S6 E98: Should I Pay That Medical Bill? ft. Marshall Allen

But if you're in that working family type of middle class range of income, all hospitals, nonprofits, hospitals are required to provide financial assistance by the irs. Look up their financial assistance policy. These are not something that you should feel bad about taking advantage of. These are benefits they get because they're nonprofits. So they're saving millions in tax dollars to provide this charity care to pay to families. So look into that because you might qualify for financial assistance for your NICU stay, and that could forgive your medical bill 100%.

This is NICU Baby's Parent Support with Kathryn Whitaker, a podcast from Hand to Hold, a national nonprofit that provides free personalized support, resources and community before, during, and after a NICU stay. My conversations here focus on education and personal stories with medical and hospital professionals, counselors, therapists, and NICU moms and dads from across the country. So whether you're preparing for a NICU stay, you're currently there, or you're months and years past your stay, you belong here. The NICU is hard. We're here to help. I'm your host, Katherine Whitaker, the mom of six children, including my very own NICU Baby. And I'm so grateful that you're here. Howdy, y'. All. Welcome back to the podcast. I'm so grateful that you're here. You know, last week we had a lot of fun, Kelly and I did, about nerding out on insurance and medical billing offices. And I felt like. And also government assistance. I felt like it was a topic that needed even more conversations. So reached out to an author and investigative journalist, Marshall Allen. I wanted to dive into some of the nitty gritty in the healthcare industry. What are some ways that you can be a better advocate for what should be covered? And then how do you uncover bogus bills? The title of his book is called Never Pay the First Bill. And when I saw that, I was like, oh, that is somebody that I need to talk to. So in our conversation, you're going to hear a lot of details about. You should consider this or don't forget about this resource. Marshall gives a ton of resources. I will make sure that we link to those all in the show notes. But this is a conversation, I think, quite frankly, I will tell you, it was really hard for me to find experts to talk about these particular subjects. And so to have Kelly's lived experience last week of what she dealt with as a mom who just encountered the system and learned along the way was so helpful. And I think that Marshall's investigations and his background and the book that he wrote and the resources that he has are going to give you all the tools that you need to be a better advocate on the financial aspect of having a NICU baby, which we all know is a massive part of a NICU stay. So my guest today is Marshall Allen. He spent 18 years investigating the healthcare system as a journalist. He is the founder of Allen Health Academy and the author of Never Pay the First Bill and Other Ways to Fight the Healthcare System and Win. Marshall has been featured on CNN, the New York Times, the Today Show, NPR, and ProPublica. And with that, let's chat.

Well, I'm really excited to have Marshall Allen with me today. You know, Marshall, the healthcare industry and medical billing is not a new topic to NICU parents. So we have a lot to talk about. I'm happy you're here.

I'm so grateful to be here. Thanks, Katherine.

You're welcome. So I. First of all, we're going to start off. You have a book called Never Pay the First Bill, which, by the way, brilliant title for a book. And in the very beginning of the book, you sort of summarize an experience that you had with your own parents and the medical industry. So maybe for those who have not yet read your book, can you sort of give them an overview of what happened to you, personally speaking, when it came to your parents and healthcare?

