Never Pay the First Bill with Marshall Allen

Any business needs to make a profit, we want them to be well compensated for taking care of us. The problem is, what's the line between profit and profiteering?

There you go.

Because once you're in the category of.

Greed or profiteering, then what you're doing.

It changes things a lot. When you're talking about health care compared to buying a new car or buying a new flat screen television, sure. Morally it changes the equation a lot because we can't really control what healthcare we need. And so if you're going to exploit.

My sickness for profit, then that's not right. Ethically and morally, that's not right. It is legal, it's not criminal, it's unethical and it's immoral, but it's not criminal. A lot of this stuff is totally allowed, you know, within the bounds of the law.

That's the problem in and of itself though.

That is, that is. But what I'm trying to do with never pay the first bill is reframe these conversations. So we say, look, it's okay to make a profit, but it's not okay to profiteer. Not when it's not when you're talking about my sickness or my family's sickness.

Welcome to the Rock Stars Rocking podcast. Powered by voluntary disruption, a show dedicated to people who are crushing their business and life goals. These are bite sized conversations with leading rock stars in their respective industry who are pumped to share their story to help drive you to the next level. So are you ready to rock? Speaking of rock stars, here's your host, Eric Silverman.

Hey Rockstars. Welcome back to another episode of Rockstars Rockin where every week I have the most famous rock stars of them all. And I'm not talking about musicians, although we had one musician prior this week. I'm so super excited to have on our good friend Marshall Allen, healthcare reporter at ProPublica. But better than that, or leading from that, which we'll talk about. He is the new, soon to be best selling author of Never pay the first bill which is available on on Tuesday, June 22, anywhere books are sold. You can get it on Amazon and so forth and I imagine other places. Welcome to the show, Marshall. I'm excited to chat with you man.

Thanks Eric.

I'm glad to be here.

Hey, so I appreciate it. I've had the pleasure and privilege of meeting Marshall over the last year and a half or so on various zoom calls. We both know a ton of folks in this industry, the employee benefits insurance industry, so I've been introduced to him Multiple times. And I had the pleasure of meeting you most recently in Dallas at an event that you were speaking at that I attend every year.

And I didn't even realize you were launching a book. So that was news to me. So I'm so excited I got an advance copy. Thank you to yourself and your publisher, Penguin Random House, for sending it over. If you don't mind, can I just dig right in? Because I got a lot of questions for you, man.

Dig in, man. I'm ready. This is great.

All right, well, let's unpack some stuff. So first off, I can't help but start with where you started. So you're a reporter, you grew up, you went to school, you wanted to be a journalist, right?

But I don't think, I mean, you tell me if I'm wrong. I don't think you had a dream one day as a little boy where you said to your parents, mama, I wanna be an investigative reporter in the healthcare industry. I don't think that came out of your mouth, did it?

It never came out of my mouth. In fact, I like to say my career path was. I never had a clue. Like I didn't have any idea what I wanted to do. I didn't even know that I wanted to be a journalist. In fact, I spent five years in full time ministry before I became a journalist.

Oh, wow.

Then I started freelance writing. I became a reporter at some small papers in Los Angeles, did five years there covering crime, you know, city council, school board meetings all year.

Similar to healthcare.

Yeah, very similar. Right. So I go to Las Vegas at the Las Vegas sun in 2006. So this is now 15 years ago, and I didn't have a beat to cover. I was doing kind of what they call ga, like general assignment reporting. And one day my editor asked me to lunch. And you know, when your boss asks you to lunch, you're going to have a conversation. You're kind of. You get your defenses up a little bit, you're hoping it'll be good, but it might be bad. So you're not quite sure.

No Jerry Maguire moment?

No, no, not like that, fortunately. So anyway, he sits me down and he's like, hey, you know what? We really want you to take over the healthcare beat. We want you to cover health care. I had never even considered covering healthcare. In fact.

I didn't have a high opinion of that type of journalism, to be quite honest. And the first words out of my mouth to my editor before, sometimes I speak without thinking.

And I said, I cannot imagine anything more boring. Than writing about healthcare, because that's how I felt. I felt I had read so many, I think, bad stories based on hospital press releases. You know, like the hospital got a da Vinci robot and look, now the robot's doing surgery and they bring the TV crew in and they're like, look at the wonders of the robot, you know, or the disease of the week stories. You know, the media is notorious for like so now before the pandemic, of course, once the pandemic hit, we had a new respect for the disease.

But before that, you know, you were always hearing about some latest calamity or the latest cure. A lot of really, frankly, press release funded stories. Well, I am so happy to say that I was completely wrong. And I told my editor then I said, let me give it a try. I said, obviously I believe in you guys. Let me try it for six months and see how it works out. What I found when I started covering healthcare, because when I cover healthcare, I look at it from the point of view of the patient, the person who has the most at stake in every healthcare interaction and the least control. And they're also, by the way, the ones paying the bill. In one way or another, they're the ones funding it. Once I started doing stories about healthcare from the point of view of the patient, I found that I was tapping into stories that dealt with the things that people care most about in life. Number one, their health and number two, their money. Because healthcare is dangerous. Healthcare can hurt you.

