Interview with Marshall Allen, Author Never Pay The First Bill | The Zemar Podcast

Welcome back to the Zmar podcast. Today I have a guest, Marshall Allen. He is a investigative journalist, background, and now moving and trying to make a movement into our industry, but as a employee benefit employer, arena try to help save money, not only on the employee level, but employer. Welcome to the show, Marshall. Thanks for taking your time.

Thank you for having me here. Butch.

Yeah. Would you take a quick moment to introduce yourself to our audience and that way they get to know you a little bit and what your background is.

Yeah. Thank you. First of all, thanks for having me here and I appreciate everyone who's listening. I know you know, you have to be careful about what you're putting into your ears these days, so thank you for listening to us. So my background is kind of unique. I actually never knew what I wanted to do for my career. So I started off, I spent five years doing youth ministry, of all things. Then I went to seminary because I thought I would stay in Christian ministry. I ended up freelance writing, and that led me into the media. And then I spent 20 years as a journalist, most of that as an investigative reporter, investigating our healthcare system. And so I went. I'm a very morally minded person. I mean, that's kind of why I went into ministry. And then I find myself as a morally minded person entering our healthcare system, writing all my stories from the perspective of the patient and the person who's engaging in the care, trying to navigate this fractured, backwards, upside down healthcare system. And so I spoke to thousands of patients and experts, patients engaging with the system for all the stories. I did hundreds of them. I would have the patient waive their HIPAA privacy rights, so I would get their medical records, I would talk to their doctors, I would talk to their hospitals, I would talk to their insurance. I was able to get at what was actually happening with these cases. Right. I did a lot about the quality of care and I did a lot about the cost of care. The last 10 years I was in journalism. I worked for ProPublica, which is probably the biggest investigative news organization in the country right now, based in New York City. I Recently just left ProPublica and now my day job, I work for the Office of the Inspector General. So now, of all things, I work for the federal government, which is something I never thought would happen.

But the OIG gives me the opportunity to do inspections and evaluations of how our taxpayer dollars are being spent on healthcare for Medicare, Medicaid, the cdc, the nih, all these big programs. I always have to add the caveat that I am not here speaking as An OIG representative. Right. I'm not here speaking for the government. I'm here talking personally as an author and educator. And then finally I wrote the book Never Pay the First Bill. And the subtitle of the book is Never Pay the First Bill and Other Ways to Fight the Healthcare System and Win. And I think the end when part might be the most important part of the whole title. Because what I'm showing in the book is how individuals and employers can push back against this totally unfair, unjust healthcare system. Overpriced, wasteful, exploiting people's sickness for profit. I'm showing in the book step by step. It's a manual about how to fight back and win. And when I say win, I'm talking about getting better healthcare benefits at a lower price. That is the win that I think the data supports that. And as you know, that's already happening around the country where more, more informed and progressively minded health insurance advisors are teaming up with employers. And they're not doing things the same old, same old way. Right. Have to keep doing it the same way. And when they change, they're really unbundling. I mean to simplify it, they're unbundling their health benefits package, they're changing the incentive structure, they're making it transparent, they're looking at the prices, they're reviewing the claims.

Yes.

They're getting out of these twisted, deceptive pharmacy benefit contracts.

Yes.

And they are finding ways to save 30, 40, even 50% for their employers while the employer waives, co pays, waives deductibles, improves the benefits for the employees. I mean, what employee in America has been hearing at their annual enrollment meeting, hey, by the way, you got a reduction in your premium, we waived your deductible. And now instead of you wondering where you need to go for the highest quality care, we have a direct pay relationship with this orthopedic practice. I mean it's, it's amazing to see what's happening. And so I've independently documented all this. As a journalist, I put it all in my book. And now the book has led to me launching my own company called Allen Health Academy. And my mission with Allen Health Academy is to make, make this idea of health care, financial literacy and equipping employees part of every employer sponsored health plan. I think that patient education is a huge missing component of bringing about success for these employer sponsored health plans. And so the first thing I'm going to launch is a video curriculum that I'm calling the Never Pay Pathway that'll be coming out in a couple months here. And that's based on the book. It's taking all of the how to tactics and principles in the book and combining them into 16 short 3 to 5 minute videos so that an employee can go through the whole curriculum and they can learn how to avoid treatment they don't need.