Yeah, definitely. Thank you. It's really ironic that in the process of writing a book about bogus medical bills and unnecessary medical treatment, I ended up having that happen to my family. But it just shows how common these problems are. So I know people in your audience are entering into this nightmare scenario through the nicu, but this is happening to every working person around the country to one degree or another. And in my mom and dad's case, my dad had suffered from dementia at the time, and my mom had put him in a nursing home. But my dad was very physically healthy, really physically fit, and my mom had power of attorney over my dad. So any medical care that he would receive needed to be approved by my mom. And it would be difficult to do good medical care, my dad, anyway, without my mom, because my mom was his caregiver and she knew everything about his medical history. And my dad really had a lot of cognitive decline, so he wasn't really capable of answering questions. Anyway, those were the strict instructions for the nursing home. Do not do any medical care on my dad and don't do anything without my mom's involvement. Well, lo and behold, my mom noticed when she was looking at a pharmacy bill from the nursing home, A drug, Flomax, that it said on the pharmacy bill, had been given to my dad for about a month. And thank goodness my mom checked those bills, because otherwise no one had told her that my dad had been put on this medication. My mom had also noticed a worsening in my dad's care over the previous month, but she didn't know what it was attributed to. Sometimes you would have good days and bad days. Well, it turns out Flomax can have a negative cause. More impairment for people who have dementia and cognitive impairments. And of course, when my mom saw that he was on it, she had him taken off of it because there was no medically justified reason to have him on that drug. And she asked, how did this happen? And we found out the hard way, because then soon afterwards, she got a medical bill for an examination that another doctor had done on my dad without my mom's knowledge. The bill was for $445. So you had a case of an unnecessary examination done in violation of my mom's power of attorney. Then my dad was put on a medication that caused, or we seem to think caused him cognitive decline, because as soon as he was taken off of it, he really improved in his ability to interact with people. We had this problem, a billing problem, a quality of care problem, a violation of power of attorney. My mom then needed to untangle this problem. Of course, I was working with my mom to do this. My brother was very engaged with my mom. What's so amazing to me about these things? In this case, the nurse practitioner who did the examination apologized right away and admitted that it was an error to put my dad on this medication. But then we had the problem of the medical bill. These billing departments, sometimes they back down easily, sometimes they don't. In this case, they didn't. And so we had to have a lot of meetings. And one of the things I recommend to all patients is that you get your medical records. Every patient has a right to their medical records without charge and the entire medical record. And so my brother, who lived locally there near the nursing home, and my mom went to the nursing home to make copies of the medical records. And it was at that time that the nursing home administrator said, are you trying to shut us down? And my brother said, no, we're not at all. But we're just people who care about what's right and wrong, and we want to make sure that this is handled in a way that's fair to my mom. And then he said, you may also want to look up My brother and what he does for a living. And I think I hate that tainted the process because I always want to engage with the medical system in a way where people don't realize I'm an investigative reporter. And so in this case, though, I don't know that they did look me up. But we got a call back from the administrator in charge of the billing company and he said, hey, look, we decided it's in, you know, it would just be better to let this whole thing go and waive the bill. And so I just nodded and smiled and said, yes, we agree, that would be what's best. And so that's what ended up happening. They ended up dropping the bill. That's what I show people in my book and in my health literacy videos that are based on the book and in my newsletter. I show people how to.

Increase the leverage, gather the evidence that you need to see if the treatment was appropriate, if the bills are fair, if the bills are accurate, if the insurance company is denying payment on something. People need to be equipped to know how to win those appeals with the insurance companies. In most cases, people can win when they conduct these fights, but it can be, sometimes it's easy, sometimes it's very hard. Sometimes it takes months of phone calls, emails making, filing complaints, sometimes filing a case in small claims court, it can be easy or it can be difficult, but it can be done.

As a NICU parent, I mean, in our case we had a 44 day stay in an intensive care situation and multiple surgeries. So it certainly was not. And I'm sure those moms and dads who are listening are like, yes, we have received bills. I think the big challenge, Marshall, certainly if you're brand new to maybe not necessarily healthcare per se, but maybe receiving so much of an influx of, you know, bills from anesthesiologist or specialists or the hospital and what's in network, what's out of network, it can feel really overwhelming. So sometimes we get a bill. In fact, just last week I got two bills and my husband said, are you going to pay those? And I said, no, they're, they're not real. Like, first of all, data service was like a year and a half ago, but I'm just going to shred them because they're not real. And lo and behold, he was like, no, I think you should call. And when I called, she's like, yeah, actually you can just shred them. As people are receiving some of like this huge influx of bills, Marshall, what's your best advice to them? How do you know, when a bill is a bogus bill or when it's a real bill, like, what are some of the steps that people should take to be like, okay, this is a legitimate bill. I need to make sure that the, you know, obviously the things on this, I need to make sure that those are either covered by insurance or covered by the government, or they're not. And now how do I move forward? How do you know if it's real or not real?

