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00:01:34.600 | Hello, and welcome to another episode of All The Hacks, a show about upgrading

00:01:44.040 | your life, money, and travel all while spending less and saving more.

00:01:47.840 | I'm Chris Hutchins, and I am excited to have you on my journey to find all the

00:01:51.280 | hacks.

00:01:51.760 | Now, in a normal year, my experience with our healthcare system just includes a

00:01:56.320 | visit to the doctor, maybe some blood work, a couple dental cleanings.

00:01:59.760 | But 2021 was a bit different.

00:02:01.880 | Between fracturing my foot on a wedding dance floor and a random case of

00:02:06.000 | shingles, I've had three visits to the ER, which came with some interesting

00:02:10.400 | medical bills.

00:02:11.120 | So I am really excited to be talking today with Marshall Allen.

00:02:15.240 | For over a decade, he was a reporter at ProPublica investigating the cost and

00:02:20.640 | quality of our healthcare, and his work has been honored with several journalism

00:02:24.440 | awards, including the Harvard Kennedy School's Goldsmith Prize for

00:02:27.560 | Investigative Reporting, and he was a finalist for the Pulitzer Prize for

00:02:31.480 | Local Reporting.

00:02:32.240 | But most importantly for today, he is the author of a new book called Never Pay

00:02:37.080 | the First Bill and Other Creative Ways to Fight the Healthcare System and Win.

00:02:41.440 | So we're going to get tactical and talk about how we can all push back about the

00:02:45.480 | high cost of healthcare, including negotiating with doctors and insurance

00:02:49.000 | companies, picking the right plan with our healthcare, preventing expensive

00:02:53.280 | bills before you get care, and the tactics you need to negotiate any bill

00:02:57.560 | you get.

00:02:57.960 | So without further ado, I hope you enjoy my conversation with Marshall Allen.

00:03:02.520 | Let's get started.

00:03:03.680 | Marshall, thanks for being here.

00:03:08.000 | Thank you, Chris.

00:03:09.520 | I'm really excited to be here to talk about hacking the healthcare system.

00:03:12.800 | This is going to be fun.

00:03:13.680 | Yeah, I want to just start off asking what led you to dedicate so much of your

00:03:18.360 | career to researching and writing about healthcare?

00:03:21.400 | You know, it's actually an accident, Chris.

00:03:23.200 | I had no intention of covering healthcare.

00:03:25.480 | In fact, I thought writing about healthcare would be extremely boring.

00:03:28.800 | And when my editor at the Las Vegas Sun newspaper asked me, took me out to lunch

00:03:33.680 | one day and asked me to cover healthcare, this was in 2006, I actually, my first

00:03:38.800 | words were, I cannot imagine anything more boring than writing about healthcare.

00:03:42.400 | And I quickly realized how wrong I was because I started doing stories from the

00:03:48.680 | perspective of the patient who has to engage with the healthcare system.

00:03:53.320 | And I definitely have an investigative bent to me.

00:03:56.800 | And I also have a very people focused value to the journalism that I do.

00:04:01.240 | So as soon as I started looking at our healthcare system from the point of view

00:04:04.680 | of the patient who has to navigate the system, which is completely fractured,

00:04:09.160 | overcomplicated and opaque, and they have to navigate the system.

00:04:15.560 | They have to pay for the healthcare they received.

00:04:17.920 | And it's completely overpriced, unjustifiably overpriced.

00:04:21.560 | And they have to navigate the safety and the quality of the system, which

00:04:25.800 | is very difficult to tell.

00:04:27.160 | And unfortunately, medical errors are a leading cause of

00:04:30.040 | injury and death in this country.

00:04:31.760 | So as soon as I started writing about healthcare, looking at the quality,

00:04:35.560 | looking at the safety and looking at the cost, I found that I was able to do

00:04:39.880 | stories that immediately had a lot of traction with, with the audience.

00:04:44.120 | They could really help people right where they're at.

00:04:47.320 | I could stand up for people who are being taken advantage of.

00:04:50.440 | And so it's been really satisfying these last now 15 years of digging

00:04:56.320 | deep on our healthcare system.

00:04:58.000 | Yeah.

00:04:59.400 | And was there a moment in this career that you said, now's

00:05:02.520 | the time I have to write a book?

00:05:03.760 | I started feeling after I'd been at ProPublica for about five or six years,

00:05:09.400 | you do enough of these stories about outrageous medical bills, and you dig

00:05:14.800 | into people's medical records, you share the records with experts,

00:05:18.640 | you share the bills with experts.

00:05:20.480 | I started to learn more and more about how the system actually works instead

00:05:25.640 | of the ways that we're told that the system works or this facade that's

00:05:28.920 | been built up around the system.

00:05:30.400 | So I began to get a deeper understanding of the system because I talked to thousands

00:05:36.320 | of experts and patients over the 15 years.

00:05:39.680 | And then I dug into hundreds of cases of individual patients who had been just

00:05:44.400 | completely screwed by the system in one way or another, I saw there's a complete

00:05:49.160 | lack of accountability and I looked at it across a broad level of stakeholders.

00:05:54.520 | You know, I was talking to doctors, insurance companies, patients, hospitals,

00:05:58.240 | but always looking at it from the point of view of the patient.

00:06:00.880 | So I realized, okay, I have a lot, I have a lot to say here, I've learned a lot.

00:06:05.280 | And I'm getting at the same time, emails and phone calls almost every day from

00:06:10.320 | patients who are having their lives utterly wrecked by our healthcare system.

00:06:15.520 | And so let me just throw out some statistics because I think it's important

00:06:19.120 | to ground the conversation about what an urgent problem we have here.

00:06:22.560 | First of all, we spend about twice as much per person on healthcare in the

00:06:27.800 | United States compared to the citizens of any other developed country.

00:06:31.880 | In other words, the problem here isn't that we're not spending enough.

00:06:35.640 | In fact, we are spending twice as much per person than citizens of other

00:06:39.800 | countries, and we still have about 30, 40 million Americans who

00:06:44.320 | don't have any insurance coverage.

00:06:45.920 | We probably have about that many more who are what I would

00:06:48.800 | call functionally uninsured.

00:06:50.400 | Which just means that the health benefits they have are so thin that maybe they

00:06:57.000 | have a deductible that's $5,000 or $3,000 a year, but they only make $60,000 a year.

00:07:03.320 | So if you're making 60 grand, you're paying out a monthly premium for your

00:07:07.600 | health insurance, and you still have to pay the first $3,000, $5,000, some people

00:07:14.080 | are on a high deductible plan that makes them pay the first $10,000.

00:07:18.120 | In that case, they are functionally uninsured.

00:07:21.240 | They're only going to use those benefits if they have some catastrophic accident

00:07:25.280 | and they're paying everything out of pocket.

00:07:27.080 | Now, when you have that problem, now you get these massive bills, which are

00:07:32.480 | unjustifiably high in many cases, full of errors, as I found through my

00:07:37.720 | reporting and talking to experts.

00:07:39.480 | Now, people that have these high deductibles where they pay the first

00:07:43.160 | dollar and the bills are outrageously high, they cannot afford them.

00:07:48.600 | And now we have a problem of medical debt.

00:07:50.640 | So one out of every three Americans right now has medical debt.

00:07:54.560 | And one out of every five Americans has medical debt in collections.

00:07:58.520 | So these numbers are staggering.

00:08:01.920 | It is a travesty what's happening to the American people and working

00:08:06.320 | Americans are hit the hardest.

00:08:07.760 | And so that's why I decided, okay, I'm going to put all the tips I've learned

00:08:12.000 | into a book and where I haven't learned the tips, I'm going to go find the

00:08:16.240 | experts who have the knowledge that I can share with the audience and in each

00:08:21.840 | chapter, I'm going to show here's a common problem people have with the

00:08:25.880 | healthcare system, and here's how to tackle it and here's how to fight back

00:08:29.920 | and win the key words in my subtitle in my book and other ways to fight the

00:08:35.200 | healthcare system and when we're talking about winning here and the way I define

00:08:39.720 | winning is we should be paying much less for our healthcare and getting much

00:08:45.160 | better healthcare than we're getting right now.

00:08:47.040 | So I define a win as saving a lot of money while getting better care, not just

00:08:52.640 | mediocre care or denying yourself care, because that's typically what's

00:08:56.480 | happened to people. So it's been really satisfying to write the book and start

00:09:00.840 | getting feedback from people who are putting these tactics into place.

00:09:04.000 | Yeah, I've witnessed some of the high costs in the last few months. It's

00:09:08.840 | crazy. I assume these hacks are not just for people who are in high deductible

00:09:14.000 | plans or who are underinsured. Are there are some of these beneficial to anyone?

00:09:18.560 | They're beneficial to everyone. In fact, with each of these tips, you could save

00:09:23.520 | hundreds or even thousands of dollars per healthcare encounter. The numbers

00:09:28.440 | here are so staggering and I'd love to hear about some of your experiences over

00:09:32.200 | the past year because the numbers are so staggering that if you can even get one

00:09:38.000 | erroneous charge taken off of your medical bill, you might save hundreds or

00:09:42.000 | thousands of dollars. If you can go, a really common one is the high cost of

00:09:46.880 | imaging. So let's say you need a CT scan or an MRI. Your doctor might refer you to

00:09:52.280 | the MRI facility that's right down the hall in the hospital where they work.

00:09:56.480 | Hospitals are the most expensive place to get these scans done. Same with lab

00:10:01.840 | tests. But if you can find an independent imaging center, it may be half a mile

00:10:06.680 | away from the hospital imaging center. They'll do the same CT scan, same MRI,

00:10:11.840 | same x-rays, whatever you need, and you will save hundreds or even thousands of

00:10:16.160 | dollars per scan, and MRIs and CTs being more expensive than the x-rays. But you

00:10:22.600 | can save huge amount of monies just by routing yourself away from the hospital

00:10:26.840 | for imaging tests.

