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You heard about it here. Again, that's longangle.com. Hello, and welcome to another episode of All The Hacks, a show about upgrading your life, money, and travel all while spending less and saving more. I'm Chris Hutchins, and I am excited to have you on my journey to find all the hacks.

Now, in a normal year, my experience with our healthcare system just includes a visit to the doctor, maybe some blood work, a couple dental cleanings. But 2021 was a bit different. Between fracturing my foot on a wedding dance floor and a random case of shingles, I've had three visits to the ER, which came with some interesting medical bills.

So I am really excited to be talking today with Marshall Allen. For over a decade, he was a reporter at ProPublica investigating the cost and quality of our healthcare, and his work has been honored with several journalism awards, including the Harvard Kennedy School's Goldsmith Prize for Investigative Reporting, and he was a finalist for the Pulitzer Prize for Local Reporting.

But most importantly for today, he is the author of a new book called Never Pay the First Bill and Other Creative Ways to Fight the Healthcare System and Win. So we're going to get tactical and talk about how we can all push back about the high cost of healthcare, including negotiating with doctors and insurance companies, picking the right plan with our healthcare, preventing expensive bills before you get care, and the tactics you need to negotiate any bill you get.

So without further ado, I hope you enjoy my conversation with Marshall Allen. Let's get started. Marshall, thanks for being here. Thank you, Chris. I'm really excited to be here to talk about hacking the healthcare system. This is going to be fun. Yeah, I want to just start off asking what led you to dedicate so much of your career to researching and writing about healthcare?

You know, it's actually an accident, Chris. I had no intention of covering healthcare. In fact, I thought writing about healthcare would be extremely boring. And when my editor at the Las Vegas Sun newspaper asked me, took me out to lunch one day and asked me to cover healthcare, this was in 2006, I actually, my first words were, I cannot imagine anything more boring than writing about healthcare.

And I quickly realized how wrong I was because I started doing stories from the perspective of the patient who has to engage with the healthcare system. And I definitely have an investigative bent to me. And I also have a very people focused value to the journalism that I do.

So as soon as I started looking at our healthcare system from the point of view of the patient who has to navigate the system, which is completely fractured, overcomplicated and opaque, and they have to navigate the system. They have to pay for the healthcare they received. And it's completely overpriced, unjustifiably overpriced.

And they have to navigate the safety and the quality of the system, which is very difficult to tell. And unfortunately, medical errors are a leading cause of injury and death in this country. So as soon as I started writing about healthcare, looking at the quality, looking at the safety and looking at the cost, I found that I was able to do stories that immediately had a lot of traction with, with the audience.

They could really help people right where they're at. I could stand up for people who are being taken advantage of. And so it's been really satisfying these last now 15 years of digging deep on our healthcare system. Yeah. And was there a moment in this career that you said, now's the time I have to write a book?

I started feeling after I'd been at ProPublica for about five or six years, you do enough of these stories about outrageous medical bills, and you dig into people's medical records, you share the records with experts, you share the bills with experts. I started to learn more and more about how the system actually works instead of the ways that we're told that the system works or this facade that's been built up around the system.

So I began to get a deeper understanding of the system because I talked to thousands of experts and patients over the 15 years. And then I dug into hundreds of cases of individual patients who had been just completely screwed by the system in one way or another, I saw there's a complete lack of accountability and I looked at it across a broad level of stakeholders.

You know, I was talking to doctors, insurance companies, patients, hospitals, but always looking at it from the point of view of the patient. So I realized, okay, I have a lot, I have a lot to say here, I've learned a lot. And I'm getting at the same time, emails and phone calls almost every day from patients who are having their lives utterly wrecked by our healthcare system.

And so let me just throw out some statistics because I think it's important to ground the conversation about what an urgent problem we have here. First of all, we spend about twice as much per person on healthcare in the United States compared to the citizens of any other developed country.

In other words, the problem here isn't that we're not spending enough. In fact, we are spending twice as much per person than citizens of other countries, and we still have about 30, 40 million Americans who don't have any insurance coverage. We probably have about that many more who are what I would call functionally uninsured.

Which just means that the health benefits they have are so thin that maybe they have a deductible that's $5,000 or $3,000 a year, but they only make $60,000 a year. So if you're making 60 grand, you're paying out a monthly premium for your health insurance, and you still have to pay the first $3,000, $5,000, some people are on a high deductible plan that makes them pay the first $10,000.

In that case, they are functionally uninsured. They're only going to use those benefits if they have some catastrophic accident and they're paying everything out of pocket. Now, when you have that problem, now you get these massive bills, which are unjustifiably high in many cases, full of errors, as I found through my reporting and talking to experts.

Now, people that have these high deductibles where they pay the first dollar and the bills are outrageously high, they cannot afford them. And now we have a problem of medical debt. So one out of every three Americans right now has medical debt. And one out of every five Americans has medical debt in collections.