Sure.

How to analyze a hospital bill to make sure it's accurate and fairly priced, how to even sue in small claims court to protect themselves if they're getting price gouged. These are things that unfortunately, given the predatory nature of our health care system, employees need to know. And so I'm making it more accessible through these videos that will come out and I'm hoping by the end of March or around that time.

Yeah, you hit a lot of great points. A lot of the talking points that advisors all over the country are talking about. I mean obviously everything you just summed up can some people listening this would say it's too good to be true. Right? The good news is it's been around for a long time. It's just now finally the tipping point, right? Right. The tipping point of employers just fed up with situation people being too loyal to branded carriers that have been historically gouging things that are premiums and how they're expensing the claims without actually showing the data. And so they're profiting big time. And then of course, and you do highlight some of it in your book about the Affordable Care act just gave them more reason to increase that in order for them to make more money they had to increase claims. And so it's an indirect adverse selection kind of deal where the employer is paying all this extra money just so the, the insurance company is making more money in results. So the federal government really just gave them incentives or basically a golden key to make more profits in the long run.

And yeah, if you, if you think about the insurance company, they're just a middleman, right? They're just taking a cut off the total amount of the revenue. And if the total amount of the revenue is bigger, they make a bigger cut. That's their incentive. And then look at the self funded plans. I mean they're not even paying the bills on the self funded plans. They just administer the plan. So they don't care about the prices on self funded plans.

Right.

And I've been digging in to the hospital because of the hospital price transparency final rule, right? I can dig in and I can see on all these hospital websites they're posting their prices and you're seeing now the outrageous amount that insurance companies are negotiating for their prices. Their discounted prices are often higher than the cash prices. Yes, you see that all over the place.

Yeah. And then some won't give you the discounted price, the cash price, if they know that you have insurance and they kind of try and block it because then they make more money for sure. A lot of you highlight a lot of things even on your website, like the average family premium cost is on nearly $22,000 a year. And a lot of my podcasts, I point out that these people, I mean, whether you're paying it individually or you're paying it through your employer, the employer's front money on it, that you pay $20,000 or more for a year for health care. And we don't know how it works. We don't know how the ins and out. You don't need to be an expert, but we don't spend the time. I tell you, if you went out and spent, and this is the example I always give, if you spent $20,000 on a car, you would know every button on that car. You would know exactly how it works from front to back.

But that's right.

Then $20,000 or more on health insurance. We don't know how it works. And again, you don't need to be. It could be as simple as. And this is a personal example where I got busy. We had fourth quarter. My. Obviously my family doesn't stop health care. They had some claims. A claim was going and I'm like, I put it to the side just because, hey, I'll deal with this at a later date because I don't have time right now. And so when I finally got the final notice, because I forgot about it, I call them up and I'm like, hey, can you give me some clarity on this? Because it's not matching the explanation of benefits just because of. Just a quick. It took me two minutes. Yeah, I called them and they said, can you hold on for a minute? Five minutes later they come back and they said there was a billing mistake, we're going to go ahead and take care of this. And it actually made it zero. And how much did you say there it was? 1500 bucks.

Wow. I mean, that's an amazing example because I call the book never pay the first bill. Not because I'm saying never pay your bills, but what I'm saying is never pay the first bill until you have checked it to make sure it's accurate and to make sure it's fairly priced. And there's sometimes it's really easy. Right. You looked at your eob, you saw that the bill did not match the eob. You called, they corrected it. So one thing I'm trying to overcome is this myth that this is always really difficult to do. It's not always difficult to do. In fact, a lot of times it's really easy. And I show, in my book, I have a whole chapter where I show people how to analyze a medical bill, how to understand it, how to understand an eob, how. And then step by step, what you should do to make sure that your bill has been adjudicated properly, to make sure you're not getting ripped off on the price, to make sure it accurately is capturing the care you actually received instead of being upcoded or including charges for things that didn't even happen.

Yeah.

And the thing that most patients don't understand, that you and I know and your audience here knows we know how common these mistakes are. Right. We know not to trust the system. The problem is most employees out there, they assume like, well, my doctor got his medical degree from Harvard or wherever.

Yeah.

