Never Pay Your First Medical Bill - Do This Instead... | KOSHER MONEY Ep. 51

But it's incredibly common for things to go wrong in the hospital. And then the cost of health care is completely unjustified and outrageous and causing a huge amount of harm to all Americans, but especially to working Americans, people who are not old enough to be on Medicare, or people whose incomes are too high to be on Medicaid, which is most people. So working Americans and employers are really bearing a disproportionate share of the burden of our high health care cost. And the dirty secret as I started digging in on our healthcare costs is that the costs are unjustified and they're unreasonable and they could be much, much lower.

The book I'm holding in my hands will literally save you hundreds, if not thousands of dollars over the course of your lifetime. I'm thinking thousands. We had the author of this book called Never Pay the First Bill and Other Ways to Fight the Healthcare System and Win in our studio. He came in from Dallas Te and he shared with us principles you need to have in your arsenal to fight the healthcare industry. You are going to receive bills from hospitals, from medical providers, and you need to know what you can do to make sure you don't get ripped off. Phenomenal episode. Grab a pen. You're going to want to listen to this episode two, three times. But this book is something you need to have on your coffee table at all times. Without further ado, I give you Marshall Allen.

Being a Jew, awesome. Managing personal finances, not so awesome. Welcome to Kosher Money.

Welcome back to an episode of Kosher Money. We're digging into the healthcare industry here with Marshall Allen, came in from Dallas. Thank you so much, Marshall, for being here.

Pleasure to be here. Thanks for having me here.

So I found out about you. I read your book, or at least I saw an influencer promoted, and I said, okay, I read maybe two books a year. This is going to be one of them.

I'm honored.

Now, my second time through it, and it's fascinating because when I think of the healthcare industry, I think of a world where I'm optional lists like I don't have an option. This is. I pay what I pay and there's. There's nothing for me to do. So let's talk first about you, how you got into this space. What do you do day to day and we'll work our way into your story.

Well, I spent more than 20 years as an investigative journalist. Seventeen of those years have been covering the healthcare industry. And I originally didn't even set out to be a journalist. I actually started my career in Full time ministry. I did youth ministry for five years, and then I got a master's degree in theology and I thought I would continue in ministry, but I started freelance writing. I really got caught with the journalism bug and I went into the media. And so when I started covering healthcare, the fascinating thing to me was how ethical and moral what's happening in healthcare is right now. So I view the lens very much through a ethical and moral lens. And when I started digging in on what's happening to Americans with our healthcare system from an ethical and moral perspective, I was immediately outraged at what's happening to people, because first of all, the quality is often not good. In fact, medical errors and adverse events are one of the leading causes of death in the United States today. It's not something people talk about very much, but it's incredibly common for things to go wrong in the hospital. And then the cost of healthcare is completely unjustified and outrageous and causing a huge amount of harm to all Americans, but especially to working Americans, people who are not old enough to be on Medicare, or people whose incomes are too high to be on Medicaid, which is most people. So working Americans and employers are really bearing a disproportionate share of the burden of our high healthcare cost. And the dirty secret as I started digging in on our healthcare costs is that the costs are unjustified and they're unreasonable and they could be much, much lower. And so that's what led me to write Never Pay the First Bill. Because I had learned a lot of things by telling hundreds of patient stories and talking to thousands of experts who work for insurance companies and hospitals and doctors. And I wrote it as a how to guide for individuals and employers to understand what they need to know about some principles that they can apply to navigate the healthcare system in a way that's gonna save them money. And also how to tactics. So I wanna show people actionable they can take to save their families hundreds or even thousands of dollars per healthcare encounter. So when you think about your personal finance and managing your family budget, if you go down the wrong path with a healthcare encounter, it could cost you thousands of dollars more than it should. And they will still come after you for those bills, they will still send you to collections. And so people need to be informed before they encounter the healthcare system so they can be protected.

You mentioned Americans, right? We have a lot of international listeners. Is healthcare insurance in America different than what it is internationally?

Very different. Every country has its own system, and ours is, I would say, a unique reflection of who we are as Americans. And I think about this a lot because I lived overseas for a few years. And when you look at our healthcare system, like a lot of things in the United States, as long as it's making money, people are pretty happy with it. And it's about one fifth of our economy and it's making a lot of money for the big healthcare players. And so it can be hard to rein it in. You know, the hospitals are some of the biggest employers in any small town. So it's hard for the local politicians to crack down on the hospitals and say you're actually price gouging our community. Or even in many cases, they're suing the community to recover medical bills that are unpaid. Insurance companies are some of the biggest companies in the United States. And so in the United States, it seems like we think more about if it makes money, we're good with it, regardless of the harm it might be causing to a lot of people. And so that's a tension that exists in our healthcare system. It's for profit. But the problem is we're spending on average twice as much per citizen on healthcare in the United States than the citizens of other developed countries. England, Norway, Canada, Australia, New Zealand. All these other developed countries on average spend half as much per citizen on healthcare. And they get way more for their money. They don't have the massive deductibles. They don't have tens of millions of people still uninsured. So we're spending all this extra money and we're just getting way less for our money.

How did this happen? Was this, you know, 1982? Overnight someone said, hey, let me turn this into a massive behemoth of a business. Was this a slow transition into a world where hardworking Americans are spending literally thousands of dollars a month on just premiums? How did we get get here? And we'll get into the nitty gritty of it. The second part to that question is, do you see this changing anytime soon?

Well, it goes back, I mean, deep in our history, it goes back to the 1700s. And I'm talking about employer sponsored healthcare because that's what makes it unique. I mean, there are some other countries that go through the employers, but it's kind of odd that our employers have anything to do with our health care at all and that your health insurance might be covered to your employment. But in the 1700s, there was a law passed in the United States that started taking a portion of the paycheck sailors to pay for hospitals for those sailors. And pay for medical services for those sailors. And then in the 1800s, when the railroads were expanding and the forestry companies were expanding out into the west, they also started taking money from the paychecks of the employees to pay for the doctors, pay for the hospitals that they would build as they expanded westward. And then it really accelerated after World War II. In World War II, they put a wage freeze on. And so to better compensate employees, they started offering health benefits and making health benefits much more mainstream. You had the first health insurance plans starting around that time. And it just started expanding and expanding and expanding until now we have about 160 million Americans employees who are on employer sponsored health plans. And you probably have another, I don't know, 30 to 40 million getting it individually, or maybe it's less than that. Maybe combined it's 30 to 40 million getting it individually or they're uninsured. And a lot of those people would fall into the category of underinsured because even if they have benefits through their employer, they're still overpaying. Their deductibles are massive. The deductible is the amount of money that you have to pay before your health insurance plan kicks in. So many Americans, it's routine now to have a $1,500 deductible per person, $3,000, $5,000, $10,000. Deductibles are not unheard of these days. If you have a $10,000 deductible, you're effectively uninsured unless you have just more than $10,000 in the bank. And if you look at statistics about people's bank accounts, about half of Americans don't have more than about $400 in their bank account at any given time. So even a fifteen hundred dollar deductible, if you've only got $400 in the bank, you can't even cover your deductible. So you're not going to even have your health insurance plan kick in. You're going to go into debt for any bill over a few hundred dollars. And so the costs have increased a lot. They've increased a lot more since the Affordable Care act came into play. But in the last 20 years, the costs have gone up exponentially. The hospital services especially have been the highest cost increase in the last 20 years. Higher education is lower than that. But any other consumer good has had costs go up at a much lower rate or even decrease over that time.