Well, there's a few different places you can start, and everybody's situation is different. But some principles that apply here. Number one, make sure that you don't pay a bill if you have insurance until you've made sure that your insurance plan has fully and properly adjudicated and processed the bill. You can find that out pretty easily by calling the customer service number of your insurance company. Those customer service people are pretty good at telling you, okay, was this claim submitted from the hospital or from the doctor? Did we receive it? Did we process it? How much did we pay on it? And make sure you understand, by the way, your plan documents, because you need to understand how much are you supposed to be paying for that co payment? That's the amount that you pay when you go for the visit. How much do you have to pay on your deductible? That's the amount that you have to pay before the insurance kicks in. How much do you owe for what's called coinsurance? That's after the deductible is paid, Maybe your plan pays 80% and your coinsurance is 20%. So you're still on the hook for 20%. And then you have again, these complicated, crazy terms. Right. Then you have the out of pocket max. Well, the out of pocket max, that's the maximum amount that your family is supposed to pay before the insurance plan covers everything, 100%. And I think in your guys's case, with NICU cases, you're going to be hitting that out of pocket max. You're going to be that deductible.

Yeah, first day.

Yeah, first day one, you're going to be having everything paid and having the plan pay. So you should be skeptical of any bills that you're getting from that initial NICU visit. If you have a traditional insurance plan that's really backed by the regulations of the Affordable Care Act. So that's a principle. Right. Make sure your insurance plan is covering it and covering it accurately and then. And that you're not paying more than you should, because sometimes they'll do things like not apply something to the deductible. So there'll be a charge. Let's say Your deductible is $2,000, which means you have to pay 2,000 before the plan pays anything. Well, they'll, they'll send you a bill and then your insurance company won't apply that bill to the deductible. So now it's not counting. So now you're paying more for that deductible than you should be. So you do have to watch these things. You have to know these crazy terms.

It's a form of financial literacy that we don't ever get taught until we have to learn it the hard way. But it does pay off to make sure that you understand what these terms are, how your plan works, and then check to be sure it's how it's being applied. Now another thing that you should know with the NICU is about financial assistance policies. Anybody who is middle income and below and middle by middle income, you know, the median family income for a family of four in the United States is about $70,000. So if you're, let's just say ballpark, you're at 70,000 or below for a family of four, which many people are, half the Americans are at that level. Make sure you check into financial assistance policies because you might qualify for a generous, generous discount or even having your bills 100% forgiven. And this is especially for people who are not on government plans like Medicaid. You know, a low income person on Medicaid isn't going to get hit with these bills because Medicaid covers it. But if you're in that working family type of middle class range of income, all hospitals, nonprofits, hospitals are required to provide financial assistance by the irs. Look up their financial assistance policy. These are not something that you should feel bad about taking advantage of. These are benefits they get because they're non profits. So they're saving millions in tax dollars to provide this charity care to families. So look into that because you might qualify for financial assistance for your NICU stay and that could forgive your medical bill 100%. So in other words, it disappears, which.

Could change your life.

It could change your life. So let's say your out of pocket max for Your plan is $8,000 and you're a middle income family, that makes say 60,000 a year. $8,000 is going to hurt you financially. You can't afford that. So if you can get that bill forgiven, then you don't need to pay anything for it. And I really want to recommend and encourage that Everybody look up a charity called $4. It's $like-o l l a r4f o r.org and $4 is a, is a non profit that will do all of this for you. So they will do it for free. All you have to do is work with their people. At $4, they'll apply for financial assistance on your behalf, they'll follow up on it, they'll check in with the hospital to make sure that they're properly applying their policy. And again, they save you possibly tens of thousands or hundreds of thousands of dollars. So I encourage everyone to look into that.