00:10:27.920 | Yeah, I'm fortunate that I have a healthcare plan that makes hospital ER

00:10:32.600 | visits fairly affordable. But you know, that doesn't mean that I didn't get to

00:10:36.560 | see the full prices that were getting charged. And it's wild. I think I saw a

00:10:41.200 | doctor for 10-15 minutes and the bill was like $7,000.

00:10:46.000 | Unbelievable.

00:10:47.600 | And one thing I'll ask is, is there, I'm on what's called an EPO, right? And so I

00:10:53.320 | have a $100 deductible for an ER visit. And so for me, I was like, okay, is there

00:10:58.440 | any benefit to me negotiating that $7,000 bill down knowing that I'm just

00:11:03.680 | paying 100 of it? And what impact would that have?

00:11:06.640 | That's a great question, because it gets at one of the fundamental

00:11:09.720 | misunderstandings I think we have about healthcare when we get healthcare

00:11:14.040 | through our employers. So we need to stop saying and thinking that someone else is

00:11:18.840 | paying for our healthcare. And it's really easy to do because they've taken

00:11:22.680 | the pain away from you of that immediate out-of-pocket cost. You're only paying

00:11:28.000 | that $100. But as our healthcare costs go up, so they're overcharging, and then

00:11:33.760 | the health plan is covering most of that cost, that is still coming out of your

00:11:37.880 | premiums. And so you are going to see a rise in premiums every year because of

00:11:43.200 | these overcharges to your health plan. And so you might not feel that immediate

00:11:46.800 | pain of it coming out of your wallet, or out of your bank account. But year after

00:11:51.400 | year, because of these high costs, we have seen health insurance premiums and

00:11:56.320 | deductibles rise by 5 to 10% a year for premiums. And then we have deductibles

00:12:04.200 | going up at outrageous amounts at the same time. And then the other trick that

00:12:08.200 | they play is they reduce the amount of coverage that you have. And so when you

00:12:12.680 | look at this rising cost of healthcare, this is eating into the compensation

00:12:17.960 | that our employers allocate toward our wages and our benefits. So think about

00:12:22.920 | it this way. When you get hired, you get a compensation package. That

00:12:27.440 | compensation package includes your wages, maybe a 401k or retirement

00:12:31.960 | contribution, paid time off, and hopefully health benefits. The thing is,

00:12:37.520 | our employer isn't actually paying for our benefits. What our employer is doing

00:12:41.800 | is funding our compensation, then that compensation belongs to you and me as

00:12:47.560 | working Americans, right? Now, if our compensation is being consumed by $7,000

00:12:54.880 | bills from the doctor in the emergency room, even though we don't feel it

00:12:59.800 | immediately, because maybe you just have that $100 deductible, you are going to

00:13:04.160 | feel it in the long term, because this is sucking all of the compensation out of

00:13:08.600 | your employers compensation pool, which leaves less money for your employer to

00:13:13.160 | give raises in the next year. And it also causes higher rises in premiums and

00:13:18.000 | deductibles, as I mentioned. And so when economists look at the reason wages are

00:13:23.160 | stagnant in the United States over the last 10 2030 years, the rising cost of

00:13:28.520 | healthcare is a huge cause of wage stagnation. And it's because our

00:13:33.520 | compensation is getting consumed by all of these outrageous and unjustified

00:13:39.080 | medical costs. And so I'm trying to help working Americans see it, see the big

00:13:44.000 | picture. It's not just that deductible or that amount that you pay out of

00:13:48.200 | pocket. It's also the monthly premiums that keep going up, and the wage

00:13:53.480 | stagnation that's caused by our compensation just disappearing because

00:13:58.160 | of high healthcare costs.

00:13:59.360 | Yeah, if anyone out there is listening and has an entrepreneurial itch, I would

00:14:03.920 | love to see you try to turn all of the tips and tricks that Marshall's worked

00:14:07.680 | on in this book and in his career into a product that could just scan my medical

00:14:11.440 | bills and tell me what I should be fighting back against.

00:14:14.800 | Yeah, and this is a big thing now. And it's going to become a bigger and bigger

00:14:19.560 | thing in the coming years. And I predict real disruption is coming for our

00:14:26.680 | healthcare system. It's consuming about one out of every five dollars in our

00:14:31.880 | GDP is from healthcare. It's not sustainable. There's, to me, a lot of

00:14:37.840 | signs of a bubble that's not able to be maintained. And so once employers and

00:14:43.720 | working Americans team up with all of these vendors and entrepreneurs that are

00:14:49.280 | creating these really innovative products that are identifying the problem

00:14:53.640 | and what you can do about it, things I think are going to change pretty

00:14:57.200 | quickly.

00:14:57.720 | Yeah, I don't want to go too deep because I feel like we could spend hours

00:15:01.280 | on this. But is there a succinct way to explain why our healthcare system is so

00:15:07.200 | broken and expensive and we spend twice as much as other countries?

00:15:10.960 | Yes, here's how I would answer that question. If I had to boil it down to

00:15:15.880 | one thing, we have allowed the profit motives that are not unethical or

00:15:23.240 | immoral in other contexts. Let's say you open a restaurant and you want to

00:15:27.720 | charge five hundred dollars for a steak. If you put the price on the menu and

00:15:32.080 | it's a five hundred dollar steak and people want to come in and buy it,

00:15:35.040 | there's nothing immoral or unethical about doing that. But if you overprice a

00:15:40.880 | health care procedure that somebody needs to survive and you don't show

00:15:46.200 | them the price up front, but you hit them with that outrageous price after

00:15:51.120 | they have gotten the procedure they needed to save their life, that's where

00:15:54.840 | the profiteering becomes to me a moral and an ethical issue. None of this is

00:16:00.200 | illegal or much of it is not illegal, but it's not right. I believe it's not

00:16:06.000 | right to charge someone more than you should when all they're trying to do is

00:16:11.600 | get the care that they need to save their life or to heal their body or to

00:16:15.520 | take care of their sick child. So this same profit motive that drives a lot of

00:16:21.240 | the American economy, when it's applied to health care, it becomes really

00:16:26.040 | unsavory and extremely harmful to the American public.

00:16:29.160 | And in other countries, are there ways people solve this that don't involve

00:16:33.360 | the government getting into health care, which I know is a pretty hot topic

00:16:37.040 | here?

00:16:37.360 | I haven't done enough research to speak authoritatively about what's

00:16:42.640 | happening in other countries and how they do it. But what I can tell you is

00:16:45.800 | this, they're spending about half as much and they have much, much better

00:16:50.160 | outcomes in terms of the health of their people. They get the same high

00:16:53.880 | quality medical care, their disease burden is much lighter, their life

00:16:58.320 | expectancy is much longer. And so we are doing it in the most expensive and

00:17:04.960 | not, we're not getting our money's worth when it comes to health care. So I

00:17:09.320 | don't know exactly how they're all doing it enough to say the tactics

00:17:13.440 | they're using that we should employ. But what's clear is we're not doing it

00:17:16.840 | right here.

00:17:17.480 | Yep. So, you know, you mentioned imaging as a big way to save, what are some

00:17:22.360 | other kind of easy big wins for saving on health care before, you know,

00:17:27.840 | ultimately, I want to jump into what happens when you get that bill. But

00:17:30.680 | before you get a bill, what are some of the best ways to start to

00:17:33.440 | preventatively save on your health care?

00:17:35.360 | So there are some principles that listeners can keep in mind to hack the

00:17:40.200 | health care system. First of all, realize that there is extreme price

00:17:44.600 | variation in our health care system. So if you need a knee replacement, you

00:17:49.760 | could spend as low as say $20,000 at one facility, or as high as $80,000 at

00:17:55.920 | another facility. It's that extreme and the quality is not going to be that

00:17:59.960 | different. If you need a medication, you could get a branded medication, or

00:18:05.960 | you could get a generic medication in many cases, that's the exact same

00:18:10.240 | chemical composition as that branded medication, but at a much, much lower

00:18:14.760 | price. And so with each of these decisions, if you know in advance, okay,

00:18:19.240 | where's the best place to get this? Where's the most value based place to

00:18:23.200 | get this? Where's the highest quality place to get this? Then you can begin

00:18:28.200 | asking some questions to pursue the best value care, which by value, I would

00:18:33.360 | define that as the lowest cost and the highest quality.

00:18:36.880 | And how do you research those costs? So let's say I do need a knee

00:18:40.600 | replacement, and I haven't listened to this podcast knowing that $20,000 to

00:18:44.280 | $80,000 could be the range. How do you price kind of compare without the

00:18:49.480 | information?

00:18:51.320 | Hospitals are now required to post their prices on their websites. There's

00:18:55.400 | a federal government regulation called the Hospital Price Transparency Rule.

00:19:00.880 | And they're required now to post their prices for all their different

00:19:04.680 | procedures. And that includes the cash prices. So in other words, if you have

00:19:08.040 | no health insurance, or don't want to use your health insurance, you just

00:19:11.680 | want to pay cash, they have to post the Medicare prices, they have to post all

00:19:16.240 | the negotiated prices for all the different insurance companies that do

00:19:19.560 | those procedures in those facilities. So if you know that in advance, let's say

00:19:24.400 | you need a colonoscopy, which is a very common preventive procedure that people

00:19:28.720 | in your audience are going to need to get at some point in their lives. You

00:19:32.240 | can look now in hospital websites, and if they're following the federal

00:19:35.960 | government's rules, they will have their prices posted. And so you can check the

00:19:40.760 | prices at local hospitals, you can call ambulatory surgical centers and talk to

00:19:45.880 | them and get the prices there. And that's a good way to identify prices.