And the hospital is a big fancy looking building with a marble atrium fountain and you know, you know, the coffee too, flying through the atrium, you know.

Yes.

So they must know what they're doing when it comes to the billing side. Well, the thing is, they are processing so many millions of claims a day, mistakes are made all the time and people are paying for them and they're getting sent to collections because of these mistakes. So we have got to equip and empower employees to do what you just did, Butch, because you just saved fifteen hundred dollars. That's huge.

Yeah. And that was the final notice before collections. And it's only because I got busy. Imagine if I just paid the bill because that's what the bill came in. And you don't know how many conversations. Well, you do, but. But our audience may not know how many conversations we have on a regular basis where billing mistakes happen all the time. We had one even personally, that actually the insurance company is defending us and saying we're not processing this claim because it should have been included with another code. And we call and we go on a three way call because the provider says that's wrong. So we go on a three way call and they said they made up the code. They put P at the end of the code because they're professionals. That's exactly what they told me.

You couldn't make that up.

So the thing is, I have had so Butch. This is what's amazing. So you know how to get them on a three way call.

Right.

You know how to persist?

Yes.

I talk to patients all the time who have the same kind of thing happen, but the provider refuses to correct their billing error. They refuse?

Yes.

And so I have to show the patient. Now here's what you have to do to make the provider pay attention to you. And frankly, I have a whole chapter in the book about how to sue in small claims court.

Sure.

It requires them to file a case in small claims court to say, hey, you know what, your billing mistake that you refuse to correct. You won't even listen to me. You keep blowing me off. That's what they do. They blow them off once they file that case in small claims court. Wow. It is amazing to see how the power balance flips.

Sure.

Because now the hospital or the doctor or whoever it is is required to hire an attorney at a cost of hundreds of dollars an hour to defend a case that might only be worth hundreds or a few thousand dollars. And it totally changes the power balance. And it's very satisfying. But it's also a tragedy. We have to do this right. Because these mistakes are so common and they don't correct them. So that's amazing.

Yeah, yeah, yeah. And I just want to hit, I mean that was one section. So as much as I know about billing from a broker's perspective, that was insight in your book. Just to highlight that, that I didn't know. Right. I never been to small claims. Which also brings the light that even if you just learn a little bit about the healthcare, you could save thousands of dollars a year just to do the examples we just talked about before even file on a small claims. It could be just, I think most providers are, I want to say especially smaller ones, they, it's all unintentional. It's not necessarily, maybe the system's set up that way, whatever. But if you place the phone call and actually try to start the communication, a lot of times it could get resolved right away. That doesn't happen all, it doesn't happen always. But, but, but I'm saying just a little bit of knowledge, a little bit of trying to figure it out and your system that you're trying to put together is going to help with that. And I think that's fantastic that you're trying to work through the actually broker advisors you're working through as well as the employer and trying to get these tools in the hands of employees and other participant policyholders so they can be a little bit more equipped and not feel so vulnerable because they said, hey, he went to Harvard. And that was arguments. Even with family members, I would have. I'm like, yes, but he puts his pants on the same way I did. And in fact, we've been in doctor's offices where they Googled information and. And it's like, okay, so they may be a little bit more resourceful maybe to access the information, but they're still human. Right. And so the system still set up that way. And a lot of these smaller practices, as they grew, they were not only the doctor, but they were the head nurse, and they were the office manager all at the same time. And they don't have time for everything.

Yeah. And also, we make a big mistake when we put the same trust that we give to clinicians. If we put that same trust on the financial side of the healthcare system, that is our big mistake. You know, we're too trusting because we know that the doctors and nurses are there to care for us. And yet the billing side, that doctor probably has hired a different billing company to handle all their bills. They're up coding stuff. They're incentivized to maximize the billing as much as they can. I had a case with a patient that I'm helping right now sue in small claims court. Now, the funny thing is, now the hospital attorney is trying to negotiate to get her to lower the bill. Yeah, this was a very simple case where a guy cut his knee, went to the emergency room. They billed it as a level four emergency room visit, which a. Which is a complex emergency room visit. This guy just had a few stitches in his knee, but because he got a tetanus shot, the attorney for the hospital is saying, oh, no. If they get any kind of an injection, even just a regular little tetanus shot, it is mandatory that we require were required to bill it as a level four. A complicated emergency room case. No, that's not true at all.