Thank you. I know that you mentioned in your book that the negotiated rate that insurance companies have with hospitals can vary pretty widely. So how do you know, or is there a place, Marshall, that people can go to say in some cases they may have a choice into which hospital they take their child to? This may be either, you know, post nicu, maybe they're going to be rehospitalized, or they have a choice in which hospital their baby is at and they can like comparison shop a little bit. And this may be for future surgeries. But how do you know what hospitals are charging for what service? You know, for the same service? I'm assuming that can vary widely. But how do you know what one hospital versus another is paying for that particular service and what your costs are going to be? This podcast is produced by Hand to Hold, a national nonprofit. But we're more than simply a podcast. Be sure to download our app in the Apple Store or on Google Play or you can visit our website to discover all the ways that we can support you as a nicu parent. @handtohold.org you can join one of our support groups, sign up for counseling, find loss and bereavement support, request a peer mentor, or check out our educational resources and family stories. And all of that is at no cost to you.

You're right that it can vary a lot. And it can vary based on the type of insurance plan you have or if you're a cash pay, self pay patient. There's a few different places that we can now look and this is all in the process of improving. There was a rule called the hospital price transparency final rule that was became effective at the beginning of 2021. And this rule says that hospitals are required to post their prices, all of their discounted insurance company prices, on their website in a searchable form and on a spread on a spreadsheet. About half the hospitals say are complying. They're not all complying but many of them are and what we're seeing now is massive price variation between hospitals for different services. So there's an app called Billy and that is you can just google Billy app hospital prices and it'll pull it up. I think the website is apptribilly app. I'll look up that website. So that's the exact one and we can get it in your show notes. But what Billy does. These are some data wizards who have scraped hospital websites and they have a map, they'll show you a map in your town of hospital prices based on the type of service that you need. And it's important too that people understand whatever the services they need that there are billing codes associated with those services. And as much as you can, you want to get those billing codes so that you can look up and really do an apples to apples price comparison. It's, it's challenging sometimes to do it on the front end because you don't always know exactly what the services you're going to need. And so it's easier to do on the back end once you've received that bill. So this is something that is done more and more on the front side of things with the services that we need and on the back end after we've received the bills. There's a couple other places I want to point you to. Jason Health does lab services through independent contracts with labs. A lot of times if you get referred for a lab for your child and they just refer you to the lab center at the hospital, Hospitals are by far the most expensive place. Worst place to, yes, worst place to go, it's just going to be way more expensive. So let's say you're on a high deductible plan and let's say you're in year two. Okay, so you've met your deductible and your out of pocket max for year one when you had that first, first NICU stay, but now it's year two and you're doing some follow up visits and they say, oh well, we need to have this basic lab panel done for your child. Well, you can go to an independent lab and get a much, much better price on that. And if you're on a high deductible plan where you have to pay all those dollars out of pocket, it might make sense for you to pay out of pocket and do it through an independent lab rather than go to the lab where your hospital refers you. And that's also true for imaging tests like MRIs or CT scans, X rays, anything like that ultrasounds at an independent lab or, excuse me, imaging center. The prices are going to be way better than if you have that done at the hospital. A company that does imaging is called Green Imaging. They do direct contracting with imaging centers around the country. You can also just look up your imaging center. They're usually right next to the hospital. It's not inconvenient to go to these places. It's very convenient if you know, okay, I need a CT of the abdomen and, and you have the billing code, it's usually a five digit code for that particular service. Well, then you can call the imaging center and say, I need a CT of the abdomen. What's your cash price for that service? And then you can compare the prices before you go get those services.