Okay, so right now I'm going to work through my emotions right now. You've saddened me.

Yes, it is sad.

This is the gloom and do.

Yes.

And I want you now to get me mad because I've read your book and it does start with how specifically you got into this space, an occurrence with your dad. Can you walk us briefly through what happened there and how that led you to writing this book?

Yeah. So the story with my mom and dad, I mean, one thing I think that's unique about this, I compare it to the pandemic. We were all affected by the pandemic. We were all had to alter our lives because of the pandemic. This is like the pandemic for our personal finances, every American, and we're all being afflicted by it. And so it doesn't matter if I'm here in Long island, if I'm in Dallas, Texas. I grew up in Colorado. I've lived other places around the country. Everybody is dealing with the same problem, and people feel very paralyzed by it. But I make that point because my own family has been affected by this, too. So the story of my mom and my dad. My dad suffered from dementia for eight years before he passed away about a year ago. And my mom cared for him faithfully. And at certain points during his care, especially during his decline, she had to put him in a nursing home. Sometimes it was just for respite, you know, to give her a few months of break or a few weeks of break. Well, when she admitted into this one particular nursing home, I think this was in about 2018, she specified he had a primary care doctor. He was actually very healthy physically. So she specified during the admission that she did not want him to be treated by any physician that came into the nursing home. She was going to take him out, take him to his doctors, have them look at him, because they knew his history. So she didn't notice anything wrong until he had been there for about three months. And they started noticing a real decline in my dad's cognition. He was actually pretty high functioning for a lot of years with his dementia. But he had a month where his cognition just got worse. He wasn't speaking as well. His balance seemed a little off. And my mom is pretty attentive to his medical bills and his medical records. And she noticed on the medical bill that there had been a drug added to his regimen that he should not have been taking. And she looked into how this drug got added to his regimen, and she found that he had been prescribed this drug by a medical provider that came in and saw him without her giving consent and without her knowing about it. So she Looked up the drug and found that this particular drug does cause cognitive problems with people who are on dementia, or it can cause them that could be a side effect. And so she called the facility and thankfully, immediately they listened to her. They took him off the drug, and he recovered right away. So it didn't cause any permanent damage. He didn't take any falls or anything like that. Thankfully, physically, it didn't have a big damaging effect on him. But what if she hadn't caught it? You know, so that's one thing. Thankfully, she was alert to it, she was attentive, and she caught it, and they listened and they took him off of it. Well, then the billing company calls, they sent my mom a bill for this primary care visit that she had not given consent for, that she had not approved, and in fact, had caused my dad harm. Well, that became a battle to contest that bill. And sometimes these fights when you contest a bill are easy and taken care of in five minutes. You can save yourself hundreds of dollars in a matter of minutes by making one phone call. Sometimes it's a bigger fight. And so in this case, they insisted that, no, we provided the service, you owe the money. And so there you go. Now we're off to the races with, how do you now contest this bill in a way that's going to convince them, I like to say, give them the incentive they need to do what's right, to do what's ethical. And in this case, there had been no consent given. I got engaged. My mom had signed over to me the right to talk to the nursing home and get engaged with the organization that the doctor worked for. And so we started this process of getting the medical bills, getting the consent forms, contesting it. And thankfully, as I pushed back on that, we did have to continue to press them. They didn't immediately back down. But eventually what happened is my brother was in the nursing home making copies of all the medical bills. And I usually try not to say this. I don't want people to know I'm an investigative reporter, because I want the experience in the wild.

You want the organic.

Yes, I want the organic experience that any other patient experiences. Because once people find out I'm a journalist, it often contained things. Well, my brother mentioned, hey, have you looked up who my brother is? And then soon after that, I don't know if that's why, but soon after that, it got corrected and they waived the bill. And I did also call the nurse practitioner that did the examination of my dad. And this woman was very apologetic. She understood that the drug had caused an adverse outcome for my dad. I really appreciated that because you don't always even get an apology or acknowledgement for those kinds of things. So I felt like, at least on the clinical level, they took it seriously and they understood that this shouldn't have happened. On the billing side, it took a little more pressure, but eventually they finally waived the bill, and the billing manager for the doctor group said something like, oh, I think we just decided it's in everybody's best interest if we just let this go, you know? And I said, yeah, I think that's right. That's what I've been trying to tell you. So, you know, whatever their motivation, I don't really know, but thankfully, they did back off of that bill. But in my book, if they hadn't. In my book, I show people what they can do, and you want to contest it through various means. You can file complaints, various types of complaints with different agencies or different individuals. I think even online complaints can be effective. And then I have a chapter in my book on how to sue in small claims court, and that's something that we could have done. It's more stressful. It's logistically quite easy to do, but it is a more stressful thing to do. But it's very effective because it costs about $30 to file a case in small claims court. It's not worth their time or effort to bother to defend it. And so, as I said, it gives them the incentive they need to do the right thing, which is to come to the table, settle the case, drop the bill, and then I drop the case, and then we're done. And I have helped a lot of patients do that, and it works very well.

Okay. So the emotions I've gotten out of that last answer was the maddening part of it. Right. The stress, the anger that your mom may have felt in your family once you receive a bill, and not so much the bill that could be more surprising, but their pushb.

Yeah.

When you tried to fight it. But there was also some hope in there. Right. If it felt like you guys were empowered by the solutions you had in place, given your experience in the space and your brother's experience, you had the tools to sort of work through the murkiness.

That's right.

Talk to me about empowerment. Right. I know you speak about five different things that people should keep in mind. And we'll go through, you know. Yeah, we'll go through it. Yeah. Tell me what people who may not have the experience and the investigative chops that you have what should they know going into this? To know that what you've done is similarly attainable to them.

