Marshall Allen, "Never Pay the First Bill' Part 1 | The Ovation Show w/ Dan Labroad

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Everyone, welcome to the Ovation show where we're discussing the healthcare crisis in America. We're bringing partners, colleagues, clients, business owners together to discuss solutions and innovations that are bringing a higher quality of care to employees and reducing their out of pocket costs. At the same time, we're also reducing the employer costs and giving them more transparency and control. We're live in the Work Innovator studio today where Work Innovators is amplifying the voice of business. And today we're going to talk about really healthcare billing and again, the crisis of healthcare in America. And I'm really honored today. I've got Marshall Allen in town who has written the best selling book that going gangbusters everywhere Never Pay the First Bill. And so I'm happy to have him here. He's from New Jersey and now he lives in Texas. So another great thing comes to Texas. So, Marshall, welcome, man, thanks.

Thanks for having me here.

So let's talk first about you. I mean, New Jersey, you're I guess, a writer and an investigative reporter.

Yeah, right. So I mean, you say New Jersey. I mean, I did live there for 10 years, so I can't deny my connection to New Jersey. But I actually grew up in Colorado, so I feel much more like a child of the West. But since I went into journalism, when you're in journalism, you have to move your location to move up. I mean, to do really high quality journalism, there might just be like one or two places in each state that's doing like really in depth investigative reporting. So I started my journalism career in Los Angeles. I spent five years at a lot of small papers in la. Then I went to Vegas. I spent five years in Vegas. And that's where I started covering healthcare in Las Vegas. And then in 2011, I went to New Jersey. I got hired by ProPublica. I worked for ProPublica for a decade and now, believe it or not, I work for the federal government. That's my day job with the Office of the Inspector General. Although my caveat is every time I say that, I have to say I'm not here speaking as a representative of the Office of the Inspector General. Right. I mean, that is what I do for my full time job. But I'm really here as an author, as an educator, really promoting health literacy for working Americans. And I'm trying to show employers and employees that we don't have to do the same old thing that we've been doing for decades now. We have decades of data that show that year after year the costs go up and we get less for our money. And it doesn't have to be this way. And so in my book Never Pay the First Bill, which I'm really pleased, has been really well received by readers, by employers, by the brokers and HR people. Advisors have given it a great respect perception because in the book it's called Never Pay the First Bill. And then the subtitle I think might be the most important part and other ways to fight the healthcare system and win the and winning part is the most important part because the myth that we've all led to believe is that we have to just sit back, be passive and let this healthcare system continue to steamroll us financially. And what I know you have found, what the other next gen benefits advisors have found, what the health Rosetta advisors have and what a lot of more progressive advisors are finding and employers is that it is possible to achieve the audacious goal of spending a lot less money and getting a lot better health benefits. And that's the thing that I think regular patients and employees don't ever realize. And it's certainly, I think, the thing that employers don't realize. They don't have to keep doing it the same old way. They could deliver much better benefits at a much lower price.

When I first met you, it was at Next Gen Mastermind, one of our conferences, you came in and spoke for a little bit. And I will say our whole thing is about better care, better quality care. We say right care at the right time at the right price. And we know you can get better care, better quality for a lower cost.

Yes, the whole economics of healthcare is completely upside down compared to the way we think of any other item or service that we purchase. So usually if you buy a new car car, you spend more money, you get a better car. You know, you buy a Mercedes or you buy whatever your favorite brand of luxury car is. You spend six figures on a car, you're going to get a luxury vehicle that's going to be a better product than say the Honda or the Toyota or whatever it is that someone else might have in their driveway. In healthcare, though, it's not like that. All the studies have shown that there is not a correlation between cost and quality in healthcare. And so the big brand name medical system that's charging five times more for the same service than you could get at another community hospital or maybe an independent ambulatory surgical center, they're charging way more. But you're not actually getting a better knee replacement or a better mri, especially on the standard types of Healthcare things that people go for every day. You can get the same high quality healthcare or oftentimes even better at a much, much lower price. And when I say low price, I mean it is extremely lower. The promise I make in my book, and I don't exaggerate these things, so I'm careful with the words I choose. But I tell people as patients, you could save hundreds or even thousands of dollars with every healthcare interaction if you put the steps in place that I recommend in my book. Be aware of ridiculous price variation and don't pay more than you should for something that you could get at a much better price somewhere else. It's just people don't normally think that that's how it would work because it doesn't make any sense. It's absurd. But we've been taken advantage of for so long that we've gotten used to it. And so part of what I'm trying to do is rattle people out of the standard way of thinking about their healthcare benefits. Help consumers see that, yes, you should trust your doctor, you should trust your nurse, you should trust that clinician who' trying to heal you. But you shouldn't extend that same trust to the financial side of the healthcare system. Sadly, on the financial side, the healthcare system is preying on patients, taking advantage of them financially, exploiting their sickness for profit and driving people into debt and bankruptcy. I mean, it is a tragedy what's happening now with the high cost of healthcare.