Maybe internal. Yeah.

And so I've shown this, this patient, and in my book, I talk about upcoding a lot because I think upcoding is probably the most common type of fraud. It's fraudulent behavior that is endemic. It's throughout our healthcare system. You know, you can bill From a Level 1 to a Level 5 code for an office visit or an emergency room visit. Level one is for a simple visit. It pays less. Level five is the most complicated. It pays more. So these, these billing companies are juicing the codes. They're taking the medical record, they're exaggerating the complexity, and they're upcoding And I think this happens. I've caught it on my cases. I help patients with this all the time. So this attorney was arguing, oh, no, if you get a shot of any kind.

It'S a level four complicated emergency room case. Not true.

Yeah.

And so they're not allowed to just bill whatever they want. If you, if you type the code into Google, you can read the coding standards. There are standards that have to apply for the codes. They can't just charge whatever they want or bill whatever they want.

And I agree 100%. And, but obviously the basic person's not going to know whether it's supposed to be a level one or a level four. But, but I think if, if America as a whole starts taking just one step, positive enforcement of, just take an invested interest, right. You spend, I mean, between you and your employer, you're spending on a family over $20,000 a year. Just put a little skin in the game, understand the process. And I would say in most cases, that's probably enough to now you can start swinging and get ahead of the game. And then there's the few cases that all of a sudden go a little bit further, which you could obviously reference inside the book and then file small claims if needed, but you actually go through an outline step by step. So it's not like you're going into a blind. You give a format and say, this is what you need to do to start the process. And I think that's fantastic.

That's right. And what I'm. What I'm going to be doing with the videos, too. So the videos will be available for a fee. I'm going to make them affordable so that people have access to them, so that basically anybody who says they care about health literacy for their employees will be willing to subscribe their employees to these videos, which will give them this base foundation level of knowledge and understanding. And then I'm going to have another component to it where for another small fee, if people want coaching from me and access to me, I'm going to moderate an online group for people who are dealing with medical bills. They can submit their bill, they can submit their questions. I'll moderate that in real time, answer their questions, and even then do office hours. So I'll do weekly webinars with this group for people who are working through these problems. And so my goal is to bring this to scale where right now the book was step one. And the book is, I'm proud of the book and it's a wonderful resource. But, you know, most employees don't want to read a whole book.

That's correct.

Now with an hour of content on videos, they can watch the videos and get a certificate at the end. And the, some of the brokers I'm talking to are saying, well, what we'll do is we'll give them a incentive, give them a hundred dollar gift card from Amazon or something, the videos. So they finish the videos and then if they have that problem or if they want more advocacy and more coaching, sign up and let me help you. Because I'm walking patients through this every day right now. And right now it's not set up. I'll be launching it into the online group so I'll be able to do it a lot more to maximize the kind of online community. But sometimes people just need a little guidance and a little encouragement because it all sounds a little too good to be true. Right. So people don't quite know what to do, but people are fired up, man. I mean employees know they're getting ripped off.

Yes.

And they are willing to confront the billing department or the doctor or the hospital and say this is not right. And this gets back to my moral mindset, my moral perspective, our moral perspective. This is a moral issue. This is an ethical problem.

Yes.

And so it's not a, we don't need top down more. I mean, I'm for policies that will improve things.

Right.

We can't wait for politicians to do something that's going to, that's going to change the moral behavior that's going on here. We need to call it out. Right. And point it out. And every in every single patient has a tremendous amount of power when they make the moral argument. They can say, hey, how is it fair? I'm looking at the prices on your website. I have United Healthcare or I have Aetna or I have Cigna. How is it fair that you want me to pay 5,000 for my colonoscopy but a Medicare patient only pays 1,500.

Yes.

How is that fair? I'm sorry? Or a cash pay patient is paying 2,000. I was talking to a patient just yesterday. She's going in today for some tests. Her tests through her United Healthcare plan are costing $3,000. She has a $5,000 deductible and the self pay price is $1,500. So she's saying I want to use, I want to pay self pay. I don't want to run it through my insurance, which in most cases that's allowed.

Yeah.

No one gives people a hassle. She's being Told by this medical provider that she's not allowed to do that because their contract with United Healthcare will not allow them to let her pay the self care.