I called the book Never Pay the First Bill and Other Ways to Fight the Healthcare System and Win. And the. And winning might be the two most important words in the title and the subtitle, because this book isn't just another book where I talk about the problems and how we're paralyzed and how we're all getting ripped off. What I'm really, what my goal is, is to empower people by showing them how to win, because you can win. So I think the number one thing I would want people to understand, you can learn the skills to win these battles or avoid the battle in the first place, which is even better because you don't even have to engage in the fight because you've navigated the system in a savvy way to begin with. And so I think the most important message here is there's a lot we can do about this, but it does require us to change the way we engage the healthcare system. It requires us to learn some new skills and some new tactics. But I compare it to, like any other type of financial literacy. When I was teenager and I got my first checking account and I got a checkbook, I had to learn how to balance my checkbook. It didn't come easily to me. It was inconvenient. I didn't really want to do it. Or when I got my credit card statement, I'm checking my wife and I check our credit card statement to make sure that every charge in our credit card statement is something that we actually purchased and that it was accurately accounted for in the statement. So you have to learn to do these things. No one's ever taught anyone how to navigate the health care system or how to learn to protect your money from being taken unjustifiably from a doctor or a hospital or an insurance company. But it can be done. And in fact, when people learn these things, as I said, the promise I make in the book is that you can save hundreds or thousands of dollars per healthcare encounter if you learn how to navigate the system in a savvy way. I'll give you an example. Everything is more expensive in the hospital. Everything is more expensive in the hospital. So let's say you go to your primary care doctor and they say we need to do a CT scan or an MRI or an EC X ray or a lab test, but let's just say it's a CT for the sake of the conversation. Well, if they work for that hospital system, they're probably going to refer you to an imaging center that's related to the hospital. It might even be just down the hall. But in most cases, unless you're admitted to the hospital, you don't have to have that CT scan done right that moment. You could just take the order from the doctor and you could go to an independent imaging center. Those independent imaging centers are in every city across the country. They're usually right next door to the hospital or they're where the medical facilities tend to be. In that town, you might pay $3,000 for a CT or an MRI in a hospital. You would probably pay about $300 or $400 for it in an independent imaging center. And so if it's something where it's discretionary and you can go to an independent facility instead of the hospital, avoid the hospital at all costs. You might be paying 10 times more for that imaging test in the hospital. No one tells you that. No one in the hospital is going to tell you that. Your doctor probably doesn't even know it because the doctor is not engaged with how much things cost. But the same is true for blood tests. If you need a blood test and it's discretionary and your doctor wants to send you to a hospital, say, well, hey, look, can I go somewhere else for this? I'm sure the doctor will say, fine. A blood test is a blood test. A lot of these things are very routine. It's like more of an assembly line than people really think with the type of tests and treatments that people get on a routine basis. And so if you can just learn some of these tactics and have just a few key pieces of knowledge, you can avoid overpaying and getting hit with bills that are extremely exorbitant and unfair.

We'll be right back to this week's episode. But first, a message from Kolel Chabad, the longest lasting charity in Israel. They were created over 200 years ago to help Israel's neediest. So together with the state of Israel, they are helping people, people of all stripes, all colors, all religion. They are in need of food, shelter, clothing. They need your help. So if you have $10, $1, $18, $1,800, whatever it is that you can donate and afford, we ask that you help the dollars go a long way. Highly recommend you checking their workout. Kolkhabad.org koshermoney. You can hop around on their website, watch videos. If you actually ever go to the co sell the western wa, you'll see Kol Chabad. It's really cool. Next time you're in Israel, send me a picture if you have my phone number. If you don't have my phone number, ask your friend for my phone number. Someone somewhere has my phone number. You can ask Kevin Bacon to ask his friend to ask his friend to ask his friend to ask his friend to ask his friend. And you'll get my phone number that way. But really, sponsor Kol Chabad's work. They're amazing. Now back to this week's episode. So there's two ways I can go with this conversation right now. One is we can discuss if someone is actually in the ER for a quasi emergency. Not something, you know, they recommend a CAT scan. There's that murky area where you're in a hospital. There's clearly some emergency going on. Do you really want to make an appointment for a CT scan that you may need now, but you'll get the scan in a week when obviously it costs more money in the hospital. Should you be going that route every single time?

You can't always do it. If you're in the hospital for something urgent or for an emergency visit, you're not going to be able to go elsewhere. So some of these principles don't apply every time you go. It's all case by case and it does require. Require some decision making and being wise. I think one principle is you never want to delay care that you should be getting right now, but you do want to make sure that the care you're receiving right now is care you actually need. And I'll give you another example. My wife suffers from migraines and so she will every now and then get such a bad migraine that it causes her to be nauseated and causes her to vomit and get dehydrated. And then we need to go to an urgent career to get her some pain medication and get her hydrated. And once she gets that, she's fine. Well, every time we go in, or most times we go in, they treat it like it might be a possible brain aneurysm. You know, what if her brain is bleeding out right now and we tell them, look, we have every indication. She's had this happen a lot of times before. This is a migraine that's prompted this type of pain. Do you really think this is a brain aneurysm or could we just wait and see how she does before we go do the ct? Could we wait and see how she does with the pain meds and the saline and just get her hydrated and see and Some anti nausea medication, and that's usually what they do. But if we were following their guide, they would send us for a ct. Many times they would have sent us for a ct, which would have been a needless ct, because we know that that's not what's going on with her right now. But you have to push back. You know, a lot of times people are intimidated and they don't want to question the recommendation of the doctor. But a lot of times these things that are being offered are discretionary. They don't know for sure what's happening. They can't tell you for certain that the drug that they're recommending or the procedure they're recommending is actually going to help with the problem that you have. Unnecessary treatment is incredibly common. In fact, Maybe they say 25% of all the treatment provided is unnecessary. So imagine if you could just avoid the care that you don't need. They're going to recommend things to you all the time and it's not necessarily the right thing to do. And so the question I tell people to ask to avoid unnecessary treatment is what happens if we wait? What happens if we wait? If it's discretionary, if it's not an emergency, if it's not an obvious thing where they guarantee it's going to work? Ask that question, what happens if we wait? And then maybe you can go get a second opinion. Maybe you can do some research on your own. Maybe you can change your diet, change your exercise. I'll give you a great example of this one. I often get referred to people who want help finding a doctor. And so I got referred to a guy named Jeff who was a friend of a friend because he was having pain in his back and his neck, and so he thought he needed a spinal fusion. So I said, well, I'm happy to find you some doctors to go visit, but just so you know, a lot of back surgery they find is later unnecessary or doesn't actually work. So you might want to try some less invasive treatment. So Jeff goes to the first surgeon and the surgeon says, jeff, if we don't schedule, this is an emergency. If you even go play golf on Saturday, you might be paralyzed. I'm going to book an operating room right now and we're going to schedule this operation. Jeff says, okay. He goes and visits a second doctor to get a second opinion. That doctor wasn't quite as dire, but he also recommended surgery. Before Jeff took the advice of either of those doctors, he went to physical therapy. He had six sessions with a physical therapist. He learned some stretches and exercises he could do at home. He changed his diet. And then the other thing he did, he's a fourth degree black belt in taekwondo. He's about 50 years old. He reduced the intensity of his taekwondo training. So he was training maybe more like a 50 year old instead of a 20 year old. And lo and behold, through those different approaches, his pain in his back and neck completely went away. It was completely resolved. Jeff has actually become a friend of mine now through this mutual friend. And I see him every now and then at a party or a get together and I'll ask him, hey, Jeff, how's your back and neck? He's like, it's still great. It's been four years now. And he just shakes his head now, thinking about what would have happened if he would have followed the advice of those first two doctors.

He certainly said without pain.

Pain. Yeah, no pain.

No pain.

Yeah, exactly. No pain. And the complications he could have suffered, the limitations in his lifestyle, and the cost would have been extreme if he would have undergone that operation. So you just have to know, look, they get paid when they do stuff. It's usually fee for service. Payment is what they call it. So you want to be a little skeptical and a little cautious and understand what incentives are they operating under. And maybe I need to help them question their own incentives and make sure that what I need is actually what I need.