Yeah, the code that you're talking about for, I mean, most NICU moms know this, or you're about to learn that the CPT code is what it's called. So that's like the actual number. I remember, Marshall, there were a lot of times that we would be in doctor's offices and one I would say, hey, is there a cheaper place that we can go get, as a matter of fact, blood drawn or what. What. How did y' all build this? Like, how did you code it? Because what we found is as we would go back to the same doctor's office and let's say we were having the same recurring problem. I decided there's gotta be a way to cut this off at the past. And so I would start asking before they ever left the room, how did you code that? Just, just so that I know. And then so many times we would catch it there. Instead of me having to spend 45 billion hours on the phone with the insurance company.

Yeah.

Going back and forth between them and the doctor's office to get it coded. Right?

Yeah. And I think the folks like you who are dealing with the healthcare system a lot have a lot more experience dealing with these things than people who don't have to deal with it in a routine way. And so one thing to look for with those routine visits is how are they coding those visits? Because they can code it on a level one to a level five. A level one office visit is for the simplest type of care. A level five is for the most intensive care. But a level five, that's really like a life or death situation, you know, they shouldn't be coding something that's routine as level four or level five. But you see it happen all the time in medical billing where it's called upcoding. And honestly, this is a fraudulent practice because what they're doing is they are using a code that does not accurately describe the services that were provided to the patient. And so by checking that, you can get the prices dropped by a lot of money by dropping it from a level five to a level three or from a level four to a level two. And you know, we're not medical experts, so we can't just always say, oh, that was definitely a level three and not a level four. But some of these are extremely unreasonable and extremely obvious that even a layperson could see it where, you know, you take your child in for a regular checkup and they bill it as a level five, like it's a life or death situation. And they did like a five minute examination, didn't even do any procedures or anything like that. You're like, this is not a life or death situation. And that's also where I encourage people get the medical records. Because the medical records are documented by the clinician that's providing the service and they are required, their license is on the line for their accuracy in their medical records. And so the juicing of the codes doesn't happen by the clinician, it happens by the billing department. So that medical record will show this was a five minute routine checkup, a follow up visit. No services were performed, no examination, no lengthy medical history. Well, that's shown in the medical record. Then you can take that record and you can call the billing department and say, hey, you know what? The records don't show that this was a complicated case. You can't bill me for something that didn't actually happen. We need to notch it down a couple pegs and go down to the level one or the level two, not the level four or level five. And that will save you a lot of money.

No, I think it was just after our son's birth. It was an emergency C section. And I remember getting the bill and thinking, this feels hot. I mean, it was our fifth baby, so it's pretty familiar with how much it costs to have a baby. And so I asked for the medical records. Lo and behold, when we went through the medical records, I found out that they, like, there were some double charges in there, but also some medication that they said that they gave me that they didn't. But had I not asked for the records and actually we, we even had to go into the nurse's notes because it was in the or. Yep. So I remember when we went back through that and we got like $700 back. And so I love that you're encouraging people to. To ask the question. So here. Here's a question for you. So if you know that something's wrong or you know that maybe there might be a discrepancy. Marshall, how are you assertive, but not so assertive that they back up and they don't want to help you anymore? Because sometimes it gets a little heated, like you get a little frustrated. So how do you sort of put your foot down and stand up for yourself, but also making them an advocate and helping you solve the problem?

That's a really important question, because one thing you don't want to do is burn a bridge with the one place that you are depending on to provide you or your child the care that you all need. And so we're really between a rock and a hard place in these situations. So what I try and do is, first of all, always be polite. Always be professional. Don't make big accusations. It doesn't do any good to put that billing department on the defensive. But what I do is just appeal to what's right. And I think there's a lot of moral force behind standing up for what's right and for what's true. And so I try and appeal to what's fair and what's accurate and to what's true.

And.