00:19:50.760 | Another place that we can look for prices, there's a lot of now technology

00:19:55.400 | companies that are producing prices and making these a lot easier to look up. So

00:20:00.280 | look for some of these startups that are producing prices. There's one called

00:20:03.920 | turquoise health, there's one called health cost labs, just Google health

00:20:09.880 | care prices. And a lot of these startups are popping up and they're providing

00:20:14.120 | prices up front. Another tactic, call and ask, call and ask for the cash prices,

00:20:20.440 | especially because often the cash prices are even less than what you would pay

00:20:24.760 | with your insurance plan. And so it does take some legwork up front, you might get

00:20:29.800 | some doors shut in your face as people tell you we can't give you the price or

00:20:33.800 | you can't get the price. But more and more, the prices are becoming available.

00:20:38.440 | And people are offering the prices. So you know, more progressively minded

00:20:43.240 | disruptive health care providers, hospitals and doctors are posting their

00:20:48.400 | prices. So check out something like Surgery Center of Oklahoma. Surgery

00:20:52.920 | Center of Oklahoma is a surgery center that has just posted their prices just

00:20:57.360 | up on their website. And so if you're wondering what you should pay, you might

00:21:01.440 | want to consider going there. Of course, that might require some travel, you

00:21:05.080 | might not want to do that. But you could at least check their prices and see how

00:21:08.600 | those prices compare to prices in your community.

00:21:11.880 | And are these prices, let's say I go to the Surgery Center of Oklahoma, and I

00:21:15.920 | need a procedure and I see a price, are the prices in my local area, if I call

00:21:20.200 | my doctor or local hospital, are they negotiable such that I can say, well,

00:21:23.120 | it's so much cheaper here? Could you do it for less?

00:21:25.920 | Yes, this is another principle that applies to healthcare. So let's say

00:21:30.040 | principle one is, there's huge price variation, and you might be able to get

00:21:34.360 | a better deal somewhere else. Principle number two would be everything is

00:21:40.440 | negotiable. So when they there's a really crazy way they do healthcare

00:21:45.280 | pricing. I mean, it makes absolutely no sense. But when they charge you

00:21:49.680 | something, they make up the charges. It's an outrageously high amount because

00:21:54.720 | what they want to do is take those charges and then apply insurance company

00:21:59.360 | discounts. So usually UnitedHealthcare or Blue Cross or Aetna will apply a

00:22:05.280 | discount. And then that's how they get customers. They say, look, we get you

00:22:09.280 | the best discount at the hospitals in your community or with the doctors in

00:22:13.160 | your community. But those initial prices that the hospitals or doctors post are

00:22:18.360 | fantasy numbers, they are not grounded to anything in reality. And so the

00:22:23.800 | negotiated price that the insurance company pays, it might be 1/10, or 1/5,

00:22:29.800 | or 1/3 of those initial charges. And that's why even on your your particular

00:22:34.680 | bill, the $7,000 bill from your doctor, that might have been a $7,000 charge.

00:22:40.200 | And then that charge got negotiated down by your insurance company and

00:22:44.600 | resulted in a lower payment.

00:22:46.400 | Yeah, in fact, I the first bill I got from one emergency room is 9000. And

00:22:51.960 | then I refresh the page like two days later, and it was down to 5000. And I

00:22:56.240 | was like, Oh, how did that like, I just somehow that $4,000 disappeared. And

00:23:01.080 | it was because I guess the Cigna negotiated price that I had was much

00:23:05.080 | lower than the original price the hospital charged.

00:23:07.520 | That's exactly how it works. And so you saw that in real time in real life with

00:23:12.680 | yourself. But it just goes to show the charges are not the charges. The price

00:23:18.760 | is not the price. And when you know that in advance, as a consumer, you can

00:23:23.920 | have confidence knowing I can ask for a better deal, I can ask for a price

00:23:28.880 | reduction. And by the way, if you ask them, why are the prices this high?

00:23:33.520 | They can't explain to you why the prices are high to begin with. So a

00:23:39.120 | third principle that could be applied to the overall kind of broad way we look

00:23:44.800 | at healthcare is stop assuming any of this makes sense. It doesn't make sense.

00:23:50.840 | We assume there's a level of competence and rationale behind things like

00:23:55.840 | healthcare pricing in the United States. There's not that would be the wrong

00:23:59.120 | assumption. There are so many errors in medical bills. And by errors, I mean

00:24:05.640 | charges for things that did not occur. So you have to look at an itemized

00:24:10.960 | medical bill when you go to a hospital, you have to see what are all the

00:24:15.800 | individual items that they charged me for and how did those add up to my total

00:24:21.200 | bill. Often when you look at those itemized charges, you'll find things in

00:24:25.960 | those itemized charges that did not actually happen. So it's really easy in

00:24:31.200 | that case, to go to the facility and say, hey, billing manager or billing

00:24:36.920 | department, I'm looking at this itemized bill. And I'm seeing that these

00:24:41.900 | different things that you charged me for, I did not actually receive the

00:24:45.600 | services. So you need to remove these from my bill. It's incredible how

00:24:49.920 | common that is. In fact, if you talk to experts who review medical bills for a

00:24:54.840 | living, they will tell you that most of them contain some type of an error or

00:24:58.880 | an overcharge.

00:24:59.840 | Yeah, I'm looking right now. I had a case of shingles, but I didn't know it

00:25:03.000 | at the time.

00:25:03.640 | I'm so sorry to hear that. By the way, that is a pain.

00:25:06.720 | Yeah, so I didn't know it at the time. I went to the emergency room one night

00:25:10.160 | because it was just the worst pain I could imagine. And they couldn't figure

00:25:14.560 | out what it was. They ran the blood tests, the urinalysis, couldn't figure

00:25:17.760 | it out, sent me home, said take some ibuprofen. And the next night, it was

00:25:22.000 | even worse. And so I was like, I don't know what to do. So I had gone to one

00:25:26.120 | Sutter Health Hospital the first night. I said, I don't know what to do. But so

00:25:29.880 | I drove to Stanford, a different hospital. So two things I noticed. So

00:25:33.600 | this was an interesting experiment for me, because I went for the exact same

00:25:37.200 | circumstance to a different hospital within two days, two days of each other

00:25:40.960 | one day of each other. And I got a bill and I they did most of the same work.

00:25:45.640 | And so a couple things that I noticed that I'm curious to get your take on

00:25:49.280 | because these could be a great examples for people. So one was, when I went to

00:25:54.120 | one hospital, it was labeled emergency room visit high severity. And in the

00:25:58.600 | next hospital, it was emergency room visit moderate severity. And based on

00:26:03.480 | what I could tell, they charge different amounts based on how severe the

00:26:06.600 | circumstances is that something I could call and say, this wasn't actually high

00:26:11.200 | severity, right? I you didn't see me for three hours. Clearly, this was not a

00:26:16.000 | gunshot wound. Can we get this drop to medium or low severity?

00:26:20.240 | I love this case study. I love that you have this a B comparison in real time.

00:26:28.160 | Same patient, same ailment, two different facilities, you are

00:26:33.400 | perfectly illustrating all of the absurdity or some of the absurdity in

00:26:39.640 | our healthcare system. So let's dig into this a little bit. When you go to the

00:26:43.320 | emergency room, or when you go to a doctor visit, they have five different

00:26:47.760 | levels of severity that they code for the visit, one being the least complex

00:26:54.080 | and the simplest type of a case, five being the most complex type of a case,

00:26:58.920 | and then 12345 in between. So when they code it as a severe case, they are

00:27:05.560 | getting a much higher reimbursement for the service that they provide. But they

00:27:10.800 | aren't allowed to just put whatever number they want on the case. They can't

00:27:14.960 | just be like, well, it seemed serious to me. So I called it a level five. There

00:27:19.760 | are actual criteria that are used to assign these codes. And so this is why I

00:27:26.000 | encourage people when you get your itemized medical bill, get the billing

00:27:29.800 | codes. Make sure that you have, it's usually a five-digit CPT code. It's

00:27:35.440 | called Common Procedural Terminology. I know this is getting a little wonky

00:27:39.880 | here, but this is going to help you a lot, okay? So get the CPT codes. And if you

00:27:45.000 | don't get them from your hospital, your insurance plan will have that

00:27:48.320 | information. Just call the customer service number on your insurance plan

00:27:52.040 | and say, hey, I had a question about this particular visit. I went to Sutter Health.

00:27:57.520 | I went to Stanford on this date. Can you please just tell me what the different

00:28:01.920 | billing codes are for each of the charges? Take that five-digit code, Google

00:28:06.920 | it, and read the description of what the code describes. And it'll tell you what

00:28:13.040 | it describes and what the requirements are for them to bill that level of a

00:28:17.880 | code. A level three, four, or five billing code requires medical decision-making of

00:28:24.440 | some level of complexity. So in other words, if you have a little slice on your

00:28:29.160 | finger, it's not a complicated thing to determine what do we need to do with

00:28:33.200 | this slice on the finger. The decision is to put in some stitches. So it requires

00:28:38.300 | medical decision-making of complexity, moderate or extreme complexity, depending

00:28:43.320 | on the code. It requires an examination. If you have a level three, level four,

00:28:49.880 | level five, that requires actually an extensive examination of the patient. It

00:28:55.080 | also requires an extensive problem-focused history to be taken of

00:28:59.200 | the patient. So if you went to the doctor and they didn't do a thorough

00:29:02.760 | examination on you, they didn't take a complete history on you, and there wasn't

00:29:07.440 | medical decision-making of any type of complexity, they should not be billing a

00:29:11.960 | level three, four, or five office visit or emergency room visit.

00:29:17.360 | Yeah, yeah. And I'll say one thing I was actually really impressed by was I

00:29:21.560 | logged into the Cigna website, and I could get details and download the kind

00:29:26.280 | of EOB explanation of benefits. And then I separately logged into both Stanford

00:29:30.480 | and Sutter's kind of My Health portal and got similar data. As much as I found

00:29:35.080 | some of the data to be crazy, I was at least pleasantly surprised with how much

00:29:39.560 | access I had.

00:29:40.600 | That's awesome. And the information is right there for us. But we do have to

00:29:44.520 | take that active, engaged step to look at it. And if they're not providing it to

00:29:50.080 | you transparently, then you need to ask them to provide it. But it's your right

00:29:54.040 | as a patient to have this information.