Let's say Jeff went ahead with the back surgery, right? He's paying, let's assume he's paying $2,500 a month in his premiums for his family of six. And he goes ahead with the surgery, it's done the next day. He never really discussed payment. They come in, he signs a few papers, doesn't really know he's not feeling great. He signed some papers, he's in the hospital for a few days. He gets home two weeks later or a week later, he gets what they call an explanation of benefits. Those are those annoying pieces of letters that I always threw out in my 20s. They were mistakenly sending them to me, didn't know what they were. Even when you read it, there's jargon and numbers and you don't have a good understanding. And it says, this is not a bill. So you're like, okay, great, my insurance company will take care of it. And then like a week later, the hospital sends him a bill for $3,700.

And.

And he calls up his insurance company and says, I don't understand, I have insurance. Well, they said, yes, but you didn't Meet your deductible, and your deductible is $10,000. So now he has to scramble to pay $3,700. And we could take this conversation in so many different ways, but let's start with that explanation of benefits. When that arrives, is that just trash? What should people be looking at when they're opening it? What is an explanation of benefits?

So an explanation of benefits, or they'll call it an eob, is the document your insurance company sen to show how they processed the claim. So when you go for medical care, you get some type of treatment, the doctor or the nurse or whoever it is writes in the medical record what they did. And those medical records are usually, I would say, pretty solid and accurate to what actually happened. But there's a lot of gamesmanship that happens when the billing department takes that medical record and translates it into a claim. They call it a claim. What they send to your insurance plan plan. So they use billing codes to translate the medical services that were provided into the code that they use for payment. And that's where a lot of the stuff can get tweaked. And for instance, doctor visits or emergency room visits can be coded level one to level five. Level five is very complicated, like life or death. Level one is very simple and easy. They get paid less for a level one than they do for a level five. So their incentive is to code things as a level four or a level five as much as they can. Even if it wasn't that level of complexity, it's actually fraudulent that this happens. And I think this is the most pervasive type of fraud that happens on almost every emergency room bill that you see. They're always coding it more complicated than it should be. Once that gets coded, it goes to the claim. The claim gets submitted to your insurance plan, and then your insurance plan processes it and adjudicates that claim. They may be based on the different type of insurance plan you have. And there are, of course, hundreds of different insurance companies, thousands, tens of thousands of different insurance plans, millions of claims every day in the United States. This is just a massive system, incredibly complicated. Lots of mistakes happen. Whether they're honest mistakes because of the complexity, or maybe somebody's putting their thumb on the scale to get a little higher payment. So whether it's honest or not honest, there are a lot of mistakes that can happen during this claims processing phase. And so the EOB will tell you, did your insurance plan accurately process that claim? Does it show services that you actually received? Does it show that it was like if you have $1,000 deductible, but you notice that you met your deductible, but it doesn't show that you met your deductible, there might have been a mistake made, or, or maybe they billed you for something that wasn't something you actually received, which is very common to have happen. You need to check those EOBs to make sure it was processed properly by your insurance company. And then you can contest things and get things corrected if they were processed improperly.

So let's take this in steps. Will the insurance company ever communicate back to the hospital and say, show us your medical records, show us more details. Show us information that corroborates the fact that you did such and such service at such and such level?

Almost never. And that's why it's important for us to check, because the insurance company, I mean, if you think about it, how do they really know what physically happened to that patient during that medical encounter? They're not there on the scene to verify everything that happened. And so they're not really able to do that. And so what they do is they just make. They just pay it and they don't question it. And the insurance company also doesn't typically support the patient if the patient has a problem. Now, if the insurance company made a mistake processing it, it. They'll correct their own mistakes. But what they won't do is question the charges that were submitted by the hospital or the doctor. And I've seen this dozens of times where somebody identifies an error or they get charged for something they shouldn't have been charged for. They contact the insurance company thinking, well, I'm the member for the insurance company. They represent my interests. So of course, if I can tell my insurance company that this medical bill is incorrect, they're going to care, right? Wrong. They're not going to care. And what you find most of the time is that the insurance company really is more aligned with the medical provider, the hospital, or the doctor than they are with their own members.

Isn't the patient the customer, though? Aren't they the ones paying the bills at the end of the day?

So yes and no. And I think that's one of the biggest mistakes that we make. You know, we think that because we're the one undergoing the service or we're the one paying the bill, that we're the customer. That's how it is. And in the United States, the customer is always right. And so you think that. But actually, I had a real breakthrough on that when I had someone explain to me, an industry insider saying the industry does not consider the patient the customer. The industry treats the other stakeholders in the industry as their customers. So the insurance company's motive is really to keep the doctors and the hospitals in their networks. They want to make sure they have a broad network so they can go to employer sponsored health plans and say, look, you can, can pick your, keep your doctor, keep your hospital, they're all in our network. So they build these networks and they are loyal to the doctors and hospitals and their networks and they're not really protecting the money that they are monitoring on behalf of the patients and the employers. And so we say the customer is always right in consumer transactions in the United States, but in healthcare you're not really the customer. You are a billing unit that's entered this system that creates an opportunity for the medical providers to process claims through the care that they provide to you. And this is on the business side. I mean, I'm not real critical of the clinical side, although there are certainly things we can be critical about because a lot of over treatment can be prevented. But really the biggest games and the most deception happens on the billing side of the industry. The clinicians generally speaking, really are trying to help you and really are trying to make sure that they give you the care that you need. But when it comes to the billing side and the financial schemes that the healthcare industry creates, a lot of that is based on deception, misdirection, hiding the prices, not backing you up, rejecting claims so that you have to go through the process of appealing them to get them paid. They create a lot of barriers to us protecting our money.

So on that eob, let's assume there's three line items with various, various billing codes. A, would it show the Level 1 to 5 in the billing code? Would the level be there?

