Consent basically puts a ceiling on what you agree to charge by linking what you agree to pay to the Medicare rate. Now, the Medicare rate is typically half or a fifth or even a tenth of what a working American might get charged in a hospital. Again, I talked about the pricing variation.

Yeah.

So Medicare covers older Americans and disabled people, and they set the prices for hospitals, so they put some price control on there. So the Battlefield consent basically says, I agree to pay up to two times the Medicare rate for the service for the appropriate services that are provided. So in other words, I'm not going to pay for inappropriate services and I'm not going to pay whatever you charge, I'll pay up to two times the Medicare rate. And that's a great protection for patients. You can write that in. So if you get a paper form, you can write it in and sign it. Or if you get an electronic form, ask them to print it, and then sign it that way. Take a picture of it so you have a record of it. And sometimes they just have an iPad or something. You can actually.

Have them write it in themselves if they won't give you a printout. But like my son went to the hospital recently, to the er. He wrote it in, he had to have a printed and then put it in his record.

Yeah, but we can tell you, ladies and gentlemen, this strategy works because there's already legal precedent. Texas courts have already established that even if you do sign it and you agree to pay all billed charges, that doesn't even hold up in court. If you signed it under duress or, I mean, who wouldn't sign these forms? Marshall, if your kid is injured or if your kid is extremely sick or unconscious or something. I'm a parent. I mean, I know I'm probably going to not even be thinking about what the price I'm about to get hit with. I'm going to sign whatever I need to sign to get my kid in there to see the doctor as rapidly as possible. But listen, folks, just know that there are protections built in to the law. They're built into all kinds of things. And it's a. It's an easy way to, like Marshall said, battlefield consent. I agree to pay you, but I agree to pay you a fair price, which input was two times what Medicare would pay. So. Well, Marshall, this has been very enlightening. I know that we encourage people all the time. I've given out your book to a lot of my clients and I know that a lot of, you know, people that I talk to that know you have benefited greatly from your videos, from your curriculum, from this book. That's. We're getting real close to time. Any last thoughts? Any final words?

Well, there's one. There's one other resource I want to offer. It's a free newsletter that I put out and that's available at marshallallen.substack.com and I encourage people to subscribe. I put out these victory stories with tactics that people can use in every newsletter. So please subscribe. And then the final thing I'd say is we're not victims here. We have been victimized. But now we know we can be empowered and we can stand up for ourselves and we can actually fight back and win. That's the main thing I want to point out, and that's at the employer level and the individual patient level.

Well, that's a good segue to our conclusion here, ladies and gentlemen, that's going to do it for another episode of A Snowball's Chance in Healthcare, where each week we are having great guests like Marsha Allen. Thank you so much, my friend, for joining us.

Thank you.

Where we share tips, we share resources, we share strategies, and we're arming you to give you a snowball's chance in healthcare. God bless and have a great weekend.

Sam.