Patients die from medical errors at such a high rate that the harm caused by bad medicine is one of the leading causes of death in the United States right now. So I've made patient safety issues a big focus of my reporting over the last few years especially. I have dove so deep into the world of employer sponsored health benefits. Looking at why do working Americans pay so much for health care and get so little in return? We spend almost twice, about twice per person in the United States than the citizens of other countries. And yet we still have tens of millions of Americans. Uninsured working Americans are by far paying the highest cost. So you look at what Medicare pays. That's the government's plan for people over age 65. They negotiate rates, they set the prices for hospitals and doctors. Well, working Americans don't have their rates set that way. They have their rates set by all these crazy market forces that they have no control over. And so working Americans end up paying somewhere between like two times the Medicare rate and up to 10 times the Medicare rate. And this would be like me and my mom going into McDonald's, right? My mom orders a Big Mac and she gets charged $3. I order a Big Mac and I get charged $15. Just because of my age, frankly. And I look at this, I'm trying to reframe it. So with the book, I'm trying to reframe these. The way we look at our healthcare system, I'm looking at it from the point of view of the patient and the consumer and the employer who's funding employer sponsored health benefits. I'm trying to show. The book is called Never pay the first Bill and the subtitle is and other ways to fight the healthcare system and Win. I'm focusing on the win here. What are the things we can do? The book is a how to guide to equip employers and employees. In other words, it's about 180 million people out there who need to be equipped, big audience. What are the things they can do to fight back and win? And the big surprise is people are already winning. The problem is the typical person doesn't know what the insiders know. So you're an insider. I'm more of an insider at this point, given the knowledge I have. But people who work in hospitals, people who work in the industry, they have a lot of tips and tricks and hacks of the healthcare system that I'm trying to share with the masses through this book so that people can save hundreds or even thousands of dollars with every healthcare interaction.

So in the book, I really appreciate how you break it down into three specific components. So if you're listening to this anywhere, podcasts are consumed, I appreciate you and so does Marshall. But if you're watching this on YouTube, in the table of contents, what he does, which is brilliant, is he breaks it down into three parts, which I wanted to chat about, if you don't mind. So there's three parts. Part one is just the fight. Not just. But it's the fighting back section.

Yeah.

Part two is avoiding the need to fight in the first place. And then part three is more the employer section to help steer employers in the right direction. Can we unpack these a little bit? Can you talk about the fighting back section? There's some subsections, but in general, what that means when you say fight back.

Well, you know, sometimes I wanted to.

Start with the most immediate concerns people might have. So each chapter is broken down by a different problem that is facing consumers. So the first one I start with is the five hidden reasons why you need to fight back. Because a lot of times you're like, this is a pain.

You know, people are already having to.

Undergo some type of a healthcare situation.

Where they're in the emergency room or.

They'Re getting a scheduled procedure, or they have a child who's dealing with some type of illness. People are already in a weakened, emotional vulnerable state.

And the system then add on layer onto that that the system is so complicated and it's hard to get prices, it's hard to know how much you're going to pay.

You get all kinds of care recommended to you that you might not actually need. Your doctor's telling you to do things. You don't know if you should question your doctor or not. It's very intimidating. It's very hard to understand. So I wanted to start with the five reasons people need to fight back. So for example, one of the reasons we need to fight back is that this is our money. Sometimes we think about it like, oh, my health insurance covers it, so therefore don't worry about it, the health insurance covers it. Or we think, oh, my employer pays for my health care. Or maybe we think the government pays right through the Medicare or the Medicaid plans. But the point of this actually is as a working American especially, it's your tax dollars. So if you look at your paycheck, look at how much is going to Medicare from every paycheck, One and a half percent of your paycheck right now is going to fund Medicare. Your employer is also matching that. So 3% of your compensation is going to fund Medicare. That's a big amount of money going to the federal government from every paycheck. And we just don't think about it right, it just happens, it just gets sucked out. But also.