I agree. You know, it's interesting, you said about the car, you know, going to buy a car, when I go and look at cars, which, you know, we've all done, there's a sticker on the window and it says what the price is.

Yeah, right.

You know, and we know no one wants to pay msrp.

Right.

At least we know what that is. And that's kind of our baseline. That's. And we can call msrp, can be, you know, Medicare, percentage of Medicare, whatever. But still we have this msrp and our goal is to negotiate that down as low as we can underneath that to a certain point. So you are. The goal is, here's invoice costs, we'll call that Medicare, and here's msrp. My goal is to fall somewhere between there. Yes, we have that power and we don't have that power in healthcare, or at least they're keeping it from us.

They have been very successful at hiding the prices and they have, you know, this Chargemaster, which is again, the ridiculous way healthcare pricing works, which I'm sure most people in Your audience know, you know, they price that Chargemaster price, which is five or even 10 times, maybe even more, 10 times more than the price that they would accept. And then they negotiate a discount. So your insurance company is supposed to give you a great discount off of that. But now with the price transparency that's coming online, we're seeing more and more that those negotiated discounts that our insurance companies have been, you know, supposedly using their market power to get us, those negotiated discounts are not so great. In fact, they can vary a lot. And you see a lot of times that the cash price, in other words, if you were uninsured and went in and paid the cash price, you would pay less than what an insured patient pays with their discounted insurance company price. And so now that we have more price transparency, that's because of the hospital price transfer hospital price transparency rule that went into effect at the beginning of this year. Hospitals are required to post their prices. Many of them are not, but let's say maybe half of them now are where they're posting their prices. You see just outrageous amounts of price variation. A procedure that maybe a colonoscopy. I saw one the other day. I love.

Health cost labs. You know, Leon Wozniewski posts on LinkedIn all the time and I mentioned him in my book because he's one of these vendors that's taking the publicly reported prices, gathering them, assembling them in easily searchable formats and making them available to employers, to advisors, to consumers. So when you look at those, like I think the one he posted recently was for a colonoscopy which ranged in price anywhere from $1,000 up to, I think it was about $10,000 at the same facility. So in other words, if you were covered by one health plan, you would pay 10 times more than you would if you were covered by another health plan. And I call this discrimination. It's discrimination based on the type of insurance coverage we have. And working Americans have been getting hit the hardest by Medicare negotiates and sets prices that are usually the lower prices at a hospital, and then they make up the difference on the commercial plan. So the employer sponsored plans are paying two times the Medicare price, five times the Medicare price, even 10 times the Medicare price in some cases. And the way I look at this, I just say, look, there is no reason that you should be discriminating against me as a working American just because I have a particular type of health care coverage. And so in the book I really try and reframe the way we look at this And I try and point out these absurd and frankly, I think unethical and immoral ways that our health care pricing has evolved. And I say, look, we need to push back on this. And here's how you push back. Here are the leverage points that we have as individual consumers and as employers to bring about change and get better health care benefits at a much lower price.

You brought up something, and I use an example because it's something I just recently I went through looking at MRI is a simple knee. Knee MRI without contrast.

Yeah.

So we do the mri one facility with cigna. So that's how it started was the employee called and said, hey, I need to get mri. I have a high ductile health plan. I called them, they said, it's $1,200. Okay. I'm like, that seems high for a knee MRI. Did you ask what the cash price is? No, I said, okay, well, we need to do that. Let me call around. So I called around to five different MRI places within like a two mile radius. Yeah, they're everywhere. They range from 450 all the way up to $900 thousand cash price.

Cigna is going to charge under their negotiated rate, $1200.

Right.

My Blue Cross plan, 250.

Wow.