And what I found is that people can't win that argument, because if you've done the work that I show people how to do or that you've been doing, Katherine, you know that what you have is right, because you're looking at the medical record. The medical record doesn't document this medication being provided. And yet there it is on the bill. I'm being billed for something that I didn't receive. And we would never stand for that at the grocery store or at a restaurant or if anybody billed us for something that we didn't receive, we would quite simply say, you know what? That's really not right, and that's not fair. And so all I'm asking is that you treat me with the same fairness that you would want to be treated with. And what I found, you know, that strength, you know, again, we can be intimidated, too. It's a doctor. It's a hospital. We're just an individual, lowly mom or dad. What do we know? Right? Well, we know enough to look at common sense and say, you need to stand up for what's right. And there's a tremendous amount of power, Power behind an individual person standing up for themselves and standing up for what's right. And then I also try and appeal to just the, the expense, right? I try and tell people like, wow, this is a 200 charge for this medication that my child didn't even receive. I'm on a tight budget. I, I wish I had enough money to just give you an extra $200 for something I didn't receive. But I have like, in your case, you have five kids. I have three kids.

I.

All three of my kids right now are in college. So I would be like, I'm trying to pay college tuition for my boys here and help them out so that they can get their life started off the right way. That extra $200 is really painful for me and my family. Could you please just remove that? Since that wasn't a service that my family received. And what I found is that first of all, everything is negotiable. The prices in health care are all made up to begin with. This is not concrete stuff, okay? So if anybody tells you that it's not negotiable, they're wrong. It's absolutely negotiable. So everything's negotiable. You know, kindness wins people over. Appealing to what's right wins people over and then trying to relate to that person. So trying to just say like, I don't know, I don't know. Your family probably would have a hard time paying 200 too for something that you didn't receive. And when all else fails, if they still won't budge, hang up the phone and call back again. And you might get a different customer representative on the phone and they might just immediately be like, absolutely, I'm so sorry about that. And then they waive the 200 charge. So a lot of times these things can get fixed. In fact, I would say almost all the time these inaccuracies can get fixed. The bigger challenge is when they're just overcharging to begin with because they like to say, oh, well, this is the price that your insurance company agreed to with us when we provide this service. Well, now with, with price transparency, we can see that the charge that they're billing us is unfair because a different patient on a different insurance plan or even a cash paying patient might have been charged a much lower price. And so another argument that I make in my book is it's not fair to charge one person more than another person for the exact same service at the exact same facility. That's price discrimination based on our insurance, and that's not right. And so that's another one where when they tell Me? Well, you know, your insurance company agreed to this. I say, look, we have an agreement here between my insurance company, my hospital and me. I need to be consulted as well. There's no agreement without me agreeing to it. You can't make an agreement where you two come up with a number and then tell me to pay it, no matter how much it is. And so there's again, a strong moral argument there that this is not ethical and that it's not right. And you do see that these things can be negotiated and can be corrected when we have the evidence, and then we appeal to the evidence and just appeal to what's right.

So when you talk about. Thank you for that. When you talk about the negotiation part, like, what's up for negotiation? Can you ask a medical billing office? Can you say, like, hey, I don't have a lot of cash, but if I were to pay that bill in cash, would you give a discount? Like, give, give people some ideas of what you can negotiate. What, what's within your range of asking? We, by the way, we've done that.

And you can a lot of times. Look, the, the out of pocket costs have gone up so high for patients that doctors and hospitals are having a hard time collecting because the prices are so out of reach of most American families that people can't afford to just fork over 1,000 or $2,000. Studies show that about half of Americans don't have more than about $400 in their bank account at any given time for an emergency. So hospitals and doctors to begin with realize they might not get anything from you. So if you tell them, hey, you know what, I can scrounge up the money and pay off a lump sum right now, but I need to get a discount on that to make that happen. So could you drop, could you cut this bill down? And I would expect a discount. I would be thinking big discount. Like if they throw you a 5% or a 10% discount, that's chump change. We're talking 50% or more is really where you should be thinking when you're looking at discounts for paying off these bills. And again, if they say no, then just say, okay, I guess I'll just have to wait. Don't give them anything. And again, I'm not saying don't pay the bills, but what we need to do is make sure that the bills are fair and accurate before we pay them. So that's what I encourage people to do. Negotiate and realize that you should be able to get a discount on those bills.