Sometimes it does have it on the eob, sometimes it doesn't. And sometimes it does have it on the medical bill. The medical bill is another thing. So the claim gets sent to the insurance company, the insurance company process it, the document they produce is the eob. But then you're going to get a medical bill from let's say the hospital or whoever it is that provided the service. What you always want to make sure you get, whether it's from your insurance company or your hospital, is an itemized bill. The itemized bill details each service that you received or each treatment you received or drug that you received. And you want to make sure you get it with the billing codes included. The billing codes are typically CPT codes. Common procedural terminology. And again, this is just the lexicon. They're five digit codes that translate the medical record into the billing claim. They're easy to Google and see what they are. So, so you just want to get a itemized medical bill with the billing code and then you can look up the billing codes and you can see, okay, is that a service I actually received? And they'll often have a description on there too, on the bill. But you can also Google it and say, okay, Emergency room visit, 99285 is a level five. Emergency room visit, 99281 is a level one. If it's a 99285 and you look it up online, there are actual requirements for a high level, high complexity emergency room visit. It requires three things. One, it requires a complete examination of the patient, thorough examination. Two, it requires a medical history to be taken of the patient, a complete medical history. And three, it requires medical decision making of extreme complexity for a Level 5 ER visit. And Level 5 visits are appropriate for things like car accident victims or drug overdose victims, heart attacks, I mean life and death kinds of situations are level five. So if you went in there with a cut on your finger that you needed to get stitched and they billed you as a level five, that's upcoding, that's not the accurate code. And then that's where you're going to contest that by looking at that code and seeing did I receive that service? Is the first question you want to ask, or are they billing me for something I didn't receive? The second question is, does this code accurately depict the level of service I received? And then the third, I guess would be what's the price? So now because of hospital price transparency, you can see all of the prices that hospitals have for different services. So again, this is where healthcare is completely upside down and backwards from other consumer transactions. Usually, you know, let's say you go buy a car and we all know that if you go buy a brand new Mercedes, you're going to get a much nicer car and you're going to pay a much higher price than if you go buy a brand new Honda. You're getting something more for your money. With most consumer transactions, you go to a five star Michelin rated restaurant, you're going to pay more, but you're going to get better service, you're going to get a better experience, you're going to get better food than if you go to McDonald's. But in healthcare, a lot of these things really are the same no matter where you go a blood test, an mri, a knee replacement, a doctor examination. There's not a Mercedes level of these things and a Honda level of these things. There's not the Michelin five star level versus the McDonald's level. It's a standardized service that's provided no matter where you go. So therefore, you'd think you'd pay a similar price, but that is not the case at all. You can pay exponentially more for the same service at the same hospital, depending on the type of insurance plan you have. And so that's why hospital price transparency. This is a policy that was put in place by the Trump administration to require hospitals to post their prices. And again, when I talk about deception in the healthcare industry, we shouldn't even be having to have this conversation about posting prices. Why would we not get a price up front to begin with? Why has it been okay for 20 years that we can't even get a price? This is the normalization of deviance is what they call this in sociology. It's deviant behavior that's gone on so long that we just accept it as normal. Normal. But that doesn't mean it's right, it's wrong. So thankfully now the law of the land is hospitals are required to post their prices and they have to post all their prices. So they have different prices negotiated with every different insurance plan for all the services they provide. So let's say you're needing a colonoscopy. If you're covered by Medicare, that colonoscopy might have a price of $1,200 at your hospital. If you're on UnitedHealthcare, it might be $2,500. And if you're on Aetna, it might be $5,000 dollars. It's the same colonoscopy with the same doctors with the same equipment at the same facility. But because you have a different type of insurance plan, your insurance company has allowed a different price that they've agreed that you will pay without your consent. So this again, is something that, this has just been the way the system has worked and it's been hidden until now. But now that we're seeing these prices and we're seeing this unjustified price variation, I'm trying to help people reframe this. I mean, what this is, this is discrimination against working Americans based on their health plan. There's no reason that a working person should have to pay more for a service than someone who's on Medicare. You know, but my mom being on Medicare for that colonoscopy would be billed 1200. Me being on a commercial plan, would be billed 2 times that, 5 times that, even 10 times that. That's the range of difference for medical services for working people compared to Medicare. That's something that we need to stop accepting. And that's what I'm encouraging people to do. Use this new transparency rule, use this knowledge that we now have, this evidence that we have of this unjustified price variation to contest your bills, to say, hey, wait a minute, I don't understand. Why am I being charged $5,000 for a service that someone else is only paying $2,000 for? That's not right. And I'm not going to accept that.

But didn't you accept it without accepting it when you signed up for your insurance plan? Meaning Oxford UnitedHealthcare agreed to that $2,500 colonoscopy. So it's sort of after the fact. Okay, yeah, you're right. You are paying more than someone on a Medicare plan, but you signed the prices for Oxford and that's what you're gonna pay. What right do you have to come? Not right, but like, what? Leverage.

Yeah.

To come back.

So that's a great question, because that is what they would always say. They would always say and the hospital would always say, well, Mr. Allen, your insurance company contracted at that rate with us. And my response to that is, this is a multi party transaction that we're engaging in here. You have the hospital, you have the insurance company, you have my employer and you have me. I didn't agree to it. My employer didn't agree to it. So you basically have an insurance company and a hospital agreeing that I should pay more than other patients. For what reason? I don't accept that. So that is the answer they always give. Well, this is the contracted rate. And I say, well, how am I part of a contract that I didn't have any knowledge of and I didn't sign, I didn't agree to this. And if you would have told me, hey, Mr. Allen, when you go get your colonoscopy, it's going to be $5,000. And I'd say, well, what are other people paying? Well, some other people pay $2,000 or $1,200. I'd say, well, I want that price. Price. They have created a system with rules that are set up for us to be unjustifiably charged more than we should be charged. And so my response to that is, I don't accept your rules. If I'm part of this transaction, you need to Actually be fair with me and with other patients so that you're not charging us more than other patients. So this is unjustified, it's discriminatory behavior and it's causing a huge amount of harm to working people. We have now about 100 million Americans who have medical debt and about one out of every five Americans has medical debt that's in collections. So they are getting hounded by bill collectors because they can't afford these costs. Meanwhile, we have about a trillion dollars that's wasted in healthcare every year. The healthcare spend is a little over $4 trillion a year. All the studies estimate that up to a trillion of that, one fourth of that is wasted spent spending and it's wasted on things like unnecessary care, unjustified high prices, fraud, the billing complexity. I mean think of the madness of all these insurance companies, all these plans, all these ways of processing claims. They estimate they could save hundreds of billions of dollars if they just simplified the way we pay claims. For example, stop with the unjustified price variation. That'd make processing the claims a lot easier. If the prices were just posted and we could see that'd make things a lot easier, a lot more simple. So I think, my point is we have been accepting their way of gaming the system in their favor. And I think it's past time for us to stand up for ourselves, for employers and working people to get educated and then understand, no, we don't have to accept this. And so we need to push back.

So let's talk about pushing back. Let's talk about contesting. If you do get on the Google machine and start searching and you find that, that, hey, I feel like my visit was upcoded on the explanation of benefits. I'm looking through the medical bill. Something doesn't add up here. What recourse does someone have? What are the logical next steps to take? Assuming they don't have money for a lawyer, they don't have necessarily too much extra time. But they want to fight back, right?

So there's lots of things that you can do and there's no one size fits all approach that's going to work every time. So it's a little more like strategies and principles and tactics and things to try, try. But the first thing you always want to do is do your research so you understand what a fair price is. So let's say you've gotten that itemized medical bill you've gone to. The websites I recommend are fairhealthconsumer.org that's a non profit organization that Gets the average of what insurance companies pay for different services. So you can put the medical billing code in there, or you can put the description of the service in there. There. Go to Fair Health Consumer and it will tell you what a fair price in your community would be. So if you're being charged a fair price, again, I call the book never pay the first bill. That's a principle. It doesn't mean you never pay your bills. It means you never pay the bill until you've checked it to make sure that it's fair and it's accurately priced.

What percentage of first bills have some level of error?

You hear lots of numbers on that. I don't think there's any actual reliable number because that study hasn't been done in a way that I think is really sound. But some people would tell you, the people that who review these bills would tell you it's more than 80%. But I think the problem there is they're looking at a. Probably a bias sample because the bills they're reviewing are ones that are questionable. So that's where I don't think anybody's ever done it. But it's extremely common. Let's just say that, I mean, everyone I know has, has seen bills that are overpriced or inaccurate. It's happened to all of us. But if it's fair and accurate, then you pay the bill or enter a payment plan or something like that. But if it's not not, your next step might be to call the billing department and ask for a discount and say, hey, I'm looking at the prices and I'm seeing that my price is a lot higher than other prices at your hospital for this service. Could you please give me a discount? And I always suggest that people just ask nicely, May I please have a discount? These numbers are made up to begin with. These insurance company discounts, the charge master rates, the initial prices that they charge charge are not the actual prices. These numbers are coming really out of thin air. So ask for a discount and ask nicely and then hopefully they'll give you a good discount.

