Never Pay the First Bill: And Other Ways to… by Marshall Allen · Audiobook preview

Penguin Random House Audio presents Never Pay the First Bill and other Ways to Fight the Health Care System and Win. This is the author, Marshall Allen.

Note to Listener this audiobook includes a downloadable PDF, which contains sample letters, advice, and more resources from the printed book.

To anyone who's been pushed around by the American healthcare system.

Introduction My mom and Dad's Healthcare Battle.

I've been an investigative reporter covering healthcare since 2006 and I've been continually astonished by the unfair nature of the American medical system. It's outrageous that we pay far more for health care than the citizens of any other country without getting our money's worth. It's alarming the way big players, drug companies, hospitals, insurance companies and others profit by exploiting our sickness and violating our trust. I talk every day to people who are getting taken advantage of by the system. I wrote this book to arm individuals and employers with the knowledge, tactics and inspiration they need to stand up for themselves and the people they care about. I also wanted to counter the idea that this is always a losing battle. Lots of people are fighting back and winning, saving hundreds or thousands of dollars by the savvy way they engage the system. I wanted to empower others to stick up for themselves and save big money. Little did I know that I would need to put my own advice into practice before I was through writing, but it happened, and I want to tell you that story here because it illustrates a lot of the principles that come into play. My two brothers and I watch over our dear parents as they age. My mom and dad agreed to let me share our family's story because they care about accountability and justice and helping others. My dad, who just turned 80, suffers from a slowly advancing form of dementia but is in excellent physical health. After years of his decline and my mom's own health challenges, it became clear that she needed help caring for him. In the fall of 2019, at the same time I started writing this book, we made the difficult decision to admit dad into an assisted living facility. As a journalist, I've written almost every type of healthcare horror story, including those about the problems in long term care homes. We did an extensive check to make sure we avoided any truly dangerous places for dad. My parents and my older brother live in northern Colorado and thankfully we found a nice assisted living facility near them. The place was expensive, more than $6,000 a month, but brand new and well appointed with flat screen televisions, comfy couch areas and good food. The staff was also kind and truly seemed to care about my dad. The problem is they got something extremely Confused during the admission. My mom has my dad's power of attorney, so she has the legal right to determine what type of care he should receive. She told the staff that she would continue to pick up my dad to take him to his established primary care doctor. My older brother was with her when she signed the admission paperwork, and they both say Mom's direction was clear. Dad should not receive routine medical care at the assisted living facility. The facility's executive director still had my mom sign a consent form for the primary care group that provided medical services at the facility. Mom's understanding was that she signed it in case dad needed emergency care, not for anything routine. My mom and brother visited my dad almost every day or picked him up and brought him to church or family events. After he had been there for more than a month, they noticed a dramatic mental decline. He went from a warm, personable demeanor to acting lethargic and detached, almost robotic. Mom noticed, but chalked it up to the dementia. Perhaps he was having a hard time with the transition. Just before Christmas, mom got a pharmacy statement in the mail. It showed that, unbeknownst to her, my dad had been on a drug called Tamsulosin, also known as Flomax, for more than a month. The statement said a nurse practitioner whom mom had never heard of put dad on the medication. Mom didn't understand. How could there be a new drug that she hadn't approved or known about? And who was this nurse practitioner? She quickly realized that the drug could have caused Dad's recent decline. And when she looked up the possible side effects, they aligned with his symptoms of cognitive impairment. She called the administrator at the assisted living facility and ordered them to stop the Flomax immediately. They complied. Thankfully, dad bounced back as soon as they stopped the drug. He had recovered, but it was despite the people who were supposed to be caring for him, not not because of them. Mom had already been unimpressed by the facility. The place felt empty. They often canceled activities, and dad didn't get enough stimulation. She had already planned on moving him out, but this sealed it. Soon after the new year, he moved to a different facility where things went much more smoothly. About two months later, we all got hit with the COVID 19 pandemic. We moved dad back in with mom, and they have been doing great. They are so happy and content to be together. But it turns out that the medication error was only one of the problems. Soon after the move out of the first facility, the billing department from the primary care medical group came calling. They didn't have Dad's Medicare insurance information. That's because they were never intended to provide his care, but they wanted his Medicare details so they could bill for a routine exam that the same nurse practitioner had performed on death.

What? This was the first my mom had heard of any exam. There wasn't supposed to be any routine treatment on dad. The bill came to $445, they said, which sounded steep to me for an exam on a healthy dementia patient. I marveled at the irony of the situation. At the same time, my dad suffered a medication error and my mom got billed for an unnecessary exam that violated her power of attorney. I happened to be writing this book about how patients can stand up for themselves when they're getting pushed around. The primary care group had stuck the parents of the author of Never Pay the First Bill with a Bogus Medical bill. Well, here we go. Game on. I had learned so many things while writing this book and now I would get to put them into practice. I knew I had the knowledge to handle the situation and it's right here in these pages. And I also had the motivation. Mom made me the point person and I began the process of unraveling the problems. I had to find out how the medication error had occurred and I needed to persuade them to waive the bill. Mom had already complained to the primary care group about the medication error. She said she wanted a full explanation for what had happened and an apology. The primary care group responded with a short letter to say they were looking into it, but they seemed to miss the point. We apologized for this medication occurrence, the letter said. That's a strange apology because they didn't call the occurrence what it was, an error. My dad should have never been put on Flomax. The letter came from the nurse practitioner, so I called her. To her credit, she spoke to me and was extremely apologetic and concerned about the error. She told me that the letter should not have minimized it. It is an error, she said. He was not supposed to be on the medication and he did receive it. I appreciated that she admitted it and I could tell she was sincere. That's more than many patients ever get. She also apologized and said she was trying to figure out how it had happened. It turns out a refill request had somehow been originated at a long term care pharmacy used by the primary care group, which has medical providers throughout Colorado. She didn't know how that had happened, but assured me that she had changed her practice. She would never again approve a medication refill without checking the patient's records. I've spoken directly to hundreds of victims of medical errors. Most of them did not get an apology when they or their loved ones suffered from a medical error. Medical professionals tend to go with the language used in the letter calling an error an occurrence or an incident to avoid taking responsibility. No one ever did tell us how the pharmacy made the mistake. Now I had to sort out what led to the bill for $445. I called the primary care group and got connected to a woman in the billing department. She explained to me that the same nurse practitioner who had made the medication error also had done an examination just days after my dad was admitted. I tried to explain that there should have been no exam at all because my mom, who has the power of attorney, hadn't given consent. The woman from the billing department didn't want to hear about that. She just wanted Dad's Medicare insurance information so she could submit the claim. What type of care did you provide to my dad? I asked. Kind of like an exam, the woman said. We're unable to bill any insurance, so we're just sitting here with a $445 balance. If he had coverage, I need to know what type of exam? I asked, leaning forward in my seat and taking notes on my computer. What code did you use to bill it? We used an Evaluation and Management E M code, she said. 99328. What does that code mean? I asked. Is it based on the time spent on the exam? I was fishing to see if they were upcoding using a code that overstated the complexity of what actually occurred so they would get paid more. My dad is as healthy as can be, except for his dementia. He had had a full we hope.

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