00:29:55.840 | It seems like with every business, you get to a certain size and the cracks

00:30:01.320 | start to emerge. Things that you used to do in a day are taking a week, and you

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00:31:00.560 | everything so much better. So right now, download NetSuite's popular KPI

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00:31:24.040 | So I am quite comfortable right now, which is actually true almost every day,

00:31:29.920 | and that's thanks to Viore, and I'm excited to be partnering with them for

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00:31:37.240 | Everything is designed to work out in, but it doesn't look or feel like it at

00:31:41.080 | all. And it's so freaking comfortable, you will want to wear it all the time.

00:31:45.120 | Seriously, I am pretty sure it's more comfortable than whatever you're wearing

00:31:48.520 | right now, unless you're wearing Viore, in which case you already know what I

00:31:51.840 | mean. And it's not just for men. My wife is as obsessed with Viore as I am. My

00:31:57.160 | favorite is the Sunday Performance Joggers. I think I have three pairs, and

00:32:01.240 | they are probably the most comfortable pants I've ever owned. Their products

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00:32:08.680 | yoga. They're also great for lounging, running around town, or their meta pants

00:32:12.880 | can even work for a night out. Honestly, I think Viore is an investment in your

00:32:17.160 | happiness. And for allthehacks listeners, they are offering 20% off your first

00:32:21.480 | purchase, as well as free shipping and returns on US orders over $75. So you

00:32:27.760 | should definitely check them out at allthehacks.com/viore or in the link in

00:32:33.320 | the show notes. Again, go to allthehacks.com/viori and get yourself

00:32:41.240 | some of the most comfortable and versatile clothing on the planet. One

00:32:45.320 | more tip that I'll share that I just recently learned was, I have an iPhone

00:32:49.680 | and I logged into the health app. And I was able to go in and log into a handful

00:32:55.080 | of medical institutions I've been at. This includes Stanford, Sutter, LabCorp,

00:33:00.080 | and UCSF, and all of the visits I've had have all been imported. So now I can go

00:33:05.800 | in and say, "Gosh, how is my blood pressure tracked over the last X months?"

00:33:09.920 | And I see it from every single visit I've been to. So I don't know if Android

00:33:14.160 | has the same thing. But, you know, I'd encourage you if you're on an iPhone to

00:33:17.600 | see if your medical organizations support this, because it was a really

00:33:21.120 | fascinating way for me to get easy access to my own data.

00:33:25.240 | That's really amazing. And we're going to see more and more of that as time

00:33:28.600 | goes on. Technology is getting more integrated with healthcare. And that's

00:33:32.360 | going to give us a lot more opportunity to be engaged.

00:33:34.600 | One other thing I noticed looking at this, and I'm looking at right now. So

00:33:38.320 | one hospital did a comprehensive metabolic panel that was $145. And the

00:33:43.720 | other hospital did a comprehensive metabolic panel, same exact code for

00:33:47.240 | $995. Is that is that something normal? Is that kind of crazy discrepancy for

00:33:53.760 | the same codes? Something that people should expect to see? And is there any

00:33:58.480 | obligation for people to charge a fair price?

00:34:01.960 | There is no obligation for them to charge you a fair price. So you are

00:34:09.400 | identifying right here with an excellent case study, the absurd amount of price

00:34:16.080 | variation. Now, let's pretend that you were paying all this out of pocket. So

00:34:22.280 | if you went to the one facility that charged you $900, you would be

00:34:26.360 | obligated to pay that amount of money. And for many of our policymakers, many

00:34:30.240 | of our decision makers in healthcare, they have the money to just pay the

00:34:34.560 | overcharges, they have the money to pay the high premiums and the high

00:34:38.120 | deductibles. And so for them, their time is worth more than their money. And

00:34:41.840 | it's such a hassle to figure this stuff out. They just pay the bills. What they

00:34:45.600 | do is they ignore the massive amount of the American population, the majority

00:34:51.120 | actually, that cannot afford to pay a $900 bill. The Federal Reserve did a

00:34:56.800 | study of the amount of money people have in their savings accounts, and they

00:35:00.360 | found that 40% of Americans do not have more than $400 in their savings account

00:35:05.400 | at any given time, the median American family of four makes about $70,000 a

00:35:10.480 | year. So for those families, they are being put into debt and into bankruptcy

00:35:17.160 | by these medical bills. And so I always encourage people like maybe you or like

00:35:21.800 | myself who can afford to pay a higher medical bill, when you stand up for

00:35:26.000 | yourself, and when you push back against these absurd medical bills,

00:35:30.280 | unjustified medical bills, you are not just standing up for yourself, you are

00:35:34.840 | also standing up for this entire population of Americans who might not be

00:35:39.520 | able to stand up for themselves. They might not have the resources to push

00:35:43.400 | back, they might not have the education or the knowledge to push back. And so I

00:35:48.240 | believe that we who have more need to see this as a justice issue where we can

00:35:53.560 | stand up for the people who are getting hit with these outrageous charges, and

00:35:58.840 | they're unable to afford them. Think about it this way. It's a basic

00:36:02.680 | metabolic panel. This is an extremely common blood test. So you you just named

00:36:08.480 | two name brand facilities Sutter and Stanford. Okay. You're telling me that

00:36:13.600 | one of them is not able to do it at the same price as the other one?

00:36:17.520 | Yeah, it blows my mind. It blows my mind. So okay, so this is really

00:36:22.600 | interesting. And I'll caveat that I know myself, and I think I know a lot of our

00:36:26.680 | listeners pretty well, any one of us might be able to pay this bill, I can

00:36:29.880 | promise you, especially for myself, I have no interest in paying ones even one

00:36:34.720 | cent that I can afford if I don't have to love it. So you know, we talked a

00:36:38.680 | little bit about how to search for the prices in advance. A lot of times we

00:36:43.080 | make the mistake or we don't ask or you're in the emergency room, I probably

00:36:46.880 | could have paused and said, Hey, before you draw my blood, how much are you

00:36:49.600 | going to charge me for this metabolic panel. But a lot of times all this

00:36:52.800 | happens after so you get a bill in the mail. And even if you have an insurance

00:36:57.520 | plan that is good, oftentimes you might have 10 2030% coinsurance. So that $900

00:37:04.480 | metabolic panel might not cost me $900. But it might cost me $300. And maybe it

00:37:10.760 | could cost me $100 or a lot less. So I'm curious if or even $30 I guess it could

00:37:17.320 | be the difference between these two bills is probably $45 and $300. So what

00:37:23.120 | do we do when we get those bills and want to push back and I'll throw one

00:37:26.840 | other egregious example I got was when I broke my foot, they left me with a

00:37:32.240 | walking boot. And that walking boot I found to be not the best walking boot.

00:37:36.400 | So I went on Amazon, I found what I thought was the best walking boot and it

00:37:39.880 | was like $52. And then I get the bill in the mail from Pacific Medical Inc.

00:37:44.720 | Sorry, guys, I'm throwing you under the bus. They deserve a solar air walker.

00:37:49.240 | And the price was $335 a marginal product that, you know, was not good

00:37:56.240 | that I replaced with an excellent $50 product cost 335. But it's too late. I

00:38:01.160 | already have this boot, I'd washed it, I've worn it. What do we do when we get

00:38:04.880 | these egregious bills, even if we only have to pay 10 2030% of them? How do we

00:38:09.920 | what do we do after the fact?

00:38:11.480 | You're beginning to make my blood boil here, Chris. I love it. I love it.

00:38:16.040 | Because it gets me fired up because it's affecting all of us. It's affecting all

00:38:21.160 | of us. We are all afflicted in the United States by this ridiculous

00:38:26.760 | healthcare pricing. And you're just citing examples yourself from your real

00:38:31.080 | life in the past year. But this is happening to all of us all the time. And

00:38:36.240 | we have got to push back on it. So let's talk about how to push back. Okay. I

00:38:41.960 | have a whole chapter in my book about how to sue in small claims court, when

00:38:46.320 | you have been price gouged, or when you have been charged for something that's

00:38:50.200 | erroneous. And I believe that this is a game changing tactic that does work. I

00:38:56.720 | documented lots of cases where it's worked. And I am now helping a lot of

00:39:01.000 | patients with these problems right now. So our small claims court system exists

00:39:06.680 | to protect individual consumers from unfair transactions by big corporations

00:39:13.440 | or other more powerful individuals. And it's a it evens the playing field

00:39:17.600 | because right now what would happen is this, you call the hospital, the billing

00:39:21.840 | department and you say, hey, you guys just charge me or this company, the

00:39:26.080 | device company, you guys charged me $300 for a boot that was a piece of junk. I

00:39:31.360 | got a much better boot on Amazon for $50. That's no good. So I would first

00:39:37.400 | start with trying to negotiate a better price on that bill. Now they would

00:39:41.680 | probably tell you this is the price that your insurance plan has agreed to pay us

00:39:45.680 | for this. So you are contractually obligated to pay it. And if you called

00:39:49.640 | your insurance plan, they would review it. And they would say, yes, this bill

00:39:54.360 | was paid in accordance with your plan. In other words, we have an agreement to

00:39:59.920 | overpay them for this piece of crap medical boot. So you as the consumer,

00:40:05.000 | they'll just look at you and shrug. And they go, that's the price that your

00:40:08.640 | insurance plan agreed to pay. And that's the plan that your employer picked for

00:40:12.200 | you. And so therefore, you get sent the bill. I don't believe that is a fair

00:40:18.560 | way that working Americans have been treated. I believe that we have a

00:40:23.920 | three-party transaction here, or even a four-party transaction. We have the

00:40:28.520 | device company, we have the insurance plan, we have the employer, and we have

00:40:33.160 | the employee, you, in this case, who is the patient. How is it fair that the

00:40:39.360 | device maker and the insurance plan come up with a price, and then they just

00:40:44.240 | tell the employer and the employee to pay it? That makes no sense. That's not

00:40:49.320 | fair. It's something that we have tolerated for too long. And now we have

00:40:54.000 | got to push back and contest. So you start by saying, I just found this

00:40:59.200 | product on Amazon that's better than the product you gave me for $50. I will pay

00:41:04.080 | you $50. How do you feel about that? If you get stoned, well, does that work? I

00:41:09.600 | do. Yes, it does work. It often works. So it depends on how much noise you want

00:41:14.560 | to make. So you know how it is, the squeaky wheel gets the oil, gets the

00:41:19.400 | grease, right? So you may have to complain to higher-ups in the facility.