That is completely bogus.

Yes.

Totally absurd. So I showed her in the HIPAA law. So the HIPAA law is like, it's like the big threat that looms over every healthcare provider that would violate hipaa.

Right?

Yeah, I showed in the HIPAA law and I gave her a printout. I showed her the printout and I said, print this. It's basically from the government's website, the HHS website, the description of HIPAA and your rights under hipaa.

Right.

And one, one of a patient's rights under HIPAA is to restrict the use of their private health information. Anything other than the health care providing itself. So in other words, I said, okay, put it in writing, bring them this printout and then put in writing, I do not give you consent to share my private health information with my insurance company.

That is your right under hipaa.

Yes.

So now, now what's this medical provider going to do? Right? They want to just extort an extra 1500 out of this patient. Yes, the patient has to show them the law. It does not allow that. So anyway, I haven't heard yet how this is going to work for her. And then, and then I told her, look, if they, if they still refuse, well, she needs this treatment. Right. So she is, she is being, you know, like being held with a gun.

Right, right, right, right.

So she needs this, she needs these tests. So I said go ahead and get the test and then we'll find it on the back end. And this is where small claims court will be a very valuable tool if they do come after her for that $3,000.

Right. And you bring up a good point not only at the medical provider, but also at the pharmacy counter. There's some pharmacies nationwide that do the same practice. And now obviously it's, it's a forefront in Washington. And so I whether gets reelected or Congress, because we've got midterms coming up, anything that's going to be updated or talked about, you're obviously going to be in tune to it and, and to my knowledge, and correct me if I'm wrong, you have a new publication website that you are publishing current events and other things related to the topic. Can you give some insight so that people could actually go to it and you and keep up to speed on anything that current events that are going on?

Definitely. So the, my personal website is marshallallen.com so I encourage people. If you want to message me or reach out to me, you can find me at marshallal or LinkedIn. I'm always on LinkedIn, so you can message me, but also my substack. So Substack is a platform for independent writers. I just recently transitioned my newsletter to Substack, and what it allows me to do is I, first of all, I write about these topics. I have a weekly newsletter that comes out and it allows me to take in. It's free for everybody. So I encourage people to sign up, subscribe, and share it. But I'm asking people if they want to make a donation for the publication. I donate 100% of the proceeds I bring in from Substack. So my suggested monthly donation is five bucks a month. And a lot of writers are using this to support their work, and it's really awesome. But I just. Because I have a day job and I want to use this to try and help other patients, I'll be donating all those funds. So I do encourage people to donate. But at least sign up for free, right? It's marshallallen.substack.com Yep.

Yeah, definitely sign up. So you could at least be current on topics that are going on and then obviously support other patients. And I'm going to include the website and domains in the show notes so that way people can get access to it. You had mentioned LinkedIn. Is there any other best contacts that people could reach out if they want to discuss further on this topic?

I think that's the best place. And also I'm happy if you want to refer your patients to me. If you have employees who are dealing with these kinds of problems, I relish helping them. I mean, I really enjoy it. And I learned a lot also through each of these individual battles. Just yesterday, you know, I was reading the HIPAA law, right? Because I was like. Because I knew it wasn't right, but I was like, what is the law here? What is the really the law that we need to cite to. To really checkmate that. That billing person who says, no, you have to use your insurance. You do not have to use your insurance. So I enjoy it. And also, you know, with my curriculum and with this project I'm doing, I want to be a service to the brokers and advis. I know you guys get hit with all of these types of cases. You're trying to put out these fires. I will. I love these referrals and I love to help people. So please feel free to send them my way.

Absolutely. Well, we'll include links in the show notes and your contact information. This has definitely been great. I encourage everybody, if they, if they're readers, to pick up the book and then obviously subscribe to the subscription. And then I think this is great. And you're, you're doing a great thing for our industry as a whole. But obviously, the end game is to help the end user, the policyholders, the patients, get ahead of the spectrum, because we're just getting gouged out there. Hey, Marshall, thank you so much for your time. I really appreciate it. And then hopefully to get you back on with some updates as current events start changing things.

That'd be awesome. Thanks, Butch. I really appreciate you taking the time to have me here.

Not a problem. I appreciate it. Thanks so much.