Our premiums, our deductibles, our co payments, our out of pocket costs, all of that is funding the system. So between taxes and our out of pocket costs and our premiums, we are funding the whole system. The American people are funding it. So even if you have this idea that oh, my health insurance covers it. Well, actually if your health insurance dollars are being wasted on overpriced care or unnecessary care, it's actually your compensation that's being consumed by these high health care costs. And when your compensation gets consumed, there's not money left over to give you the pay increases that you need. And if you look at why our pay increases are not going up, it's in large part because our healthcare costs are consuming all of the money that employers allocate to compensating their employees. We look at it in the short game. Typically, as a patient, how much do I have to pay right now? But we don't often look at it over the long term. I'm trying to help people see the healthcare system is playing the long game here. Your insurance company is playing the long game. Every year, they ratchet up those costs by 3%, 5%, 10%. And so pretty soon, as a working person, you look back and you're like, why am I paying twice as much in premiums now than I paid 10 years ago? And yet the coverage is worse. How does that work? But that is the situation that we found ourselves in. And so once you understand that, that it's your money, it's being wasted and nobody's going to rescue us. So we keep wishing, right? Oh, maybe the Democrats will figure it out. Oh, maybe the Republicans will figure it out. Well, they've made some incremental changes that have been good, but they have not figured it out. And then you go, oh, well, the health care system, like, you listen to the hospitals talk or the insurance companies talk, they talk about value. They talk about, oh, we have these accountable care organizations now, or we're changing so that we just do payment based on value. It's not actually in their incentive to take less money. And so we have to figure out what is it that we need to do to push back. They're not going to save us. They're not going to change the way they do things. So it's going to be up to us to fight back and advocate for ourselves, learn the tactics that we need to learn so that we can pay less and get the same care that we need.

So 100%, and the five hidden reasons you should fight back is huge. But I mean, you spend in a good way. You spend the better part of 20 pages or so talking about the specifics of never paying the first bill, which is the name of the book. But. And obviously it's so much more, because in the book, guys, if you don't know, it gets into a bunch of stuff, how to handle medical debt collectors, which sadly, a lot of you might have been in that situation before, how you can even sue them in small claims court. Can you just take a few minutes and unpack some of that? And then I wanted to move on to the part two of the book.

Yeah.

So with each of those chapters, I try and highlight a different immediate emergency situation someone finds themselves in, or at least an urgent, timely situation. For instance, get a medical bill in the mail.

What do you do? So the title of the book is.

Never pay the first bill.

I think that's a principle.

Right? I'm not saying never pay it.

What I'm saying is never pay the.

First bill until you have scrutinized it and analyzed it to make sure that it's accurate and make sure it's not overpriced.

How do you do that?

Well, the first step is get an itemized medical bill.

We would not go to the grocery.

Store and tolerate a receipt that just had an aggregate payment on it.

Groceries pay $300.

We'd be like, how much was the ice cream, how much was the milk?

I wouldn't do that at a restaurant either.

We wouldn't do it at a restaurant either.

Right.

Lump sum payment. But when you go to the hospital, that's typically what they give you. So every patient has a right to get an itemized bill. And that just means it breaks down each individual charge. And we need to get the billing codes with that. The billing codes used in the health care system across the country are standardized. And I talk about this more in detail in the book. The book is really a guideline to show people how the payments are made, how the claims are submitted. So if you can get those billing codes on your itemized bill, then you have a lot of power. You can go on this wonderful Internet machine that we have, type into Google billing code and like that five digit billing code and it will pull up a description of what that code is. Well, you're the patient or your loved one, maybe it's your child or something like that. You can see, does that billing code accurately describe the services you received? And let me give you an example of what a very common type of scheme is that you see all the time in hospitals. Upcoding doctors do this too. Upcoding is where they use a more complex medical billing code for a service that was actually quite simple. So let's say you go to an emergency room for a visit, they have to do an examination. They bill that at a level one, all the way up to a level five billing code. Level five being the most complicated. Well, even if they bill a level three, let's say you just have a little cut in your finger, you need some stitches. Very simple, not complicated. That should be a level one. But often I've seen these things build at a level three. Well, a level three requires complex medical decision making. It requires an extended examination of the patient. It requires an extended history of the patient's medical problems. When you have stitches on your finger, it did not require complex examination or Medical history or complex medical decision making. And that happens all the time. So if you see that they've used a level three billing code, they're charging you a lot more than they should for that very simple visit. You can also look up prices. Once you have the billing codes, you can go to fairhealthconsumer.org that's a website that gathers payments insurance companies have made in different parts of the country for different services. You can type in the code, you can even type in the description of what happened to you. Maybe you got an mri, maybe you got a colonoscopy. You can see what a fair price is for an in network or an out of network type of service. And then I think the big game changer, Eric, is the price transparency rule that went into effect just at the beginning of this year. And now this is our federal government that now requires hospitals to post their prices. Now, a lot of hospitals have not complied. They're actually in violation right now of federal rules by not posting their prices. But if we know that as patients and we know what services we received because of our itemized bill.