00:41:24.560 | You may have to complain to higher-ups at your employer. You may have to

00:41:28.800 | complain to higher-ups at the insurance division. You may need to file

00:41:32.840 | complaints to the insurance division or the health division that oversees the

00:41:37.880 | hospital or the facility. You might have to make some waves. And it depends on

00:41:42.520 | how much it matters to you. So for a $300 bill, you might be like, look, this

00:41:46.960 | is not worth it. I'm just going to pay the bill. You don't know me that well.

00:41:51.360 | Just the idea of paying six times, even if it was $5, I feel like the

00:41:56.920 | experience of fighting back might be worth it. I think it's very worth it.

00:42:01.560 | And this is what I would encourage you to do. And I'd be happy to help you do

00:42:04.320 | this. Start with just a polite call to the billing department and see how they

00:42:09.600 | respond. Start by calling your health insurance company and see how they

00:42:14.200 | respond. My prediction is that both of them are going to basically blow you

00:42:18.720 | off. They'll say this is what the plan has set as the price. And so therefore

00:42:23.760 | you have to pay. This was adjudicated according to the terms of the plan. So

00:42:29.560 | they'll basically say so the bill is the bill. So then your next step then is

00:42:33.960 | to escalate it and say, I want a reduction on this. You have overcharged

00:42:38.880 | me and it's not OK. And so you do need to become confrontational at that point.

00:42:43.040 | And this is where a lot of people don't want to do that. Right. A lot of people

00:42:46.040 | back away. But if you're the type, which I am, too, where I'm going to say no,

00:42:50.120 | not now you've got me more interested. Then the next step would be to contest

00:42:54.800 | it right to that billing department and ask for a supervisor. Always ask for a

00:42:59.320 | supervisor and go as high as you can up the chain to insist on a reduction in

00:43:05.560 | the price. Now, I'm continuing to assume that they're going to blow you off. The

00:43:10.480 | next step would be take the sample letter that I have in my book, which is a

00:43:14.440 | 30 day warning to tell them if you don't correct this within 30 days, I'm going

00:43:19.960 | to sue you, as is my right in small claims court in my state for overbilling

00:43:26.800 | me and price gouging me. There is actually a legal precedent that we can

00:43:31.200 | stand on to undergird ourselves when we take on these legal fights. And it's

00:43:35.960 | called the open price term. This is part of the Uniform Commercial Code. The UCC

00:43:42.240 | is the law that governs commercial transactions in the United States. The

00:43:47.160 | open price term says that as a consumer, if you go for some type of a

00:43:52.320 | transaction and they don't give you the price upfront, then it is assumed that

00:43:57.680 | the price that they give you is going to be fair and set in good faith. Now, a

00:44:03.360 | $300 price for a crummy product is not a price that's fair and it's not a price

00:44:09.480 | that's set in good faith. So you actually have good legal grounds if your case

00:44:14.240 | ever goes to court to argue and win a case in small claims court. But think

00:44:20.080 | about what happens. So you're going to send that 30-day warning notice. And the

00:44:23.960 | reason you want to do that is because you want to show the judge, if you ever

00:44:27.920 | go to small claims court, that you did everything you could not to waste the

00:44:32.160 | time of the court. You don't want to show up in front of a judge having filed a

00:44:35.680 | frivolous case. So you want to show the judge, "I warned them I was going to sue

00:44:39.800 | them. I urged them to renegotiate and give me a fair price. They refused to do

00:44:45.160 | it." Often that 30-day warning letter will create enough waves that it will shake

00:44:52.320 | them up and get them to give you a negotiated price that's much lower and

00:44:56.280 | that's a fair price. But if they don't, then you follow it up by filing a claim

00:45:01.160 | in small claims court. And in most states, it's about $30 or $40 to file a

00:45:06.280 | case. It can be done easily online within minutes. You've already done your

00:45:10.800 | research because you've gathered all your medical records and your medical

00:45:14.080 | bills. So you have all the evidence you need. It's not like you have to do more

00:45:18.160 | work. So you file that case and now think about the problem you've created for

00:45:22.920 | them. And this is the part I have to admit I feel maybe a little

00:45:28.080 | devious and antagonistic here, but I love this. Because now you're

00:45:34.000 | going to sue them for the difference. You've been told to pay or you've

00:45:37.320 | paid $300 when it should be $50. So you're going to sue them for $250.

00:45:42.600 | Now imagine they're going to have to hire an attorney to argue the case

00:45:48.120 | against you. You don't have to hire an attorney in small claims court. They

00:45:51.880 | probably will or they're going to represent themselves, which will be a

00:45:55.080 | total pain for them. It's going to cost them hundreds of dollars an hour to

00:45:59.760 | defend a case that is only costing and only worth $250 to begin with. So when we

00:46:05.480 | sue them in small claims court, we give them the incentive they need to do the

00:46:09.680 | right thing. We give them incentive. Now they have an urgent incentive to call

00:46:16.160 | you up and say, "Okay, look, we'll take $50." Or, "Okay, well, look, we'll take

00:46:20.160 | $100." And you say, "Okay, I'm overpaying it $100, but I don't want to go. It's a

00:46:24.720 | hassle for me to go to small claims court, too. So I'll do it for $100." So

00:46:28.760 | small claims court is extremely effective. And I would be happy if that

00:46:34.480 | were something you decided to do, and I'd be happy to help you with it.

00:46:37.240 | Yeah. And I think you outlined how to do a lot of these steps in the book. So

00:46:40.680 | it's not, there's a framework for the flow to follow from what I remember.

00:46:44.720 | Yeah, it is. I call it the Never Pay Pathway. Again, I'm not saying, when I

00:46:49.480 | called the book Never Pay the First Bill, I'm certainly not saying don't pay your

00:46:53.120 | bills. I'm just saying never pay the first bill until you have analyzed it

00:46:57.640 | and made sure that it's fair, and that it's accurate. And if it's not fair, and

00:47:02.120 | it's not accurate, then we need to push back and demand a fair treatment.

00:47:07.040 | Yeah. And one thing that we haven't touched on, which I was just totally

00:47:10.240 | fascinated by, was I got a lot of bills from the hospital, from this medical

00:47:14.520 | device company. And I was surprised that at times they would send me a bill

00:47:20.520 | before the insurance company has even responded. And the bill I got, I looked

00:47:25.960 | online a couple days later, and I was like, "This bill has already been paid

00:47:28.840 | by the insurance company."

00:47:29.800 | Wow.

00:47:30.120 | And so I could see myself in an alternate world. And I'm thankful that

00:47:34.800 | we'd communicated and this was getting scheduled. So I had some ideas of what

00:47:37.960 | to do. But I got a bill at one point for $500 for some part of this visit. And

00:47:43.800 | bam, here's where I had to pay it online. Here's how to send in a check.

00:47:47.080 | But I logged on online, it was already paid. And so is it normal for people to

00:47:51.800 | get bills that their insurance company will ultimately actually pay, that they

00:47:56.440 | might get tricked into thinking they need to pay?

00:47:58.640 | Yes, I've had the exact same experience myself, where I was sent a bill with

00:48:05.040 | all the amount due, $250, person responsible, Marshall Allen, date it was

00:48:11.000 | due. Well, with that one, I realized they had not even submitted it to my

00:48:15.600 | insurance company. They had all the insurance information, for whatever

00:48:18.760 | reason, they did not submit the claim, they just sent me the bill. And so I was

00:48:23.080 | able to route that back to the insurance plan and get that paid in full. And so

00:48:27.600 | another principle, another tactic is make sure that your health plan has paid the

00:48:33.360 | bill and adjudicated it properly before you send in any money. And you check

00:48:38.520 | that by looking at your insurance companies, it's called an EOB, an

00:48:42.200 | explanation of benefits. That document will show you what the charges were,

00:48:47.600 | what the allowed amount was for your insurance plan, how that was all

00:48:51.960 | processed will be done by the insurance company, and then it'll tell you what

00:48:56.080 | your amount is that you owe. So it doesn't mean that you're not still going

00:48:59.840 | to get maybe price gouged. But at least you'll know how it was run through the

00:49:03.680 | insurance plan. And you can make sure that the insurance paid the amount it's

00:49:07.280 | supposed to pay.

00:49:08.080 | Yeah, my examples are interesting, because they're very relevant to me. But

00:49:13.360 | are there some examples you have of people who've managed to have huge wins?

00:49:18.000 | Yeah, I have a whole chapter in the book on how to fight your insurance company

00:49:22.440 | when they've denied you the care that you need. And these are often like life

00:49:26.800 | and death struggles. Certainly it can be your financial life and death. But I

00:49:31.680 | talked to a woman named Alexia. And I helped her and her husband, after she

00:49:37.560 | had an elective procedure done that her hospital told her they got cleared by

00:49:42.680 | the insurance company. So the insurance company would cover it, while the

00:49:46.000 | insurance company didn't cover it. And so she got stuck with a $78,000 hospital

00:49:51.640 | bill because of this procedure that didn't get covered. While I walked her

00:49:55.960 | through the tactics in terms of how to fight an insurance company denial, and

00:50:00.800 | in the end, it took about a year and a half. This was a big battle for her. But

00:50:05.600 | in the end, her insurance company agreed to cover most of the bill, and then the

00:50:09.400 | hospital waived the other charges. So her family went from owing $78,000 and

00:50:15.160 | consulting bankruptcy attorneys, to having owing nothing, having the entire

00:50:20.360 | bill forgiven. And so that's one tactic. Another, just even the youth pastor at my

00:50:25.320 | church that I went to in New Jersey, within weeks of reading my book, he

00:50:30.280 | started pushing back on medical bills and saved $815 just in the first few

00:50:35.120 | weeks. I've also helped people with small claims court. And one thing I love

00:50:39.560 | to do is read the reviews on my Amazon page, because I'm seeing people throw in

00:50:45.960 | examples of saving $1,500 here, getting hospital facility fees waived, all kinds

00:50:53.240 | of things, where people are pushing back and fighting back and saving tons of

00:50:57.320 | money.