I was reading the book and I was like, oh, this is gold. Then when I actually got the bill, I sort of like pulled it out and I was like going through the steps and I was like, okay, coding, got it. And you break it down in steps, which I think is super helpful. Let's say they say no to the discount and you still feel that you have some sort of claim on them. Right. You feel like the pricing's not fear. I know You've mentioned going public or what are the options.

So now your goal is to give them the incentive they need to do the right thing. And so you're going to need to apply some pressure. So hospital board members and executives are people that you could reach out to. Local politicians, whether it's a the mayor or a city council person in your town or a state senator or, or some other elected representative is someone that you could notify. You could file complaints with your local attorney general's office if it looks like this might be a fraudulent type of a claim. And every time you're doing this, you want to let them know that you're doing it. You want to stir up enough dust in their billing office that you just give them the incentive they need to do the right thing to come to the table and give you that discount. That's a fair discount. And again, you want to emphasize that them I'm here to pay my bill. I'm just not going to allow you to price this at a price that's not fair to me or that's actually inaccurate or possibly fraudulent. So it depends who you're going to complain to. If those things don't work, you can file complaints on social media. Often hospitals and doctors care more about their public reputation than they do about how they actually treat people behind the scenes. So that can be an effective way to make a complaint and get attention to your complaint. And again, all you want to do is get this escalated to a high enough level that somebody in that facility says, okay, let's just give the person the discount that they need. And I do recommend always being friendly, always being polite, but being very matter of fact with them and firm and saying this is not right. You also want to get your medical records. So every patient has a right to get their medical records. Under the HIPAA law, you have a right to every document that they have, the finance documents, the claims documents and your medical records. Those medical records will often justify your so for example, if they upcoded an emergency room visit that was actually a simple visit, the medical record will show that it probably was a simple visit, it was a low level, not life threatening visit. And so you can say, look, I'm looking at my medical record. The doctor documented that it was a simple visit. You can't charge me a level 5 emergency room visit for this. And they'll often back down on that and they'll often correct that right away. In fact, I love this story of this patient named Jenny Sisson in Texas. She's a Mom. Mom. I think she had four kids and her daughter went to a hospital because she was having an appendicitis attack. And the first hospital she went to was a rural facility. And they coded that as a level five emergency room visit. Then they transferred the child to another hospital where she eventually had her appendix removed. So I love what Jenny did. The insurance company paid the bill at the level 5 level. Then they came after Jenny for about $500 more and they sent her a baby bill. Jenny just called them nicely and said, hey, I'm looking at my bill and I see that you billed this as a level five. It just doesn't seem like an appendix attack is a pretty routine type of a case. It doesn't seem like the level 5 would be justified in that case. And in that situation, they just immediately waived her bill. Took her about five minutes. So sometimes it's really easy. It doesn't always require a lot of stress or a lot of phone calls. And then in that case, she followed another step that I think people should always look into to when she went to that next hospital, she applied for financial assistance at that hospital. And I think hospital financial assistance policies are one of the most underused tools in our arsenal to take care of these bills. The IRS requires nonprofit hospitals to provide financial assistance to patients who are anywhere. It's typically about 300% of the poverty level or lower. So if you're a family of four, you're looking at, if you make 50, $60,000 a year, you would probably qualify for financial assistance assistance at non profit hospitals. For profit hospitals also have these policies. And I've seen some of these policies are very generous, especially if you have a large family or if you have other bills. I've seen policies that have forgiven 90% of a bill for a patient who makes over six figures over $100,000 a year. So don't assume that you don't qualify for financial assistance. And the way these policies work, it's usually you fill out a single page document, you explain what your income is, and sometimes they might require a tax return or a paycheck stub to verify your income. Then they process it on their end and approve it or don't approve it. Sometimes you have to persist to remind them that you qualify and get it approved. You can also go through a charity called $4 that's d o l l a r $4 f o r.org that charity will process all your financial assistance applications for, for you. So they'll do it for free for anybody if you want to find your hospital's financial assistance policy, just Google the name of your hospital and financial assistance policy and it should come up. And there also should be a phone number you can call on the back of your medical bill to ask about it. They don't often volunteer this information, but they have to provide it to you. They have to make it known. And so this should be on their websites and they should. It should be readily available. So it's not hard to find. It's just you have to know to look for it. But that could get your entire Hospital forgiven 100%. So it never goes to your insurance company. It never goes to you. I've helped a lot of patients do this myself. In fact, I just had a patient who I helped and then I also hired a patient advocate to help because it was a very complicated case. But she got a bill that was almost a quarter of a million dollars forgiven through a hospital financial assistance policy. So definitely check that out. So that's another tactic that people can use.

A short break from this week's episode. Shmuel Shayowitz of approved funding in the house in the Kosher Money studio. Shmuel Every week my bank reaches out and says, hey, I have equity in my home. Do I want to take advantage? It's at least $100,000. And the price of my home is the cost. The value has gone up in recent years. So I have access to money. Should I be tapping into that money? You know, assuming some people are listening that have money in a bank account, whether it's tied up in their home, how should people be thinking about that?

So for a lot of people very similar to you, especially if they've owned a home over the last 10, 15 years, their equity has gone up, thank God, and they've seen a very nice appreciation in their home and what the house is worth, either through their bank or, you know, poking around online, you're seeing that you have equity in your house. Now the question is, should you do something? Should you not do something? A lot of people have this false conception that just because their house is worth a million doll dollars that they are millionaires. It's certainly a part of a person's net worth, but what's important for the average Joe or Yossi should be maximizing their equity to build wealth. And that's really what it boils down to. I had a case where we were trying to finance a home and a seller could not close some. Our client, a buyer was ready to buy. A seller could not close because the seller was very busy scrambling to satisfy judgments and liens that they had on themselves. And they had a ton of equity in the house, but because they mismanaged their debt, they ended up walking away from closing, having to bring a check for $7,000. So here was somebody with $300,000 of equity in their house, and they couldn't access that even by selling. So I highly encourage those people who own a home, or even they don't own a home home, figuring out what is reasonably their budget, what should their budget be, what are their short term objectives, long term objectives, and to have the phone call with somebody that they can trust to say, should I be doing something with my equity? Should I be getting a home equity line of credit? If you have credit card debts, is that better? I've had people reach out to me who have the equity, know they can get a home equity line of credit, have $50,000, $60,000, $70,000 in credit card debt debts, and they're afraid to do anything with their equity because they don't want the bank to foreclose on them. They think that credit card debt is going to be easier than home debt and they don't know the difference. And they end up paying twice or three times as much on a monthly payment because they're not managing their assets better. And part of what we've seen with the banks that have gone out of business recently is the fact that a lot of people think, think like, oh, they had billions of dollars in the bank, the bank had billions of dollars of assets. But if you understand and you actually read the articles, when you put money into the bank, if you deposit, Ellie Langer deposits a million dollars into the bank, the bank receives your deposit. It's now a liability for them. So now it makes it a little bit easier for me to say, when you own a home, you have both the largest asset that you'll have in your life, but you also have the biggest liability. Because most people don't have hundreds of thousands of dollars in, in debt that they don't realize that they do. So managing that liability and all liabilities is the most important thing to make sure that you can build wealth and be comfortable.