UnitedHealthcare was like 1600. And so that's where you see that disparaging amount. It varies all over. And so we had to have the conversation. I know you talk about an example in your book about this is, well, you can pay 1200 with Cigna, have it towards your deductible, but you're spending $750. I mean, you gotta figure out the math and what big benefit for me. But it was amazing to see just how much it differed between all of those.

It's mind blowing. And that's where if someone doesn't have an advisor or maybe someone in their HR department or a healthcare navigator, you know, a lot of benefits plans now will bring in a vendor that can help with the navigation to guide the employee to the right place to get that MRI at the best price. And one thing I'm trying to do with my book is help employees see that you have to be engaged, you have to be a participant in the.

In the process here to make sure that you're not being taken advantage of. And we need to stop saying that someone else is paying for our health care. You know, as employees, we need to stop saying, oh, no, the employer's got it covered, or oh, the insurance company pays for it. That is the wrong way of looking at it. Because in the long run, every dollar that we overpay for health care now, even if it's the health plan paying it or the insurance company paying it, we are going to pay down the road higher premiums, higher deductibles, we're going to have our coverage reduced, higher coinsurance rates. So in the long run, it trickles down to the employee. And this is also a leading cause of wage stagnation in the United States. All of our health care is paid out of the pool of money that employers dedicate to compensation. So when the money gets consumed by the $1,200 MRI, when you could have had the $400 MRI, well, that $800 is employee compensation that's being sucked away and needlessly given to that hospital that's charging $1,200. Now, when that employer goes to give raises the next year, there's less money in the compensation pool to give raises to the employees. When economists study this, they show that over the past 20 years, the high cost of healthcare is one of the leading causes for wage stagnation in the United States. I did a story about the educators plan in New Jersey, and this one blew my mind, because at the same time the teachers were striking because of their low wages and the high cost of their health care, they had a benefit plan that was really poorly designed for out of network payments for acupuncture, chiropractor, and physical therapy. And basically, the plan had no limits. It had a way of benchmarking the price, but it basically paid 90% of billed charges. And so as long as the billed charges kept going up.

The plan just kept shelling out money. And at the time, the plan was really controlled in its design by the teachers unions. And so I heard about this. I did a records request to see just how much were these acupuncturists, physical therapists, and chiropractors getting paid, do you know, for acupuncturists, some of them were being paid, on average, $600 per visit. $600 per visit for acupuncture. That will buy you a lot of needles you can stick in your body, right, for 600 bucks per visit. Now, I found one acupuncturist who had been paid by that health plan alone, more than $1 million in that year, just by that one educator health plan. And so after I wrote that story, that created the pressure to get the unions to give in and change the design of the plan, that plan saved. Now, this was a plan with hundreds of thousands of members but that plan saved about $130 million a year. That's a lot of supplies for the classroom that you can put in the hands of the kids of New Jersey. Because of that, teachers next year now on that same New Jersey educator plan are getting a vacation from paying their premiums for two months because the plan has saved so much money. Not just because of this change, but because of some other changes. And Kristen Deakin was leading the health plan at the time. You can look her up on LinkedIn and she talks about a lot of this stuff. But it's incredible the money that is to be found by restructuring some of these benefit plans, by examining how we pay for specialty drugs even. Who knew, you know, that going to the acupuncturist could be that expensive.

Well, it's funny. Yeah. When you start taking control of it and we teach employers to do that. In fact, first they don't even know about the overspend and the profit leak they have. They just look at as, you know, we're losing money. Each year we're going to get an increase in rates, we're going to have higher claims. When you start showing them that overspend and the ways that they're spending overspending on the health care they're getting for their employees, they start taking charge. That's where, you know, we've been leading that charge for the next gen masterminds. An example you're talking about that wage stagnation. You know, we have a municipality with a couple hundred employees. So it's a smaller municipality, but there's. They've been self funded for almost three decades. And when we took over, I don't know, five, six years ago, we came in and looked at the plants and look at all these overspends. We made some changes, did some things from the pharmacy down and they had not had a raise in five years.

Wow.

And the first year we changed their health plan and started really putting some oversight into this and controlling things. The next year they gave their employees all a 3% raise.

That a lot.

But they were able to do it.

Well, that's something, right? And I mean inflation, I mean obviously we're having terrible inflation right now, but if you can't even keep up with raises, with the cost of living, then basically your employees are losing money by continuing to work with you. And so right now we're in a real.