00:50:57.720 | Yeah, I'm actually putting these things to use. There were a couple charges that

00:51:02.560 | they're like, Wow, this one x ray wasn't covered. And, and I planned to fight

00:51:06.680 | back and see what happened. One of those future reviews might include my outcome

00:51:11.000 | as well. One situation, I interviewed someone named Kevin Rose, and we were

00:51:15.800 | talking about the way people think about cardiovascular disease, and how some

00:51:21.760 | primary care physicians aren't as up to date on the latest research, which makes

00:51:25.960 | sense, because they're so busy seeing patients. And one of the things he

00:51:29.480 | pointed out that right now we look at your HDL and your LDL levels, but

00:51:34.200 | there's a lot of data out there to support that another marker, which is

00:51:37.480 | your APO B numbers, which I think it's like your APO lipoprotein B, it might be

00:51:42.280 | a better indicator of cardiovascular disease. But because the science hasn't

00:51:47.120 | caught up, oftentimes, those things aren't recommended by doctors are

00:51:50.360 | covered by insurance. And so in a circumstance where you're reading

00:51:54.560 | something scientific, that's that has journal data behind it, but insurance

00:51:58.920 | companies haven't caught up, is there anything you can do? For example, I went

00:52:03.620 | in and asked my doctor, could I get this test, doctor put in the order for it. And

00:52:08.000 | then the insurance company ended up denying it and saying actually, this one

00:52:11.120 | blood test we don't cover that was not a case of it was too expensive, right? The

00:52:15.080 | charge was it was only maybe 100 and something dollars for the blood test. But

00:52:19.260 | there's data to support that it actually might be a better thing than the other

00:52:22.560 | things I know they cover.

00:52:23.600 | So in that case, they probably were denying it because they were classifying

00:52:27.360 | it as experimental. And experimental is a category they put things in that they

00:52:33.120 | just haven't decided to cover yet. That does not mean it's experimental. And it

00:52:37.000 | does not mean that it doesn't work. This goes back to that chapter in the book

00:52:40.680 | about how to appeal insurance company denials. And I actually have some

00:52:45.160 | examples. I have an example in the book, where I dig deep on the way to fight

00:52:50.300 | these appeals. And when is first of all argue with evidence, not emotion. A lot

00:52:56.260 | of times when you get denied some type of care, you try and argue, but I really

00:53:00.460 | need this or the patient is going to get really sick without it. Or this

00:53:03.740 | patient's a young mom with three kids. And if she doesn't get the care she

00:53:07.060 | needs, she's going to die and the children will be left without a mom.

00:53:09.980 | Those are all true. You want to have an emotional component to your argument if

00:53:13.980 | it's there. But you have to argue with evidence. And so in a case like yours, I

00:53:18.380 | have some memos on my website, my website is MarshallAllen.com. And you

00:53:23.580 | can follow a template. And I actually learned this template from a woman

00:53:26.860 | named Lori Todd, who calls herself the insurance warrior. This woman has fought

00:53:31.100 | hundreds of insurance cases, and won hundreds of them. And the I really take

00:53:36.020 | my tactics from Lori, but I have some memos on my website that will show you a

00:53:41.420 | well informed and well reasoned appeal to an insurance company. And one of the

00:53:46.440 | key things is use that evidence from your studies, you mentioned that there

00:53:52.780 | are studies that show that this particular test is valuable for

00:53:56.580 | identifying this type of heart disease. cite those, you'll see when you look at

00:54:01.540 | the memos on my website, they're pages long. And so you want to actually cite

00:54:06.180 | the citations. The other thing you want to look at is your insurance plan. It's

00:54:10.220 | called the summary plan document. This is the document that's actually a legal

00:54:14.780 | contract between you as the member and the insurance company that lays out the

00:54:20.220 | insurance companies, companies contractual obligation to cover the care

00:54:24.600 | that you need. Now, a lot of times in that summary plan document, again, it's a

00:54:29.140 | contract. So you don't want to argue with emotion, think about it like you're

00:54:33.300 | negotiating a contract or fighting over the terms of a contract, they're going

00:54:37.740 | to have a thing in the contract that says that your doctor's medical

00:54:41.740 | decision making gets respected, not the insurance company's medical decision

00:54:45.860 | making. So if your doctor orders the test and recommends it for you, you might be

00:54:50.900 | able to argue from that summary plan document that your doctor has determined

00:54:55.140 | that you need this test, that it's medically necessary, that there are

00:54:58.900 | studies that show that this study that this test you want to do is credible. And

00:55:03.860 | so you need to then make that appeal and in an informed way, almost more like a

00:55:08.780 | legal argument to that insurance company to get them to cover it.

00:55:11.900 | Yeah, this comes back to something that that Kevin mentioned, which was, when

00:55:16.420 | you're looking for that primary care physician that you're working with, it's

00:55:19.900 | important to find someone that aligns with what you're looking for. So instead

00:55:23.940 | of finding someone who's willing to put in the order for the test you want, find

00:55:27.220 | someone who actually believes in the research that you're interested in, and

00:55:31.020 | would back you up in that argument. And so I come back to what you said earlier,

00:55:35.460 | very earlier in this conversation, you said, it's really important to get the

00:55:38.820 | best care and the lowest price.

00:55:40.620 | I wish I could say that I'm eating a fully balanced diet every day. But the

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00:58:26.740 | allthehacks.com/peak P-I-Q-U-E. I just want to thank you quick for listening to

00:58:34.500 | and supporting the show. Your support is what keeps this show going. To get all of

00:58:39.700 | the URLs, codes, deals and discounts from our partners you can go to

00:58:44.420 | allthehacks.com/deals. So please consider supporting those who support us. Do you

00:58:50.500 | have advice for people on how to find the best care? Whether that's finding the

00:58:55.420 | right facilities, picking where to go, finding the best doctors, are there

00:58:59.700 | criteria you use to try to identify where to get the best care? First of all

00:59:05.460 | the answer is it's very difficult and it depends. It depends on the type of care

00:59:09.660 | you need but let's just throw out some examples. One of the key indicators of

00:59:13.780 | quality is volume. You want to know how often has this particular doctor or

00:59:19.740 | other clinician done the exact thing that you need to have done. So let's go

00:59:25.500 | back to the colonoscopy example. If you want to find a doctor who does a really

00:59:30.980 | good colonoscopy, you want a doctor who's done enough colonoscopies to be skilled

00:59:36.260 | at it. You don't want to go to a doctor and find out that you're the first one

00:59:40.100 | that they've done but that's exactly how they learn, right? They learn by doing

00:59:44.660 | these procedures on patients. I understand that they have to learn that

00:59:48.180 | way. I just don't want to be the first one doing the procedure on. So ask the

00:59:54.420 | doctor how many times they have done this exact thing that you need. Not

00:59:59.180 | something similar but the exact one. Then ask them what their outcomes are. By

01:00:04.980 | outcomes, how well do the patients fare after the procedure? Do they suffer

01:00:09.900 | infections? Do they suffer internal bleeding? Do they suffer injuries? It's

01:00:15.300 | going to depend. The complications and the recovery is going to depend a lot on

01:00:19.780 | the type of care that you're needing. So that's going to vary a lot. Is there a

01:00:23.340 | place to benchmark whatever results you get? No. This is the problem. There's not.

01:00:27.620 | And this is what's extremely frustrating. Extremely frustrating about our health

01:00:32.260 | care system. There is no publicly available data that I would say is

01:00:36.540 | reliable to tell you that one doctor or one hospital is better than another. In

01:00:42.180 | fact, we spent years digging into this at ProPublica and you can Google our

01:00:46.660 | Surgeon Scorecard Project and we did an analysis of Medicare data looking at

01:00:53.180 | common elective operations like knee replacements and hip replacements and

01:00:57.140 | other types of procedures. And we identified looking at this data common

01:01:02.260 | complications related to these procedures. And we published risk

01:01:06.940 | adjusted complication rates for about 15,000 surgeons all over the country in

01:01:12.140 | a searchable format. Now the data is dated. It hasn't been updated. So I

01:01:16.300 | wouldn't recommend going there right now and looking for current information. But

01:01:21.300 | we did this at ProPublica as a team of journalists because no one else was

01:01:26.180 | doing this for the public. And what we found was really astounding for

01:01:30.380 | complications readmissions because of complications like bleeds or infections

01:01:35.340 | or other injuries related to the procedure. Some doctors had exponentially

01:01:41.020 | higher complication rates compared to others in the exact same hospital. So

01:01:45.740 | again, another principle I'd look at is hospital quality can't be judged by the

01:01:51.060 | hospital. It really does come down to the individual clinician who's performing the

01:01:56.700 | procedure that you need. You need to make sure not that the hospital has done a

01:02:00.580 | lot of cases. Make sure that your particular doctor or surgeon or

01:02:05.300 | clinician has done a lot of those cases. And then when you ask about outcomes, if

01:02:10.660 | they are even tracking their outcomes and can give you an informed answer, that

01:02:16.020 | is a plus. That's a mark in their favor because many doctors will not even be

01:02:22.380 | able to tell you what their outcomes are. They'll be vague. They'll say, "Oh no, my

01:02:26.180 | patients do great." Or, "Oh, the complication rates are actually quite low for these

01:02:30.500 | procedures." But they'll talk generally like the national or published