We can now check prices. So we can look, maybe our hospital isn't compliant with that rule, but we can check another hospital in town and we can see, oh, okay, I got a colonoscopy. Wow. They charged me $4,000 for a colonoscopy, but they have to report the Medicare price, the cash price, and every negotiated insurance company's rate with that hospital. So you can see if you got overcharged now, and if you got overcharged, my argument is, if the bill is inaccurate or overpriced, you should contest that bill. So you can call the billing department and you can say, hey, why is it I got charged $4,000 for a colonoscopy, but I see that people with other insurance plans or cash pay or Medicare are paying $1,200 or whatever the price is. Why am I paying so much more? Because this is what our healthcare system has gotten away with. They've gotten away through all the secrecy and all the hidden prices with charging different people different prices for the exact same services. That's just fundamentally not something that I think we should accept as being fair. Now, if they don't comply, if they don't waive the prices or change the prices, that's when I think small claims court is the secret weapon for consumers engaging with the health care system. How many times have patients called the billing department and gotten the runaround or not had a bill corrected? Our insurance companies, unfortunately, Typically side with the hospitals or the doctors. They just go, well, the doctor billed for it, so I guess it was true, even if the patient says, but that service never happened. So we have too long, I think, been passive here and on the defensive. And small claims court exists in every state, in every part of the country for everyday average American consumers to defend themselves against unfair business practices that are being imposed on them. And so you can, once you know the fair price, you can actually sue in small claims court. That party that's billing you for the difference what they're billing you versus the fair price. And you can tell the judge, I offered a fair price, I'm willing to pay a fair price, but it's not fair for them to charge me way more than they should for this service that I received. In fact, there's a part of contract law of about open price contracts. And so in the book I go into the legal strategies, but the open price contract principle says if you're not given a price up front, then it's assumed that the price you receive is going to be a fair price.

So the law is actually on our side. Not only that, when you sue in small claims court, it's not likely that it's ever going to go to court. I mean, really what you're doing is you're trying to create the incentive for them to come to the table and give you a fair deal instead of price gouging you. So I think that this would work for surprise medical bills, which are very common. I think it would work for price gouging. I think it would work for billing mistakes. In fact, I helped.

A family at my church handle this. They had been over billed by their dentist by about $300.

So they had called the billing person for the dentist multiple times. This dispute went on for years. And finally I told my friend, I was like, you know, if you sue them in small claims court, it will require them to respond and take you seriously. So they filed a case. It usually costs about 30 or $40 to file a case. So it's not expensive. You don't need to be an attorney or have an attorney to do it. They filed the case and lo and behold, they got a call from the attorney for the dentist. Because think about it, from the dentist side, now he's got to hire his attorney at hundreds of dollars an hour for a stupid $300 billing dispute. So the attorney called him and said, look, my client doesn't want this to become public. He doesn't want to go to trial. What do you need. And my friend said, I need you to pay me my $300. So they wrote him a check for the $300 and they were done. They settled the case. So by using small claims court, we take it out of the venue where they create all the rules and game the system in their favor.

You take control.

You take control. You put it on a level playing field and you say, now you're going to play by the justice systems rules. Now the risk here is if you lose, you're going to have to pay the bill. So there is a risk. If you go to that trial and you lose, you're going to have to pay the bill. So this isn't for everybody. It's not for every situation. It definitely takes some courage and some moxie to pull this off, but it's something that people are doing and in fact, I've done it myself for other things, but this is something that people can do. So I'm trying to show people the tactics that other people use to win.

So let me ask you a question. Let's back up for a minute. I love that example of small claims Corp. Because candidly, I've never thought about that until I heard you talk about it, which I'm like, probably what, hundreds of millions of people.

But I want to back up. We know it's the law that hospitals have to post all the pricing, right, all the various cash price, Medicare, various insurance company pricing, right. But not everybody's doing it, which is, let's just call it, it's criminal. They're breaking the law. Why are they doing it? And is there what, what's what, when will that be enforced? Like, what's going on over there?

You know, the penalty for lack of compliance is only $300 a day. So that's a pretty small penalty.

It's nothing.

A lot of the hospitals are claiming it's like too complicated for them to figure this out, which is not true at all. One of my five reasons, in fact, for fighting back is that the healthcare system is not broken. It was made this way. Right. The people in control who want to keep the status quo are making a lot of money through the secrecy and the hidden prices. So I think that they don't want the prices to come out. I think that's one issue. I also think that we greatly overestimate the sophistication of our health care system. It is chaos in a lot of those billing departments. A lot of them are operating with software that is literally decades old. I've talked to people who work for big insurance companies who said they were using software that dates back to the 90s. So I think a lot of these systems are very old, so maybe it is difficult for them to do. But I also think if they wanted to figure it out, they would spend the money on whatever system they need to do to get it figured out. And we know it's possible. Dentists can do it. So you go to your dentist, you can get the prices for everything.

Sure.

So it's not that complicated. It's not impossible to do. I mean, restaurants can do it.

And I know healthcare is complicated, I get it, but it's not that complicated.

Well, you know, this specific topic reminds me of, I don't know what year it was, but there was a law and I think I could be wrong. I think it started in New York, but it might be wrong. Where restaurants had to post the calorie count for every menu item on the big board, and now it's normal. And restaurants all over the country pushed back because they thought it would hurt sales. And I think studies came out that showed it didn't hurt sales because consumers got so used to it, calories were right there, good, bad or indifferent, and people just ordered whatever they wanted anyway.