Man, I could ask you so many questions. So, in fact, a bunch of them are answered in your book. So if you haven't gotten Marshall's book, Never Paid the First Bill, it's really, really good. It has some great practical information in there. It's really broken up into some great chapters. Marshall, thank you for writing it. I always ask this question as my last one because I think your wisdom and your life experience is always worth a lot, particularly for our listeners. So if there is a family listening to this and they are feeling very overwhelmed by the amount of bills and just the whole process of having to figure it all out, what would your best advice be to them as they encounter this new season?

Well, I have good news for people. Okay, So I have. I raise money through my newsletter to hire professional patient advocates for families who are in really, really difficult circumstances. So I would encourage them to call me, reach out to me, and let's see if I can hire a professional patient advocate to help them, you know, if they have a NICU stay and they're just overwhelmed and can't figure out what's going on with their bills, if. If I can't. A lot of what my resources do is help people help themselves, you know, by getting educated, getting equipped, learning how to advocate for themselves, understanding the perverse incentives in the system, and how to not get caught up in those financial pitfalls. But if it's a really crazy case, you know, where they just are, you know, up to their ears and red tape and trying to care for sick children and everything else, reach out to me, and let's see if I can hire a patient advocate for you, because if you don't have the money, maybe I can hire one for you. If you do have the money, a patient advocate, they'll usually charge between, say, 100 and 200 or $250 an hour. So they are expensive. But what they can do is take that burden of all the red tape and all the billing confusion out of your hands, advocate for you with the doctor in the hospital. And usually these cases, at least on the billing side, can be resolved with within about, let's say, on average, five to 10 hours of their time. So you're looking at a charge of under $1,000 or $2,000. It's expensive, okay? So a lot of people can't afford it, but it's worth it because you can have that advocate find an avenue to get the coverage that you need to get your bills dropped down to make sure you're not being taken advantage of. So I think the one thing I would advise people on. Well, there's two. One is, first of all, you can figure out a lot of this stuff on your own, and you have got to do it. I just urge you to, because even if you meet your out of pocket max on that NICU stay, you're going to be raising these kids and taking care of your family for the rest of your life. These are skills that will pay off over the years. You will save thousands of dollars. So it's definitely worth learning these financial literacy skills. And then if you are overwhelmed and in a really bad situation and just can't figure it out, reach out to me or hire a patient advocate on your own and let's get you the help that you need.

I love that, Marshall. Thank you. I didn't know that you had that. So if people want to connect with you outside of patient advocacy, what are some ways that they can find you or connect with you online?

So if you want to message me, my website is marshallallen.com that's a really easy way to get in touch with me. I read all my messages, I respond to them. My. My newsletter is a great way to kind of keep up with regular, ongoing tips that I provide people. That's@marshallallen.substack.com and then, of course, I have the book, if people want to read the book that's on Amazon or wherever you buy books. And then I turn the book into a series of health literacy videos. So if you want to watch videos and use that kind of different form of engagement to learn, the videos are@allenhealthacademy.com and this is something I do for employer groups. I'll do talks for employees. I do talks for advocacy groups. So if anybody ever wants to do a webinar or something like that, that's something I love to do as well. So I'm having a lot of fun helping people this way. It's really, really satisfying to people to have people have David stand up to Goliath and win. It's really satisfying. So I love equipping people and empowering people in this way.

Well, it does feel good to sort of conquer the thing that you think is never conquerable. And you do it and you're like, hey. And now, like you said, those skills are transferable not just in the NICU, but for every medical encounter that you may have. So, Marshall, thanks for such great adv and wisdom and so many excellent resources. We appreciate it.

Well, I hope that all of Marshall's advice is going to be something that you can put into action today. In today's two minute take, there was.