01:02:33.780 | complication rates. I want to know what your complications are, doctor. And so you

01:02:39.780 | need to ask them specifically. And if they can answer that for you, that's a

01:02:44.020 | plus because most of the time, our healthcare system is like a giant

01:02:48.460 | assembly line with no quality control in place. So they're not checking the

01:02:53.180 | outcomes of patients six months down the road or a year down the road or two

01:02:57.780 | years down the road. So if your doctor can even give you an informed answer,

01:03:01.900 | that's really a positive. And I would recommend pursuing that doctor as

01:03:07.420 | opposed to others. Yeah. One other thing I want to touch on is avoiding care. One

01:03:12.100 | of the things that I read in your book is that there are a lot of doctors that

01:03:16.300 | propose medical procedures or medical tests that you might not need. And I'd

01:03:20.620 | love you to touch a little bit on how you can save money just by asking the

01:03:24.220 | right questions. I'm glad you brought that up because sometimes we get the

01:03:28.420 | idea that fighting back is like a real confrontational thing. Or like, "I'm gonna

01:03:32.700 | contest this medical bill." Or, "I'm gonna sue them in small claims court if

01:03:36.380 | they're overcharging me." One of the easiest things we can do that can save

01:03:40.300 | us the most money and the most risk of harm, avoiding medical care you don't

01:03:45.620 | need. They estimate when they study the health care that's provided that as much

01:03:50.320 | as 25% of the health care that gets provided is not actually necessary. And

01:03:55.660 | this is things like having you do some type of an imaging test that you don't

01:04:00.540 | actually need or putting you on a drug that you don't need. Or if you look at

01:04:04.340 | the studies about back surgery, it's really common that back surgery gets

01:04:09.260 | done on patients who would have done a lot better with physical therapy or

01:04:13.300 | chiropractic instead of an invasive operation. So I think that the best

01:04:18.740 | question to ask your doctor to make sure you don't get care that you don't need

01:04:23.060 | is, "What happens if we wait?" So let's say your doctor is offering you some type of

01:04:29.100 | discretionary test or procedure or drug. If you ask, "Doctor, what happens if we

01:04:36.140 | don't do this right now and just wait and see or try something else?" it causes

01:04:42.220 | the clinician to reframe the conversation. So all of a sudden they're

01:04:45.900 | not talking about the risk of doing the procedure, they're talking about the risk

01:04:49.460 | of not doing the procedure or the test or the blood work. Because every single

01:04:54.300 | one of these tests comes with a risk. Every procedure comes with a risk.

01:04:59.100 | There's no such thing as a low-risk elective operation, for example. I have

01:05:04.580 | talked to families who have had their children die because of low-risk

01:05:08.080 | elective operations that went wrong. And so I encourage people, ask what happens

01:05:13.220 | if we wait, see if waiting might be an option, see if there might be something

01:05:17.540 | less invasive that could be done or less expensive that could be done to see if

01:05:22.860 | these problems can resolve themselves in different ways. And I think that will

01:05:26.700 | protect people from a lot of care that they don't need.

01:05:29.460 | Yeah, I've seen a couple doctors for something called a neuroma, which is like

01:05:34.300 | an enlarged nerve in my foot. And one doctor, their path was, "Let's try these

01:05:41.020 | cortisone injections and then surgery." And this other doctor was like, "Actually, I

01:05:44.220 | have a pharmacist that makes this compound that helps reduce the swelling

01:05:48.060 | of nerves." And it totally worked. And on my right foot, the result was, about five

01:05:53.620 | years ago, I had surgery because one thing didn't work. And on my left foot, it

01:05:57.540 | flared up recently. And a $70 - it wasn't covered by insurance - but a $70 compound

01:06:03.060 | that was effectively like a lotion. It had the same effect in terms of no pain

01:06:08.100 | as a surgery, which was wild. So I think sometimes it's searching online to read

01:06:14.060 | about these things. Sometimes it might be seeing a few doctors. But if ever the

01:06:18.060 | result is the only thing left is surgery, I would say maybe get a second opinion.

01:06:22.540 | Second opinions are also essential, right? Especially if it's something

01:06:26.500 | that's more invasive or expensive, make sure that you really need it. And most

01:06:31.540 | care that we get is actually not emergency care. And so usually, you do

01:06:36.220 | have the time to take to do a little more research, to get a second opinion,

01:06:40.580 | just to make sure that what's being presented to you is absolutely necessary.

01:06:44.820 | Yeah, that makes sense. So one thing we didn't touch on that I want to jump into

01:06:48.780 | is for someone who works at an employer. We could start with employer, but also,

01:06:53.180 | you know, I have a podcast. Maybe one day it's a full-time business and I'm

01:06:56.620 | looking on the exchange. How do you save money but also pick the right health

01:07:02.300 | care plan? There's a lot of options nowadays. Many employers, mine included,

01:07:06.220 | offer, you know, PPOs, EPOs, HMOs, high deductible health plans. How do you help

01:07:11.820 | people think about those decisions?

01:07:13.420 | Well, it's really a hard answer to give in a general way because everyone's

01:07:19.020 | situation is so specific. So some people have kids. Some people have health

01:07:25.220 | problems or ongoing health concerns. Some people are very low risk and willing

01:07:30.900 | to take more risk themselves. So it's a hard question to answer generally. But

01:07:35.860 | let me just give you a few things since we're talking about hacking the health

01:07:39.580 | care system that people can try. If you are a healthy person and your family is

01:07:45.340 | relatively healthy, you might not need the complete amount of coverage that's

01:07:50.260 | going to come with the highest premium and lowest deductible. You might say,

01:07:54.580 | look, I can take more risk and it's a trade-off because you're going to save

01:08:00.380 | on your premium and you're going to maybe take the risk of paying more out

01:08:05.060 | of pocket down the road. But a high deductible plan might make a lot of

01:08:08.940 | sense for you. If you're on the individual market, you might benefit by

01:08:13.860 | going with something more like a health sharing plan. There's these different

01:08:17.700 | health sharing plans. Some of them are faith-based. Some of them are not where

01:08:22.300 | it's not actually insurance. So this is the risk you're taking. It's not an

01:08:26.700 | insurance product. It's an agreement that people have made to pay one another's

01:08:31.060 | medical bills. The premiums on those health sharing plans are much, much lower

01:08:36.500 | for a family or for an individual than your premiums would be on the health

01:08:41.620 | insurance market. And you might want to pair that with a direct primary care

01:08:46.700 | relationship. So direct primary care are doctors, and this is becoming more

01:08:51.180 | popular, who are taking payment directly from the patient, say it's a hundred

01:08:56.020 | dollars a month or two hundred dollars a month, for all the care that you need.

01:09:00.020 | It's much more specialized in terms of the care that you

01:09:03.940 | need. And they're catering to you more like they're paying customers so that

01:09:08.780 | you're going to get much more of their time and much more of their attention. So

01:09:12.100 | you might find, if you're looking at the individual market, that going on a health

01:09:16.300 | sharing plan and a direct primary care relationship with a doctor is going to

01:09:21.220 | get you better care at a much lower price. It's just that there's more risk

01:09:25.980 | involved. So it's really hard to answer these questions in a way that's going to

01:09:30.900 | satisfy everybody because everybody has different needs and have different

01:09:35.740 | tolerance for risk. Yeah, a couple of things that I found going through this

01:09:39.820 | search process. So I'm very intrigued by, not in the individual market, working

01:09:44.300 | with an employer plan, but these cost-sharing programs are super

01:09:47.780 | interesting. And I assume that if it's individuals agreeing to pay bills, that

01:09:51.460 | you actually probably are eligible for whatever the cash price is and you're

01:09:54.820 | not dealing with insurance negotiated prices. Is that right? Right. Yeah. And

01:09:58.980 | it's going to have more friction when you go to the doctor. Your doctor might

01:10:02.540 | be like, "What? Health sharing plan? What are you talking about?" There might be

01:10:06.380 | more friction on that end. You might have to pay more of the money upfront and

01:10:09.740 | then get it reimbursed. So the hassle factor might be greater. But think about

01:10:14.700 | it this way. I mean, your premiums could easily be $2,000 a month for a family.

01:10:19.740 | And you might be saving $1,000 or more per month on your premiums. And so look

01:10:26.660 | at it as paying yourself a salary of $1,000 a month by saying, "I'm going to

01:10:33.020 | engage with the health care system in a different way." And actually there's a lot

01:10:37.500 | of growth in these plans, in these health sharing plans and with direct primary

01:10:42.460 | care, because actually people are quite satisfied with them. Some of them are

01:10:46.900 | scams. So again, you have to do your research. Make sure you're not getting

01:10:50.780 | ripped off. Check your reviews. Get references to actual patients who have

01:10:55.780 | used these plans and make sure you understand what you're getting into. But

01:10:59.820 | I have found I have several friends who are on these plans and they've had good

01:11:02.980 | experiences with them. Yeah, that's so fascinating. In years that I've considered

01:11:07.060 | a high-deductible health plan, I think pairing it with an HSA is amazing

01:11:11.540 | because you can put pre-tax money in, you can take it out, it can grow. Oftentimes

01:11:16.500 | your employer will contribute to it. I think Google has one of the most

01:11:19.620 | interesting high-deductible health plans for employees because they give you

01:11:24.660 | enough money that you effectively meet your deductible for the high-deductible

01:11:29.540 | health plan. So you get the low premium, but the risk is taken away because

01:11:33.020 | they're giving you this money and they're giving it to you in an HSA, which

01:11:35.900 | you don't have to use this year. You can use it forever. Yeah, so I love the HSA

01:11:40.260 | compared to the FSA, the flexible spending account, where it's use it or

01:11:44.620 | lose it. I really get frustrated with the use it or lose it idea with health care

01:11:49.460 | dollars because what you end up having happen if you haven't spent your

01:11:53.060 | flexible spending account money is you're like trying to find, "Okay, what can

01:11:57.540 | I spend in the month of December to get rid of this money?" And it's just really, I

01:12:02.580 | don't like the FSAs, but I agree with you. Those HSAs are good. And my book has

01:12:07.340 | actually three chapters in it for employers, and I'm hoping that employers

01:12:11.220 | will get more engaged with this because if employers can work together with

01:12:16.260 | their employees to design better benefit plans, they could save hundreds or

01:12:22.220 | thousands of dollars for every health care encounter for their employees, and

01:12:26.140 | then the employer saves exponentially more than that. So the incentives really

01:12:30.500 | are aligned for employees and employers to work together to tackle this problem,

01:12:34.980 | and I actually have a much greater hope that they will be able to figure out our

01:12:39.940 | health care reform, and it can be consumer-driven, and it can be driven by

01:12:44.500 | the market instead of being driven by something like government regulation or

01:12:49.580 | politicians. We haven't seen our politicians on either side of the aisle

01:12:53.900 | put real solutions in place that are helping the public, and so I just don't

01:12:58.180 | trust that's going to happen. So I think the employers and the working Americans

01:13:02.220 | are really our greatest hope.