Hiring. There's hiring problems right now. Right. Employers can't find good employees. They're having a hard time retaining good employees. And so this is a way that you can keep your best employees. You can draw in more employees. And the thing I like to point out, too, it is causing harm to stay in the same situation we're in right now. I saw this report, you might have seen this, that CBS News put out today that showed just how many patients and how many employees who are insured are going without the care they need because they can't afford it. We've put all of these people on high deductible health plans. The prices are so high and so outrageous that they can't afford them. And so they are going without the care that they need. And there have been a lot of studies that show what a problem this has become. But this is not just now hurting people, people financially. I mean, this is hurting people physically. We could. It would not be an exaggeration to say that this is causing people to go without the care they need, which is causing them physical harm and maybe even hastening their death. So this is a life or death decision right now. In fact, I know your book, right?

Oh, that. Great segue.

Tell me about the book. Right. Because it's coming out tomorrow, right?

Yeah. And you made a really good point though, is those decisions that the C suite is making that determines, you know, how much they're paying for health insurance. But go back, you mentioned high deductible health plans. Go back in, you know, 2014, 2011, these were, these were brought up as skin in the game.

Yeah.

It's going to drop rate significantly. Let the employees kind of pitch in and pay a little bit more of their share. And now you fast forward to now. Well, first of all, from a premium standpoint, there's very little difference between a high doctor health plan and a decent copay plan. We write very few high doctor health plans anymore. What happened is you had employees are suddenly getting these high doctor health plans. And the goal was, hey, they take the difference in premium, put it in hsa, use that to pay for their bills. Well, there isn't that anymore. And so now you have employees that are stuck with, I have no coverage. So I meet 6, 7,000, $8,000, and they can't afford to take care of themselves. In fact, in the book, we talk about that. I talk about it in a chapter on PBMs and drugs.

Give us a title of the book, though.

Yeah. Life and Death Decisions of the C Suite.

There we go. Life and Death Decisions in the C Suite.

Right along Fixing the health care Care Problem. And I think that's. We see that all the Time is people forego their medicine. And the stats I show, you know, it shows in there. 50% of people taking a med have, have either rationed it, skipped it, cut pills. They're doing something because they can't afford to get those drugs. But the same goes with healthcare. I can't afford to spend 150 to see my doctor. I can't afford 250 or 300 to see my specialist because it goes towards my deductible. I just don't have it. And we're taking that away. And one of the things in the mastermind is we really focus on is how do we put the benefits back in benefits, how do we lower that deductible, how we lower the employees cost, how do we get them better care? And again, it's all goes back to what you talk about is the pricing of it and that transparency and pricing you mentioned earlier. Have you ever seen Adam ruins Everything?

I've seen it a couple times, but.

I'm not too familiar with you. So Adam ruins everything that. He's funny.

Yeah.

But he does one completely on the charge master.

Oh, I've seen that one.

That one. And we'll throw it up. And we'll throw it up in the video during when we edit it so that people can download it and see it. It's funny, but it really talks about how the Chargemaster was developed, which is just a crock.