That's a great idea.

So that, that's just what came to my mind. And, you know, I'm in Maryland and the calorie count is there. I don't really pay attention to it. Maybe it's just me, but I think part of it, and maybe I'm wrong because I'm on. I'm on your side, I'm on the healthcare side, but I think it's just hospitals assuming it's gonna be terrible for business when they're not looking at it the other way and how transparency will actually be, in my opinion, instill more faith in their consumer to use that establishment with high expectations and be excited about it.

You may be right about that. I also think that when we look at price variation, me, as an investigative journalist, I'm usually focused on the negative.

Side of that story.

I'm highlighting the worst offenders who are cheating people and ripping people off. However, on the other side, you have the people who are offering a fair price, a low price, and those people should proudly post their prices. And in fact, if I was going to make a recommendation to healthcare executives right now, I would urge them to lean into this and lower their prices right now if they're not on the low end so that they can proudly boast the value of. Because that's a great Opportunity they have right now we are all feeling the pain of high health care costs. In fact, year after year, surveys show that health care costs are the number one financial concern of the American people. Imagine if a healthcare system in a big city started to boast about their prices and say, look, we're going to give you a fair value and excellent care. Because the other thing studies have shown is that you don't get better care just because you pay more for it.

Right?

There's not, there is not a link between the cost and the quality, which is another thing we assume as consumers, right? We think, oh well, if I buy a Mercedes or if I buy a Lamborghini, I'm going to get a top of the line vehicle, right? That's not the way it is. When you get a knee replacement. If you get a knee replacement at a community hospital with a good doctor and a good team, or a big marquee, famous, nationally ranked medical center with a good doctor and a good team, you're going to get a good knee replacement. We're not talking about, of course, like some specific type of cancer care or some really complicated type of operation that very few people do. I mean, I'm talking about for your general type of healthcare, which is a very common type of procedure or treatment. An MRI at one place is not better than an MRI at another place.

Right.

The cost is crazy different.

The cost can be crazy different. Crazy different. And so that's what the book. I have a chapter, so you mentioned the second section. The second section is about avoiding the need to fight. So let's take the MRI example.

I talked recently to a guy named Kevin who's in Amarillo, Texas. This guy needed 2 MRIs before he underwent a back operation. He was referred to a hospital based imaging center and he called them. But he was on a high deductible plan. So he had to pay the first $10,000 of any care he needed. Very high deductible.

That's ridiculous in and of itself.

That is ridiculous in and of itself. He was functionally uninsured unless he had a catastrophic accident. So he called the hospital imaging center. They said it'll be $11,000 if we bill your insurance for two MRIs or if you pay cash, which I always recommend people pay the cash price or ask for the cash price. That's another chapter I have. If you pay cash, it'll be $9,000. Well, Kevin, he talked to a friend about this who works in the employee benefits space. His friend referred him to Green imaging. I'm guessing you've heard of green imaging. Greenimaging.net is a company that has direct pay contracts set up with independent imaging centers. He sent his orders for his MRIs to green imaging. They referred him to an imaging center that was half a mile away from that hospital in amarillo. He paid $950 cash for those two MRIs. So in the drop of a hat, he saved $8,000. Same MRIs, in fact, that was the cost. He had them read and he got copies of the images. Probably, arguably better than he would have had at the hospital. He saved 8,000. So sometimes if you just know that this price variation exists and you know where to watch out for it, one principle is don't go to a hospital for anything that you can do outside of a hospital. The hospital is always going to mark it up and sometimes at levels that are so extreme you can't even believe it. So if you follow these principles and avoid the high prices, then you're not even having to fight because you haven't gotten that crazy, outrageous bill for the $9,000 MRIs. You've avoided the price gouging on the front end. And you don't have to confront anyone. You don't have to sue anyone in small claims court. You just saved yourself eight grand by avoiding the high price place. And by the way, this type of variation is everywhere. When you look at the price hospitals get for delivering babies, it can vary by thousands of dollars between hospitals in the same city. So even if you're on an insurance plan and you're like, oh, birth is covered. Well, you're still going to have a coinsurance. You still might have a deductible. It might make a big difference to you if you have your OB gyn go to this hospital versus that hospital, or if you pick an OB GYN that's in the lowest price hospital. So with knee replacements, hip replacements, everything has this variation. And if you know that in advance, you can avoid these problems to begin with.

Knowing is half the battle, right? That's. Knowing is half the battle. It could be more than half the battle. You know, let me ask you this, right? And I use this example often because I'm a small business owner. I have a handful of employees.

And I totally understand that. We're all, I'm not a nonprofit. I'm in business to make money. I gotta feed my family and pay my employees.