If you're looking to build wealth, tap into the equity or just have a money question. It's not just mortgages. Visit approvedfunding.com koshermoney. Get in touch with Shmuel. Tell them your friends at Kosher Money sent you. And now back to this week's episode. I'm thinking, now, what if Someone's listening to this after the fact. It's gone to collections. They've been throwing out the letters. They sent the debt collectors to voicemail every time they call. Is it too late for them to take such recourse?

It's pretty tough. And that's why you want to learn these things up front. Because once it's gone to collections, now it's important to define what type of collections we're talking about. And this is, again, we got to get in the weeds here a little bit. Because initially, if your bill, let's say it's six months late for your doctor or hospital. Hospital. And they send you to collections, that might just be a bill collector that they've hired to represent them and collect for them. In that case, you can still contest it. And then that process might go on for three months or six months or longer. But in some cases, hospitals, doctors won't do this. But hospitals will sell your debt to a debt buyer, and then that debt buyer will have a bill collector coming after you. That's a different situation where you won't be able to negotiate with the hospital anymore because they've now sold it to a debt buyer. That could take a year for that to happen, or more than a year that your bill is past due. So it depends on how long you've been ignoring the bill. And so the first question you want to ask if you get called by a debt collector. Well, there's a few things you want to do, and I have all this in the book that's laid out. But the first thing you want to do is contest the bill in writing to that debt collector. And I have a template that you can use in the book. Book, you can just adapt that template, send that letter by certified mail to that debt collector that says, I'm contesting this in writing. You need to justify to me and give me the documentation that shows that you actually have a right to collect this debt. Do that whether you think you owe it or not, because you just have to protect yourself that way, because that's going to kind of stop the clock on the things they're doing to continue to pursue this collection. But then you want to ask them also, so who owns my debt? Is it the doctor or the hospital that I went to, or is it some other debt buying agency that purchased the debt from them? Because knowing who owns the debt is going to direct the path that you take to get it taken care of. If it's your doctor or your hospital, you want to follow all of those steps. That I lay out in the book all the things that I've just been talking about. The one other step I didn't talk about yet is small claims court. So I don't know if you want to go into that one. But small claims court, I would say, is like the last resort, but very effective, but much higher stakes. It's going to get you a little more agitated and maybe anxious and stressed. But small claims court is an awesome tool to fight these battles. And this is, again, I love the United States of America because when they created our justice system, they created small claims courts in every state to allow less powerful individuals to stand up to more powerful companies or individuals who are taking advantage of them. And it's often used in other consumer transactions. I just think a lot of people haven't really thought to apply it to health healthcare, but it's incredibly effective in healthcare. Again, I talk about giving them the incentive they need to do what's right for you and be fair with you. So I'll tell you a story of a woman named Leslie Donovan, who's a mom in Northern California. She had to get two ultrasound tests at her local hospital. And this was Sutter Health. And anybody who's in the medical field knows Sutter Health in Northern California is notorious for some questionable pricing activities. They've actually entered into some settlements with the Department of Justice and others, California Attorney General's office, office, because of their prices and things like that. So this is kind of a notorious hospital.

Without admitting any wrongdoing.

Well, I'm sure it was. Without admitting any wrongdoing. Right. So this was Sutter health. She got two ultrasound tests and was billed about $1,300, I think, if I recall the number. She tried to contest it. They didn't listen. She tried to do it the nice way. She tried to apply more pressure. They continued to ignore her. She ended up filing a claim in small claims court. There's brochures on how to do this that explain in layman's terms how to file a case. It doesn't cost that much, maybe $30 or so. You may need to pay another small fee to serve the papers to the person that you're suing or the entity that you're suing. But she sued them. She got a court date. And now think about what happens on the hospital side or the doctor side or the dentist side when you file that claim again against them. First of all, there's a public record of it. They don't like that. They don't want to have Something in public that shows that they were somehow not behaving the right way with consumers. It also creates a potential court date where they might have to show up and actually justify their exorbitant prices to a judge who could rule in their favor or could rule against them. Ruling against them might also create a bit of a legal precedent that they might not like for their overcharging. And the whole hassle of fighting this thing is probably going to cost them. If they have to bring in an attorney, it could cost them $500 an hour on up to bring in an attorney to defend a case that's only worth. In this case, it was worth $1,300. So it flips the power structure in favor of the individual patient because they don't need to hire an attorney to do small claims court. They can represent themselves. They can also drop the case anytime they want. So you don't have to go through with the case if you don't want to. And you have just created, again, the incentive that that doctor or that hospital needs to come to the table and treat you fairly. So in Leslie's case, she got called from an attorney for the hospital, and they immediately waived the bills for her. I think they waived the entire bill. She was willing to pay the fair price. I think that they just made the whole thing go away.

They don't want to see any of that.

Exactly. As long as she dropped the suit. And so in my book, I have a warning letter that you can send to the party that you might be suing that tells them, hey, we've. I've tried to correct this in a fair way for both of us. You have not complied. And so I'm notifying you that if you don't correct this within 14 days or within 30 days, I will sue you in small claims court. And then you want to send that letter to as many people you can at high levels in that facility. In fact, I love a mom named Leah labresco. I think her name was. I think her first name was Leah. I wrote this in my newsletter so people can get my newsletter, too, if they want to read all this stuff.

How do they find out?

It's@marshallallen.substack.com we'll put it in the Show Notes. Yeah, it's a free newsletter, and I'm always telling people how to do these things. And I'm highlighting what I call victory stories, which is where an everyday person, person overcomes this big bully. It's David versus Goliath. Every time and so David's winning, and that's what I like to show. Here's how David beats Goliath. And then we celebrate these victories, right? And we show the tactics that they used so we can all learn and be inspired by them and we can win our own battles. So I love how Leah handled this. Leah's a mom. She had a baby, took the baby in for some vaccinations. And vaccinations are supposed to be covered 100% under a number insurance plan. And for some reason, they made a billing error and they were billing her over $1,000 for these routine vaccinations and they would not correct it. So she kept going back to her pediatrician's office and saying, you need to send this to my insurance company. And they continued to not do it or refuse to do it, but they kept sending her the bills. So Leah took the 30 day warning letter in my book, and this is what I love. I love the flair, the way she did this because she brought her baby in the stroller into the pediatrician's office, she had the letter printed out. She went up to the front desk and she said, hey, I want you to sign this letter acknowledging the receipt of this notice that I'm going to sue you in 30 days if you don't correct this mistaken medical bill. Of course, that got everyone all alarmed behind the front desk. They took it to the back. Everyone's all in a frenzy because this is happening in front of other people in the waiting room. It's very awkward, it's very uncomfortable. But she's just matter of factly saying, we have tried to correct this the right way and you have not corrected. You're continuing to send me a bill for more than $1,000. That's not okay. So here's my notice. Please sign, sign here. And of course, I think they refused to sign it, but they took the letter. And then she got a call back a few days later and they corrected the bill and they got the thing taken care of. They don't want the accountability, they don't want the hassle. And so sometimes we need to be the parent in this relationship. It's not fair that we have to do this. It's not right that we have to do do this. But this is a situation we find ourselves in where we are dealing with a financially predatory healthcare system that continues to charge us for things that they shouldn't be charging us for, continues to bill us for prices that are not fair. And so if they won't correct it the nice way we might need to step in and assert some discipline on the situation. Nicely, lovingly, call it tough love, but we can do it. And when we do, do usually they crumble. And that's what's interesting about it. They usually crumble. And the reason they crumble is because they do not have a leg to stand on. This is morally wrong. And this is where I think, through a lot of the power we have, there is a lot of moral force behind a person who is in the right with what they are doing. And so the entity that's in the wrong does not have a leg to stand on ethically or morally. And so when we make that argument to them and maybe add some additional leverage and press pressures so that they begin to understand why this is in their best interest, we have a lot more power than we think. And there's a lot of power just in the insistence of pressing them to do what's right. And so that's what we often need to do.