Yeah, well, so I'm, I think part of the thing that I'm tired of and I mean I saw it a little bit in the CBS report today. I'm tired of people just talking about the problem. We know that the problem exists. In fact, when I went to write my book, I found a book by Barlett and Steele, which are two. They're lesser known famous investigative journalists. Woodward and Bernstein would be the most famous of the old school investigative reporters. But Bartlett and Steele are an investigative reporting team. They put out a book called complications back in 2004 and I was blown away. When I was doing research for my book, I was like, oh, Bartlett and Steele wrote a book about healthcare. I didn't know that they had done that. So I bought the book, I started reading it and right. The first thing they were talking about was the unsustainable high prices. And I was like, they wrote this book almost 20 years ago and they had this same problem. Nothing has been done about it. And I think that's what I'm frustrated with. It's what I'm tired of and it's what I don't want to tolerate anymore. We've tolerated this for too long. We've known about this for decades. So now we need to stop doing things the same way that we've been doing them. And employers need to get their heads out of the sand, frankly. In fact, when I wrote my book, I talked to a lot of advisors. I said, look, how hard should I hammer the employers? How much should I beat them up? Because from what I'm looking at, it doesn't seem like the employers have been real engaged here. And I don't want to make it sound like the employers aren't victims, because I think they are victims. They've been way overpaying for decades themselves. But at the same time, they have a fiduciary responsibility to manage these employee plans. Right? Have they really been asserting themselves? Have they really been engaged? Have they been checking the value that they're getting for the money that they're dedicating to this in the same way that they check all of the expenses for all the other things that they pay money on to run their business? I don't think they have. I think that they have trusted the industry. I think that they haven't wanted to engage with it. Whatever the reasons are, I don't know. But the costs have been passed on to the employees over and over and over again. And so my book actually has three chapters for employers. It's written for employees and it's written for employers both. Because I think both of them need to team up together to take on this problem. And I think it starts with educating the employees. Employees can't keep doing things the same way. They have to take responsibility. They have to realize that just because they have a card that says Cigna or United or Blue Cross, that's not better than some other type of benefit design where maybe you go with an independent third party administrator and you still have the access to the network and the doctors that you need, but it doesn't say UnitedHealthcare on your card. It's not better to have a UnitedHealthcare plan. It's actually better to have a plan that costs less and delivers more. Right. And so employees need to change the way they think. More healthcare is not better. I think we've realized that now. I have a chapter in the book about the problem of unnecessary care and how employees can avoid unnecessary care. Employees need to be open to benefit designs that would include things like maybe direct primary care or a navigation like a nurse navigator that maybe is built into the health plan that will direct the Employee to the best value care. An employee should be eager to get that information because it's protecting their money and it's getting them better care. But usually the employee is more suspicious, right? Like, I don't know, what are they trying to do? They're taking away my benefits. You know, that's what the teachers unions in New Jersey thought. We have rich benefits. That's what they thought. Well, you're actually getting ripped off. That's what's happening. And your refusal to change or to be open to anything different is actually, actually causing you financial and maybe even physical harm. So employees need to change and employers need to change. And I think together with the help of really good advisors, they can design benefit plans that will save them a lot of money and deliver better care.

I agree 100%. And I think we talked for one thing you mentioned was the fiduciary. They have a fiduciary liability. And we see employers, they, they look at every other piece of their business. They analyze, they analyze the dollars that are being spent. They do it with their 401k. We have a fiduciary liability to review the investments that are being made with the employees money in the 401k. They don't look at the health plan as, and they don't even consider it to be, oh, I have fiduciary liability. But they do. And we remind them of that. But the conversation also has changed. Where we used to talk to hr, we're now talking to the C suite, the cfo, the CEO, because they need to look at it as any other expense. Where's my money going? How much am I spending? Am I getting the product that I'm paying for?

Yes.

And I, I also think I'm about to do an article talking about how employers are afraid of their employees. And we've talked to employers and something you brought up was we bring in these changes to an employer saying, look, we can cut costs, deliver your employees better care, lower deductibles, change these certain things. But they get scared. Well, what's the employee going to say? Yeah, if you educate them. One, we've seen it personally, we've seen it. They appreciate it. They get into it. They get involved in it. Yeah, it's different. And there's some training involved. But at the same time, if they talk to their employees, they'll realize their employees are pissed off and frustrated.

Yes.

They're tired of high deductibles. They're tired of not being able to get care. And so when you work Together and the employees and employers start communicating. I think this changes are much easier.

Yes, they are. And this is, this is why I think, you know, this goes along with not continuing to do the same thing. I think educating the employees is really the campaign that I'm on right now. And I've done it with the book and now I'm doing it with my health literacy videos. So the video series, which I'm calling the NeverPay pathway, it'll be launched early next year and it basically takes the how to tactics that are in the book, the principles that are in the book, and it communicates them in a series of engaging, short, three to five minute videos. And so my goal goal for this or my vision for it, this actually came from a health Rosetta advisor named Taylor. Lindsay was the one who told me, he was like, look, your book is great, but most employees aren't going to read a book, which is realistically true, right? Most people aren't going to read a book. So he said, if you could get me the videos, give me the same content in a series of on demand videos. So that's what we're now producing is these, these on demand videos that will be packaged in a single curriculum. So in about an hour, the employee can get the overview that they need of about the principles of the way the healthcare system works, just with like the pricing pitfalls or the fact that the system is always going to encourage you to do more whether you need it or not. And then how do you navigate these pitfalls? You know, how do you check for prices before you get care, how do you check for prices after you've gotten the bill, how do you get an itemized bill, how do you get your medical records, all of these things that patients have access to. I show how to do in the book and then also in the videos. And my hope is that these will get rolled out to employer sponsored plans all over the country so that there can be this base level of understanding. And that will also then reduce the amount of friction that the employer or the benefits advisor has when they try and encourage the employees to do something a little bit differently, right? When they say, hey, look, before you just go to whatever hospital you want, call the nurse navigator, okay, call the vendor that we've set up to guide you to the best care at the best price. And then you'll be rewarded by getting that. Maybe the plan pays entirely for it if you go that route. Whereas if you pick your own doctor, go to your own hospital, you'll have to pay A deductible or you'll have to pay coinsurance just like you would typically under the plan.