So there's something to be said about a business is in business to make money. But there's a tipping point between making a Fair profit and being in business and being a good steward of the community versus, in my opinion, versus being overly egregious or dare I even, I say, criminal. It's like the mob, right? It's like a cartel, as a buddy in the healthcare industry, in the insurance side always calls it. So I think, in my opinion, we're not, and I think you'd agree, nobody's telling the hospitals and these medical centers to not make money. We get it. You have to make money and be in business. But there's a tipping point. So am I saying this right? And would you agree that with the transparency model, they can make a lot of money, they can be in business, they can help the community, the patient, the consumer knows they have to pay. It is a business.

But they should not be way over the top. And certainly they shouldn't be working for free either. Am I in the same vein with you here?

Totally, absolutely.

I mean, they have to make a profit, right?

Any business needs to make a profit. We want them to be well compensated for taking care of us. The problem is, what's the line between profit and profiteering?

There you go.

Because once you're in the category of.

Greed or profiteering, then what you're doing.

It changes things a lot. When you're talking about healthcare compared to buying a new car or buying a new flat screen television, sure. Morally it changes the equation a lot because we can't really control what healthcare we need. And so if you're going to exploit.

My sickness for profit, then that's not right. Ethically and morally, that's not right. It is legal, it's not criminal, it's unethical and it's immoral, but it's not criminal. A lot of this stuff is totally allowed, you know, within the bounds of the law.

That's the problem in and of itself.

That is, that is. But what I'm trying to do with never pay the first bill is reframe these conversations. So we say, look, it's okay to make a profit, but it's not okay to profiteer. Not when you're talking about my sickness or my family's sickness. I mean, it's really sad. But cancer, if someone gets diagnosed with cancer in this country, it not only puts their life at risk, it doubles their risk of bankruptcy. Because our system is so messed up in terms of the way that we extract more profit than should be taken and then force people to pay more than they can afford. One in six Americans right now has medical debt in collections. That's an Outrageous. Just. We should be ashamed of that as Americans, that so many people are suffering because all they did was get sick. And they entered a system where things are overpriced and no one's looking out for them. I mean, in a way, the system is predatory on the financial side, and that's where we need to identify the predators and avoid them and then reward the people who treat us fairly because there are hospitals and of course, many treat us fairly. And so we need to try and find them and then give them our business.

Well, I love how, or I guess I shouldn't say I love it. Unfortunately, most people don't realize, going back to something you said earlier, that a smaller surgical center up the street from you that doesn't have a budget to market, you don't know about as much. They're not on TV with commercials. They might do 500 knee surgeries a year and arguably would be the absolute experts, as opposed to the large brand name hospital up the street that everybody's heard of that markets on television commercials every day. They might only do, I'm making numbers up. They might only do 70 knee replacements a year, which arguably, if you think about it logically, they're a lot more expensive at that big hospital, but they're not as experienced in that specific surgery or need by far and away. And the surgical center up the street is a lot more affordable.

And.

And they're experts. They're better at that procedure.

Right.

That's why you always want to ask.

Your doctor, how many of this particular type of procedure have you done personally and what is your complication rate? And what you find is, you know, I've done a lot of analysis of data, looking at volume. There are surgeons out there who are doing like five procedures a year of some type of operation. You don't want to go to that surgeon. You want to go to the people who do the most and they might be found at unexpected places. Right?

Yeah.

And I wanted to talk about something else that you're working on before you finish up. So real quick about part three of your book, Never Pay the First Bill. Go get the book. It's on Amazon. It's available anywhere. You can get books as of next week, from the time we're recording this on June 22, 2021, on Tuesday. And check out part one, two. And even my favorite, the conclusion, standing up to Bullies, because I think a lot of it, a lot can be said about the intimidation factor that a bully brings. So let me just state this and get your opinion Real quick.

You'Re in the East Coast. I believe you're in Jersey. I'm in the Maryland area, Baltimore. And I've driven along 95 so many times I see these big billboards with major hospitals and the hospital. I think billboards target hospitals because I still feel like everything is a car dealership or a hospital anyway. There's typically a sign, like a digital sign that'll say so. And so hospital emergency room wait time is only five minutes. Come in right now. It's less than five minutes. And you know, that in and of itself is kind of baiting. I'll use the term baiting. The consumer who might be in a need to go to the emergency room.

I never thought of that.

Because they have a belly ache. Get them in an emergency room because their finger hurts. That's what they're doing.

I never thought of it that way, but I think you're right. I wonder if that's the intent because obviously they're trying to draw people in. But as you know, and the point you're making, the emergency room is the last place you should go for care unless you have been in an auto accident or have a heart attack or some real emergency.

And we're not talking about urgent care centers advertising on 95. I'm talking about a major hospital system. Multiple major hospital systems.

You're right about that. That's crazy. Because if you're in a position where you can actually shop for the wait times, it's probably some discretionary type of care that might be more appropriate for a doctor's office or an urgent care as opposed to the er. That's a great point. I've never thought about that.