01:13:04.140 | Yeah, yeah. One quick fun thing on FSAs,

01:13:07.980 | something to consider at the end of the year if you're running up with some

01:13:11.340 | balance that you can't carry over, I think you can carry over about $500 the next

01:13:15.420 | year, but if you have dollars you can't carry over, there might be things, maybe

01:13:18.500 | call a local shelter, see if there are medical products they need, you

01:13:22.380 | might be able to buy them with your FSA dollars before they expire, and donate

01:13:26.380 | things.

01:13:26.880 | That's a great suggestion.

01:13:28.180 | Are there any hacks for saving money on prescription drugs?

01:13:31.380 | Yes, absolutely. I mean, one of the simplest ones is just look up GoodRx.

01:13:35.380 | Your listeners have probably heard of GoodRx.com. It's a coupon system where

01:13:40.380 | they will show you the GoodRx price at different pharmacies in your community.

01:13:45.680 | That's a great place to look. Also, see if there's a pharmacy that has a

01:13:50.180 | membership plan near you. One that I mentioned is called Good Shepherd

01:13:53.880 | Pharmacy. It's in Memphis, Tennessee. They have a mail order system where

01:13:58.380 | they charge $5 for a generic drug per month, which often if you're not on a

01:14:04.180 | plan, or let's say you're on a sharing plan, or uninsured, or self-pay, that

01:14:07.880 | could be a better deal for you. And then check the prices at different

01:14:11.580 | pharmacies. Consumer Reports has done this. Other studies have done this, where

01:14:17.080 | if you need a drug, it could be hundreds of dollars more or less just at a

01:14:22.080 | different pharmacy in your community. So check the prices at different

01:14:25.580 | pharmacies, and you'll see that there could be huge variation.

01:14:28.080 | Is there one that does better? Walgreens, CVS, Costco, that kind of

01:14:31.980 | traditionally is the best?

01:14:33.080 | I think one study I saw showed that Costco overall had the lowest prices,

01:14:37.580 | but when they compared the GoodRx prices to all the prices, the GoodRx

01:14:42.080 | prices were usually better. The caveat with GoodRx is that it's great for

01:14:47.080 | getting an individual medication, but if you're getting that individual

01:14:50.780 | medication at multiple facilities from lots of different pharmacists, then

01:14:55.080 | you're not going to have one pharmacist that sees all of your medications

01:14:58.880 | that you're taking. That can be a little more risky because some of these

01:15:02.180 | medications can interact in negative ways with one another. And so GoodRx

01:15:07.180 | is good if you just want the one drug, but you really want to make sure that

01:15:10.880 | your primary care doctor or somebody knows all the prescriptions you're on,

01:15:15.880 | so they can make sure you don't have side effects from something that's

01:15:19.180 | interacting in a bad way with another.

01:15:21.480 | You've spent a lot of time researching this industry, and it really shows

01:15:24.380 | I love the book. What's next for you?

01:15:27.680 | I am actually on a campaign to boost the health care literacy of working

01:15:33.180 | Americans and employers throughout the entire country. And so I have started

01:15:38.180 | a side company that I'm calling Allen Health Academy. And this company

01:15:42.880 | exists to boost the health literacy so that people understand how to navigate

01:15:48.180 | these financial pitfalls of our health care system. And the first product

01:15:52.380 | I'm putting out is a series of videos, a video curriculum that I'm calling

01:15:56.980 | the Never Pay Pathway. It's just based on the book. It's taking all of the

01:16:01.480 | actionable how-to hacks in the book and translating them into a series of

01:16:06.680 | short three to five minute videos, so people can learn how to get their

01:16:10.580 | medical records, how to get an itemized medical bill, how to look up the

01:16:13.780 | billing codes, how to price it, how to sue in small claims court. Basically

01:16:18.380 | all the things that we've talked about in this podcast and more that will

01:16:22.780 | help people understand the health care system. It'll demystify a lot of the

01:16:27.080 | health care system. It'll show them how to protect themselves and how to

01:16:30.980 | save a lot of money. And this is something it's actually been supported

01:16:34.480 | by a really successful crowdfunding campaign on Indiegogo. I had supporters

01:16:39.880 | and backers raise and contribute $55,000 to produce these videos so that

01:16:45.880 | they're really going to be engaging and interesting. And I'm hoping to

01:16:49.080 | launch those early next year. And so if people are interested in those, they

01:16:53.580 | can go to my website, MarshallAllen.com and sign up for my newsletter. And

01:16:58.580 | that way you'll be informed when those videos come out. And my goal,

01:17:02.580 | honestly, Chris, is to, I want to roll these out to every employer-sponsored

01:17:07.480 | health plan in America. I want there to be an army of informed health care

01:17:12.780 | consumers so that they can contest these outrageous medical bills. They

01:17:17.680 | can push back. I mean, if we had even 1% of the Americans covered by

01:17:24.680 | employer-sponsored or individual plans or people who are self-pay, there's

01:17:29.680 | about 190 million Americans in that category. If 1% of those people were

01:17:35.380 | to push back and demand a fair deal, I think that it would no longer be

01:17:40.080 | profitable for our health care system to prey on us financially the way

01:17:44.180 | it's been done. If 1% of people demanded the prices up front and made

01:17:48.680 | sure they were fair prices, it would completely remove the ability of the

01:17:52.980 | health care system to hide the prices from us. And if we sued in small

01:17:56.780 | claims court, when we got one of these like surprise out-of-network bills

01:18:00.780 | or unjustifiably high medical bills, it would reduce the incentive to

01:18:05.680 | send us these outrageous medical bills. It would be so expensive for them

01:18:09.280 | to do it. And so I think that we do have the power to bring about real

01:18:13.980 | change in health care, but we need to equip and educate the public and

01:18:19.480 | then show them how to use this leverage to really hack the system so

01:18:24.580 | that it benefits them and so that it can benefit all of us.

01:18:27.680 | Yeah, I hope that the examples I've shared inspire a few people

01:18:31.380 | listening to go back and look at some of the bills you've paid and see

01:18:35.580 | if there's anything erroneous and see if there are any extreme

01:18:38.180 | overcharging and push back and see what happens. And so I appreciate

01:18:42.680 | all the feedback you've given, all the tips you've shared, all the

01:18:45.680 | hacks you've shared, and I hope it inspires people to save more.

01:18:49.380 | Yeah, thank you. And one more thing I want to add, I'm available.

01:18:53.580 | People can message me on my website. They can email me. I do enjoy

01:18:58.380 | helping people with their bills. So if anybody has any questions or

01:19:02.080 | they feel confused, feel free to reach out. And I talk to people

01:19:06.680 | almost every day about these issues. It's really become a hobby of

01:19:09.780 | mine, and I really do enjoy it and get a kick out of it. So I'd love

01:19:13.880 | to hear from anybody.

01:19:14.780 | Awesome. Hopefully people reach out if they need help. And thank you

01:19:17.880 | so much for being here.

01:19:18.780 | Thank you. I really appreciate the conversation.

01:19:22.880 | That was amazing. I can tell you that the first thing I'm doing next

01:19:26.580 | is negotiating down the price of that crappy medical booth. But in

01:19:29.880 | all seriousness, I wish that none of you ever have to deal with what

01:19:32.780 | Marshall and I discussed. But as I learned this year, it's unfortunately

01:19:36.280 | likely that you will. So I hope this episode was helpful. If you have

01:19:39.780 | any feedback or questions on this episode, another episode, or you

01:19:43.180 | just want to say hi, I'm chris@allthehacks.com or I'm @hutchins

01:19:47.580 | on Twitter. And to anyone celebrating this week, Merry Christmas

01:19:51.180 | from Mexico. See you all next week.

01:19:53.280 | I want to tell you about another podcast I love that goes deep on

01:20:05.380 | all things money. That means everything from money hacks to wealth

01:20:08.880 | building to early retirement. It's called the Personal Finance Podcast

01:20:12.680 | and it's much more about building generational wealth and spending

01:20:16.280 | your money on the things you value than it is about clipping coupons

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01:20:23.280 | believes that everyone in this world can build wealth and his passion

01:20:26.780 | and excitement are what make this show so entertaining. I know because

01:20:30.780 | I was a guest on the show in December 2022, but recently I listened

01:20:35.180 | to an episode where Andrew shared 16 money stats that will blow your

01:20:38.880 | mind and it was so crazy to learn things like 35% of Millennials

01:20:43.080 | are not participating in their employer's retirement plan. And that's

01:20:46.580 | just one of the many fascinating stats he shared. The Personal

01:20:50.380 | Finance Podcast has something for everyone. It's filled with so

01:20:53.480 | many tips and tactics and hacks to help you get better with your

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01:20:59.680 | out. Just search for the Personal Finance Podcast on Apple Podcasts,

01:21:03.580 | Spotify, or wherever you listen to podcasts and enjoy.