Well, yeah, you mentioned some of those things that, you know, we're doing with our clients to, you know, whether it's be eliminating or getting sourcing, especially medications. Direct primary care is a big one. We're sourcing centers of excellence where again you say, hey, if you're going to go get this surgery, if you're going to get mri, if you go here, we weigh the copay, we waive the deductible. If you want to, you want to go to your hospital where your doctor's at, great, you're going to have a deductible and copay. But if you go over here and then you get a nurse navigator, we get somebody, a medical manager, somebody like nurse Deb with aim.

Yep.

And they say, well, let's look at the ratings of it. Oh, did you know that you have a, you know, a 50 rating over at your doctor in hospital? If you go over here, it's a 92 rating.

Right.

Where should you go?

Right.

That one's cheaper and it's better quality. But there's nobody directing that. And we're seeing, I know in our next gen Mastermind Health Rosetta, we're seeing now where, hey, listen to us, we're going to show you how to direct the care and what people. What I think is funny is you talk about the logos on cards, Cigna, Aetna, pp be like, oh, they're gonna tell me where to go. You don't think Cigna Blue Cross are already doing that when they say a ppo?

Right.

They're steering you to their providers that they have the lowest contract negotiated rate with hmo. They steer you even more to a smaller network which is even lower cost.

That's right.

But the costs are for them. It doesn't lower the employee's cost or the employers. It's lowering the cost for the carrier who's paying the bill.

Right. I think one of the things that you're touching on here that but.

I want to get the word out more and more about these solutions exist already. This is already happening. I've documented in the book the stories of employers who have cut their healthcare spend by 40% while eliminating co pays and deductibles and keeping the same premium or lowering the premium. There is so much wasteful spending in these employer sponsored health plans that there's no excuse for employers to not get engaged. Right. And so one of the things I recommend for employers is talk to an independent broker or advisor. Talk to somebody who is open to a direct fee relationship even with the employer, where the employer is going to be the one paying a direct fee to the advisor rather than having the advisor who maybe takes their Money primarily from UnitedHealth Healthcare or Cigna or Aetna. The advisor's loyalty is often divided right between the employer and the industry. So I encourage employers at least have a conversation with an advisor who is open to a direct pay relationship, who will be transparent about all the ways that they make money. Which by the way, starting January 1st, all advisors are now going to have to be transparent. That's going to be a, a real game changer for the advisors who have already been transparent or who are direct fee from the employers because.

A lot of employers are going to find. Wait a minute, you've been making money off of this many vendors through my health plan. This is why you keep steering me to this same benefits design year after year after year. And I think that is going to be hopefully rattle a lot of things open. Another thing, by the way. Sorry, I know you're good. Another thing that's really going to rattle cages. I've been talking to some people about some potential lawsuits that are on the horizon where employees or unions or representatives of employees are going to possibly be suing employers for the violation of their fiduciary duty under erisa. Wow. If we start seeing some of these lawsuits happen, well, I think that's going to shake employers up and make them realize, oh, this isn't just some fun little game I'm playing here providing these benefits. I'm actually responsible for the way this money is spent. And now I think that's going to really bring about a lot of change.

We've talked about that and I do, I think there's, there's going to be that point where some employee is going to get disgruntled or the unions are probably the first one to do it. Yeah, the union employees. But we are going to see that. I think the lawsuits are coming and I think it was a few years ago there was a discussion on that within our group and we're just waiting for it. It is going to happen and we tell employers, hey, you've got to look at this this way. Don't just look at, as I hand it to hr, they tell me how much it is and we're done. They've got to look at it as any other expense of the company that they have and that they have responsibility over.

Yes. And then Employers also have to have, I think the.