Well, I can't take full credit. Our friend David Contourno, he has a TikTok channel of all things, and he talks about employee benefits. He's such a good dude. He's a client. Friend of mine. Friend of yours. And I just saw him post in the book.

In the book, in part three, the section for employers, I highlight David's work and some of the employers he's worked with.

Well, that idea of the wait times being less than five minutes for emergency rooms, that came from him. And I had to share it because I thought it was an incredible insight into how hospital systems are baiting you in for the most expensive things that they know they can get away with charging because Susie's tummy hurt or because you had a finger paper cut.

Wow. Never thought of it, but I think that's a great insight.

So anyway, real quick, before we wrap up everybody again, go and get Never pay the first bill. Talking to the author, Marshall Allen, who is still an actual healthcare reporter at point at ProPublica. Marshall, talk about this new academy you've launched as well coming out soon, the Allen Health Academy.

Aha.

I'm excited for you on that. I think that's going to be an incredible combo action with the book.

Thank you. This is something that was completely unexpected. So I wrote the book, I wrote this how to guide. I'm talking to a benefits advisor about.

The book and what he tells me.

Is he's going, this book is great. This advice is awesome.

But he said, I know that most.

Employees are not going to read a book.

Which you know, even as an author.

And as a writer, I know most people aren't going to read my articles. Most people don't read that much.

He said, what I really would love.

Is if you would create a series of videos, short three to five minute videos that explain the principles of the book.

Then I can have my employees go through that, they get a certification so that I can see that they've done it. And that that way they have this kind of baseline health literacy about how to navigate the healthcare system. And I was like, this is a great idea. I've got to do this. Since that conversation a few months ago, I started a new llc Allen Health Academy. And I'm in the process of producing videos that are based on the book that explain these principles in an easy to understand format. So within about an hour, each employee can be neverpay certified and they will have a baseline understanding of this. I'm bundling it with the book so that people can use the book as a reference guide. I think the book is still very important because frankly, the videos, you can't get into enough detail about a lot of these things that are a bit complex. So I'm bundling it with the book and if people are interested, you can go to Alan MarshallAllen.com and look up more information there. It's available for pre order now and our goal is to get this launched in July, so stay tuned for that. That's coming on the heels of the book. But I think, Eric, I think we have a great opportunity. Employers and employees, the return on investment is huge. I mean, if you avoid one unnecessary surgery or if you go to get the MRI at a freestanding imaging center instead of the hospital imaging center, each employee can save hundreds or thousands of dollars with every healthcare interaction. And when the employee saves the health plan, saves a lot of money. So I think it makes a lot of sense. I've been looking. I don't see another product out there like this. I'm hoping that we can roll this out and we can equip and empower employees so that they understand how the system works and what they can do to fight back and win. So that's. I appreciate you asking me about it. Again, people can go to marshallallen.com, sign up for my newsletter and you'll get ongoing updates about that. But I'm really excited about it. It's a very unusual thing. Again, it's like when my editor asked me, do you want to cover healthcare? And I had never thought of that. This is similar. I never thought when I wrote this book that I would be starting a side business to create a health literacy curriculum. But here I am and I'm really excited to be doing it.

You know, as I'm talking to you right in the corner of my desk, I noticed and reminder that my wife put these two bills in her name on my desk for our kids and herself. I got two bills in front of me, I'm blocking out the company's name. And I looked at them and you know, I'm in the health industry and these are not itemized. These are literally lump sum bills saying I owe. One of them is $183.37. The other one only it's real money, $9. But the reality is it's real money. So, you know, it's interesting because some people would look at it as, hey, it doesn't appear to be that much. I'll just pay it. One of these bills is literally $9.21. And then but to others, and I'm not making a joke here, $9 is $9. That's real money. And if it's not itemized, you are owed the right to have that bill, just like Marshall said. So I appreciate you explaining that very, very much, my friend. Again, before we wrap up, everybody go get never pay the first bill. Marshall Allen is the author. It's also talking about other ways to fight the healthcare system. And the key here is fight and win against the healthcare system. It's been a pleasure, my friend. I'm gonna ask you one final question. Cause I'm curious. Your opinion. Should second and or third opinions for medical procedures that a first doctor deems necessary, should those be mandatory.

Before anybody covers anything?

Yes, the answer is yes. Always get another opinion. Do not think that any care that you receive is without risk. Everything has risks make sure that you actually need that care. In fact, I say the number one question that we should ask our doctor whenever we're being recommended some discretionary care, let's say it's a drug, let's say it's an image, let's say it's a procedure. We need to ask our doctor what happens if we don't do this right now? What's the risk of not taking action? Am I going to die if I don't do this? Or could we take a minute? Could we wait? Could we try some other approaches? That's a similar related thought. Ask what the risk is of not doing this and then go get a second opinion. If it's discretionary, you have the time and don't think that it's too much of a hassle because it might just save you hundreds or thousands of dollars and a lot of pain and complications. So I definitely recommend people get second opinions whenever they can.