That's awesome. Now I'm feeling hopeful and somewhat glad.

That we have, I hope, empowered. I hope empowered. So the other thing I'm doing, actually, that I want to mention to your audience is I've turned the book into a series of health literacy videos.

Okay.

And a lot of people aren't going to read about book or a book is not going to be the way they engage with this information. And my goal is to bring this to scale. And so I've turned the book and the principles into a curriculum. It's 16 videos. Each video is about five minutes each. It's available at allenhealthacademy.com and I created Allen Health Academy to boost the healthcare literacy for working Americans and any individual who wants to learn how to better navigate the healthcare system to protect their money. So it's like a personal finance course related to healthcare spending. And there's scholarships available. If anybody has a limited income, they can pay a lower rate. They can pay what they want for the videos. But my goal is to build this knowledge so that it becomes mainstream, so that people can be protected. But also because I think we have the numbers on our side. We have, say, 200 million Americans who are afflicted by this permission problem. If we had 1% of that number get equipped and get empowered and demand an itemized medical bill, sue when we get unfair medical bills, I really think it would have a lot of power and a lot of force in the market to bring about the change that we really need in healthcare. I think would make things A lot more fair for the American people.

Highly recommend the book. I'm on my second time now. I think it's an important piece. Regardless of whether or not someone has a bill like you said said they need to be prepared for when that bill comes. So we'll put a link to the book in the show notes. Highly recommend you buy it. It's actually one of those books that you can gift to other people, especially young couples. People shouldn't wait until they're 45 to understand that all those years you could have purchased it. We'll put a link to the academy as well. Just to end off with a couple of questions. We did mention debt collections. I want to ask as it relates to a credit score. There's that myth out there and I'm curious, will medical bills affect a credit score in one way or another?

So I'll have to fact check this because I don't want to say something that's wrong, but I believe they just passed something that now says that medical debt does not affect credit scores. But in the past it has. So my answer on that is I'm going to have to look that up and get back to you for that.

Exact answer because that's something that like, yes, it's gone to collections. I don't have the money right now. Even going on a payment plan is stress inducing. People do have that question. Are there any topics that maybe we didn't discuss that you think are worth discussing? Any closing remarks?

We can talk a little bit about what to do with debt that's in collections because I think that still there are some important tactics that people can take there. You can go through the same process that I lay out in the book to identify what was fair with the bill and whether the pricing was fair and whether the bill was accurate. You can make those same arguments. And if it's been sold to a debt collector or a debt buyer. So let's say it's out of the hands of the hospital or the doctor and it's years down the road and you're being called by these debt collectors. What you need to know is that debt has been sold for maybe $0.05 on the dollar, much, much lower than the sticker price of what you owe. So if you owe $1,000, that debt buyer probably bought it for about $50. And so your go situation is to negotiate a much, much, much lower payment than the sticker price of what you owe. And you want to be careful that you do not enter into an agreement that you cannot abide by that you can't keep. Don't ever get into a payment plan that you're not going to fulfill because if you do, let's say you negotiate a discount, but then you fail to meet your payment plan, they will immediately send it back up to that sticker price because you violated the payment plan. So just hold off on it. And now you're in a relationship with this debt collector that you want to have a negotiation with the debt collector. And I think it's important to humanize yourself and humanize that debt collector as much as you can. It does. It isn't going to do you any good to call them names or yell at them, you know, it just isn't going to help. And so as much as you can, you want to tell them, hey, I'm really sorry, I don't have the funds right now to pay this debt. Is there any way we can reduce, reduce the amount that I owe so that I can start thinking about trying to scrounge up some money and bring it together and pay it? And they might give you a little lower price. I mean if talking to experts in the field, they said if it's say $1,000 bill and they bought it for $50, you want to pay about 15% of the total of what you owe. So you want a big discount on this, not 20% discount, 50% discount. You want to go for as big a discount as you can get. And then if you can pay it off in a lump sum, they are more likely to give you a better discount. But try and get that negotiated down to a payment plan that you can afford. And if you can't afford it, then let it go and let them wait on it. Make them think they're not going to get anything from you so that that will then incentivize them to bring that bill down lower and lower.

This has been awesome. Enlightening. When I have to go through the episode to make sure all is fine in terms of the audio and video, I can see myself with a pen, you know, sort of jotting down little tidbits. And there is a lot in this book that we've not discussed and I think the templates are super helpful. And like you say, you want to hear about the victories, right?

Yeah.

If anyone does have a victory, I'd love to know about it as well if it came about through this episode. And what's the best way if someone has a follow up question, are you available for hire? Because people are, they're going to come out of the Woodwork works. And a lot of people could save, like you said, thousands of dollars.

Yeah. So people can reach out to me@marshallallen.com okay. I love to help people. I even again, through my newsletter, I've raised money from subscriptions to my newsletter to hire patient advocates for people. So that's something I do. If people have a really complicated case, I have funds to help hire patient advocates. So obviously I won't be able to do that for everybody. But if somebody has a case that they need help with, let me know. And often what I'll do is I'll point people to the resources in the book or my videos. And I have people I'm helping every day with these things. So I love to do it. And until it becomes overwhelming for me, I'll continue to do it. Because for me, it proves the concept. Right? I mean, I'm showing every day. And in fact, I encourage people read the Amazon reviews of the book because it's really fun to read those because a lot of times people put in their Amazon review, I use this book and I saved hundreds of dollars. I saved thousands of dollars. I pushed back and saved this amount of money. But that for me is like the most satisfying thing. I mean, it's really fun because I wrote a book about it, but also just because everybody loves When David Beats Goliath and it is empowering and people are learning these things and it's becoming more understood and more mainstream. So I do encourage people to reach out to me via my website is the best way. LinkedIn is great, too. And I also want to mention there's three chapters in there for employees. There's so much employers could be doing right now. And so I think between employers and employees, they have the power to really transform our healthcare system for the better.

When's the documentary?

Oh, I'd love to do a documentary. Yeah. If anyone's interested in that, that would be super fun to do. But the book has just been the starting point. Allen Health Academy and the videos is kind of the next level. And yeah, we're going to keep pushing on this thing.

We got to connect you with someone at cnbc.

That'd be a blast to.

Yeah, that can make for some good ratings. Well, thank you so much. Marshall came all the way from the other side of the US and we appreciate.

My pleasure. Thank you.

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