The humility to be able to say, oh wow, we've been getting taken advantage of for a long time and there are pretty heavy implications of that. Right. I've talked to some different vendors who do like claims analysis. Right. They like ferret out fraud in healthcare claims, which I've done a lot of reporting and writing about healthcare fraud. It's incredibly common and it's just as common in the employer sponsored plans as it is in the Medicare or Medicaid plans. You hear about it all the time. It always makes headlines in Medicare and Medicaid. Well, that's because there are government funded investigators for like the OIG who I now work for and others who are actually investigating it on behalf of taxpayers. But guess who we trust to do this investigation in the employer sponsored world? We trust the insurance carriers to do it. We think United Healthcare or Cigna or Aetna is going to protect the health care dollars that are being spent by employers on health care. Actually, their incentive is not to do that. As I've talked to investigators who work for insurance companies, what they tell me is they have no problem ferreting out and spotting the fraud. They can catch the fraud immediately, but then they take it up to the executive offices and the general counsel for the insurance companies and they bring them these cases. Hey, hospital X or Dr. X is upcoding on every single single claim and they're ripping you off to the tune of whatever, millions of dollars a year. And it's expensive to try and prosecute these cases, it's expensive to try and recover these funds. It also ends up creating a very difficult relationship between the insurance carrier and the doctor or the hospital. And what they really want to do is show that this doctor or this hospital is in their network. They want to be able to say, look how broad our network is. You can go to this Marquis Medical center, they're going to crack down on that Marquis Medical center when they're up coding their different claims, when they're unbundling their different payments, when they're really cheating the health plans. These are mostly self funded health plans anyway. It's not even the insurance carrier's money. So they do not have the incentive to crack down on fraud. And so as I've talked to different vendors who do this work, which is really important work, I have a whole chapter on fraud in the book. They tell me that a lot of times it creates a very uncomfortable conversation with the employer. When the employer realizes they have had their money taken from them for all these years. And by the way, this is employee compensation that's been taken from them. It's causing their employees to pay much higher bills. This has really heavy implications. So it requires some humility for the employers, I think, to change, to say, you know what? We didn't realize the state of the game. We didn't know how it was being played and we didn't realize that we were the ones being played. So I think it's going to take some humility by employers to say, okay, look, let's own up to this. We haven't been doing this the right way. It's going to require some changes. It might be some tough short term decisions, but in the long run it's going to get us to a better place. So those lawsuits, if they do come, might shake the employer up into doing the right thing. But in the meantime, I think, look, just be humble. Recognize nobody expects that they're going to be taken advantage of the way our healthcare system has been taking advantage of us. I only realized it after years of doing digging as an investigative reporter. But I am consistently shocked by the things that I find. So I don't necessarily blame the employers. I mean, in a way they are victims. But it's time now to wake up and to do something about it.

I agree. And I think, you know, this is something we've been touting in the mastermind in our groups and the health Rosetta, et cetera. You know, we've been pushing this out there, but having someone like yourself and this book just takes it that much further. And I do, I think the humility side of it is a big component. And that's something I hadn't thought about. What I want to do is go, we're going to take a break here from our sponsor when we come back and then I want to talk about this, some of the solutions you've done and the results you're seeing because I see you on LinkedIn and Facebook and Amazon and people putting in all the savings they're doing and they're following your steps. So I'll talk a little bit more about that when we come back. In the meantime, let's hear a quick word from our sponsor.

ClaimDoc is a medical claim auditing and member advocacy company. We provide fiduciary services to employer sponsored benefit plans. We specialize in reference based practice. We ensure that the benefit plans are being charged in a fair and reasonable basis. They review the invoices or the bills. I was like, well that was interesting piece. And then kind of dug into a little bit deeper and it just was really appealing. Where claim doc thrives is we have a member advocacy department. We're hearing from members giving us feedback that they were so thankful to be given a person to talk to on the phone. The second aspect that really sets sets us apart is our 360 degree understanding of risk. We understand the employee's risk from a credit perspective. We understand the employer's risk from a fiduciary standpoint as well as the litigation defense risk on both parties. I've saved we'll say hundreds of thousands of dollars through doing this process. I could not say enough about ClaimDoc.

We want to get special thanks to our sponsors Craig Shelley Luxury Watches of Beverly Hills success North Dallas where Bill Wallace has been connected to people for over 30 years and of course work innovators that is amplifying the voice of business. So this is the end of part one with Marshall Allen. Never pay the first bill. Stay tuned for part two.