Negotiate, negotiate, negotiate. That may have been my biggest takeaway from today's conversation. You can negotiate anything. The worst thing that someone is going to say to you is either no or they're going to counter with something different. But there is no shame and there's nothing to be lost in asking, can we cut that bill in half? Can I pay that out over a different payment system? Can my monthly payment look different than what you have pre calculated it to be? I think the biggest thing for me is when we were encountering a ridiculous amount of bills all at the same time is that they all wanted to be paid and they had a certain payment amount. And I remember looking at them saying, I can't pay 20 bills this month. It's not possible. I mean, we are not made of money. And even if we were, this would be an exorbitant amount of things to cover. And so we started negotiating and I started saying, like, all right, this is what I can do. And I say, because I can't give you money that I don't have. So negotiating and I think appealing to people's desire of what is right. I thought that was excellent advice that he gave. You know, Kelly mentioned it last time when we talked about empowering the person on the other end of the phone to help you solve the problem, believing that, hey, I believe that you were going to help me solve this problem. And I think Marshall's addition to that is I'm going to appeal to what is right here. This service that you're charging me for or this, this medicine that you administered actually didn't happen. And so I'm choosing not to pay for that because it's a service or a medication that we didn't receive. And so I think that you can understand why we're not going to pay for that or why we don't think that we should be charged for that. So appealing to people's rottenness, I think can go a long way in helping you have good, constructive conversations when it feels very overwhelming. And then the last thing, and he mentioned it here at the end, but ask what's available. There is, are so many assistance programs that exist in your hospitals. Y' all, don't be, don't be ashamed. Don't feel like, oh, I don't want to, I don't want to ask you, you should ask. No matter what your income level is, no matter whether you have insurance or no insurance, ask what programs are available to you, because that's why they exist, to help you pay your medical bills. And y', all, you have a lot. I have no doubt that the stack of bills that you have is pretty impressive. And so ask what's available. It's there for you. I will say that after my conversation with him and really after starting to read Marshall's book, it kind of inspired me. There's a medical procedure that our son has to have on a fairly regular basis. And I always think when I get the belt that feels high, I wonder if it should be that high. And so I'm going to take my good advice from both Marshall and from Kelly, and I'm going to do a little bit of investigation to figure out, is that covered? Could we get more paid for that? Is that the cost that we should be paying for that? I think it's just going to give me some peace of mind. And like Marshall and I said, all these skills that you're learning as an acute parent, they are not going to go away, y'. All. You are going to get older and you're going to have to do that maybe with your parents, with other family members, with children who get broken arms and all sorts of other things that just live in is meaning that you're going to encounter the healthcare system and other avenues. And so these skills are definitely transferable and they are not going to go away. You are becoming such a smart person, y'. All. This is what the NICU does to you is it equips you with so much knowledge that you did not yet know that you needed. But what a gift, right? These two conversations, such a gift. I have really enjoyed them. If you've loved them, if you've gotten some great wisdom from them, some good practical advice, and you're enjoying them, please give us a rating over on Apple Podcasts or Spotify or wherever it is that y'. All. Listen to your podcast, watch us on YouTube. That's always fun. You can see our faces and hear what we say. And, yeah, definitely share it with. With someone that you love that you think may benefit from it. You know, we are going to switch gears a little bit, and next time, this is what you're going to hear.

I think the best day, I mean, I think the obvious answer would be, say, like, the day she came home. She came home on Easter, but probably was when I got to do Skin to Skin. My wife was the first one that got to hold there. But I remember the first day I did Skin to Skin, I had, like, a specific shirt that it kind of, like, had a pocket that she. That I got to hold her with. And I don't know, it just felt so cool. Like, it was, you know, like, a process because she had all the wires on her, like, getting her into, like, my arms and stuff. But I just remember, like, holding her for, like, the first time and probably just crying. But it, you know, I just felt so grateful. And I think that was, like, the first, like, real hope I had.

Sam.