And look, I look at it no different than if you think you need something done at your house, plumbing or electrician type stuff or a new roof. I mean, I had a new roof put on my house. I had five roofing experts come out and give me their opinion. And here's the thing, every one of them who proclaims they're the best of the best, they're the experts, they all had a differing opinion on what we needed and how much it costs and what material and brand to use. So, you know, I wasn't intimidated to go to another roofer. I didn't feel bad to tell the first and second roofer, I'm going to get a second opinion or fourth opinion. Yeah, I think a lot of people when it comes to medical, they're sitting with the doctor face to face and they just got told some crazy news that they think they need X, Y or Z procedure. And I think a lot of people goes back to that intimidation factor where they. I don't know, I really feel like people feel like they're going to hurt the doctor's feelings. Like it blows my mind.

It is intimidating. Right.

And I think what we need to.

Be more savvy about though, is recognize, especially if you're going to say a surgeon, they get paid for doing surgery.

They don't get paid for letting you.

Walk out the door.

Bingo.

Their incentive is to do more. And so they might be biased. They are biased, in fact, in the way they are. And here's another thing, just to reassure.

Any patient out there, they're not going to be offended if you say you're going to get a second opinion. In fact, they won't be offended at all. So just tell them this is a standard thing that people do. Get another opinion, do some research, look it up, ask them what the risk is of not doing it.

And then make an informed decision based on the info you get. In fact, a good example of this, I had a friend named Jeff who thought he needed back surgery, and he was having a lot of pain in his neck. This guy is a real athlete, third degree taekwondo, black belt, and.

He went to one surgeon. So he called me because he wanted my help finding a good surgeon, and that's something I help a lot of people with. I found him some surgeons he could consult. Well, the first surgeon he talked to said, this is an emergency. If we don't do this right now, if you even go play golf, you're at risk of being paralyzed. We need to schedule this immediately. He went to another doctor. That doctor wasn't quite as alarmist, but he also recommended surgery. Jeff still wasn't sure about that. He ended up going to physical therapy. He had six physical therapy appointments. He changed his diet. He quit training so aggressively. He was in his late 40s, so he realized, maybe I need to tone down on the taekwondo training. And the pain in his neck went away. And now he just shakes his head, thinking that he could have undergone a really invasive spine surgery if he would have listened to that for a surgeon.

Bingo.

He saved himself tens of thousands of dollars for him and his health plan. And a lot of back surgery has complications, infections. They have to redo the surgery. And by the way, you get billed for all those complications, too. So take your time. You know, I say, like, live to fight another day. You know, you can avoid the confrontation right there. You don't have to make that decision at the moment. Take a step back and evaluate it. You don't have to commit right on the spot.

I was that example. It's funny you said that. Long story short, 20 years ago, I'm 21 years old, and I was having back problems for many months, and I went to my doctor. He said, hey, go see this surgeon. He's fantastic. You don't need surgery necessarily, but he'll give you good advice. Within five minutes, the guy says, yeah, you're definitely gonna need surgery. And I'm 21 years old, and I'm like, And I'm not the fitness guy your friend is. But I was like, get out of here. From what I knew then, and nothing compared to now, back surgery can make your back worse than what you're dealing with. So here I am 20 something years later. I've never had back surgery. Yeah, I don't have the best back, but I'm not in constant pain. I feel great most days. And it just blows my mind that the first thing a surgeon would say is, you need surgery. That's like going to a car dealership with a crappy old car. What are they going to say? Yeah, you need a new car. I mean, come on, right?

That's incredible.

I mean, that is 21 years old. And the first thing is, let's operate.

They're salespeople. They're sales people. Let's just call a spade a spade. They're salespeople. All right, well, listen, everybody, go get never pay the first bill. Marshall Allen, it's been a pleasure, a privilege. I appreciate you, my friend. I look forward to seeing you again in person sometime later this year. I think we'll be at some similar events. And if anybody wants to reach Marshall Allen, all of his websites and information that he talked about earlier in the show will be in the show notes. If you haven't already done so, please go ahead and comment or like or subscribe to our podcast if you're watching this on social media. We appreciate you very much. We thank you. We hope you tune in next week as well where we're going to have another rock star guest. For everybody behind the scenes at the Rockstars Rockin Podcast, I'm Eric Silverman. That's Marshall Allen. This has been another incredible rockin episode. And as I always say, don't just have a great rest of your day, make it a great rest of your day. Thank you, Marshall.

Thanks, Eric.

Thanks so much for tuning in to this episode of the Rock Stars Rocking Podcast. If you haven't done so already, make sure you're subscribed to the show wherever you consume podcast. And if you feel so inclined, please leave us a review. 5 stars would totally rock. Until next time, rockstars. Keep rocking.

Sam.