So these numbers are staggering. It is a travesty what's happening to the American people and working Americans are hit the hardest. And so that's why I decided, okay, I'm going to put all the tips I've learned into a book and where I haven't learned the tips, I'm going to go find the experts who have the knowledge that I can share with the audience and in each chapter, I'm going to show here's a common problem people have with the healthcare system, and here's how to tackle it and here's how to fight back and win the key words in my subtitle in my book and other ways to fight the healthcare system and when we're talking about winning here and the way I define winning is we should be paying much less for our healthcare and getting much better healthcare than we're getting right now.

So I define a win as saving a lot of money while getting better care, not just mediocre care or denying yourself care, because that's typically what's happened to people. So it's been really satisfying to write the book and start getting feedback from people who are putting these tactics into place.

Yeah, I've witnessed some of the high costs in the last few months. It's crazy. I assume these hacks are not just for people who are in high deductible plans or who are underinsured. Are there are some of these beneficial to anyone? They're beneficial to everyone. In fact, with each of these tips, you could save hundreds or even thousands of dollars per healthcare encounter.

The numbers here are so staggering and I'd love to hear about some of your experiences over the past year because the numbers are so staggering that if you can even get one erroneous charge taken off of your medical bill, you might save hundreds or thousands of dollars. If you can go, a really common one is the high cost of imaging.

So let's say you need a CT scan or an MRI. Your doctor might refer you to the MRI facility that's right down the hall in the hospital where they work. Hospitals are the most expensive place to get these scans done. Same with lab tests. But if you can find an independent imaging center, it may be half a mile away from the hospital imaging center.

They'll do the same CT scan, same MRI, same x-rays, whatever you need, and you will save hundreds or even thousands of dollars per scan, and MRIs and CTs being more expensive than the x-rays. But you can save huge amount of monies just by routing yourself away from the hospital for imaging tests.

Yeah, I'm fortunate that I have a healthcare plan that makes hospital ER visits fairly affordable. But you know, that doesn't mean that I didn't get to see the full prices that were getting charged. And it's wild. I think I saw a doctor for 10-15 minutes and the bill was like $7,000.

Unbelievable. And one thing I'll ask is, is there, I'm on what's called an EPO, right? And so I have a $100 deductible for an ER visit. And so for me, I was like, okay, is there any benefit to me negotiating that $7,000 bill down knowing that I'm just paying 100 of it?

And what impact would that have? That's a great question, because it gets at one of the fundamental misunderstandings I think we have about healthcare when we get healthcare through our employers. So we need to stop saying and thinking that someone else is paying for our healthcare. And it's really easy to do because they've taken the pain away from you of that immediate out-of-pocket cost.

You're only paying that $100. But as our healthcare costs go up, so they're overcharging, and then the health plan is covering most of that cost, that is still coming out of your premiums. And so you are going to see a rise in premiums every year because of these overcharges to your health plan.

And so you might not feel that immediate pain of it coming out of your wallet, or out of your bank account. But year after year, because of these high costs, we have seen health insurance premiums and deductibles rise by 5 to 10% a year for premiums. And then we have deductibles going up at outrageous amounts at the same time.

And then the other trick that they play is they reduce the amount of coverage that you have. And so when you look at this rising cost of healthcare, this is eating into the compensation that our employers allocate toward our wages and our benefits. So think about it this way.

When you get hired, you get a compensation package. That compensation package includes your wages, maybe a 401k or retirement contribution, paid time off, and hopefully health benefits. The thing is, our employer isn't actually paying for our benefits. What our employer is doing is funding our compensation, then that compensation belongs to you and me as working Americans, right?

Now, if our compensation is being consumed by $7,000 bills from the doctor in the emergency room, even though we don't feel it immediately, because maybe you just have that $100 deductible, you are going to feel it in the long term, because this is sucking all of the compensation out of your employers compensation pool, which leaves less money for your employer to give raises in the next year.

And it also causes higher rises in premiums and deductibles, as I mentioned. And so when economists look at the reason wages are stagnant in the United States over the last 10 2030 years, the rising cost of healthcare is a huge cause of wage stagnation. And it's because our compensation is getting consumed by all of these outrageous and unjustified medical costs.

And so I'm trying to help working Americans see it, see the big picture. It's not just that deductible or that amount that you pay out of pocket. It's also the monthly premiums that keep going up, and the wage stagnation that's caused by our compensation just disappearing because of high healthcare costs.

Yeah, if anyone out there is listening and has an entrepreneurial itch, I would love to see you try to turn all of the tips and tricks that Marshall's worked on in this book and in his career into a product that could just scan my medical bills and tell me what I should be fighting back against.

Yeah, and this is a big thing now. And it's going to become a bigger and bigger thing in the coming years. And I predict real disruption is coming for our healthcare system. It's consuming about one out of every five dollars in our GDP is from healthcare. It's not sustainable.

There's, to me, a lot of signs of a bubble that's not able to be maintained. And so once employers and working Americans team up with all of these vendors and entrepreneurs that are creating these really innovative products that are identifying the problem and what you can do about it, things I think are going to change pretty quickly.

Yeah, I don't want to go too deep because I feel like we could spend hours on this. But is there a succinct way to explain why our healthcare system is so broken and expensive and we spend twice as much as other countries? Yes, here's how I would answer that question.

If I had to boil it down to one thing, we have allowed the profit motives that are not unethical or immoral in other contexts. Let's say you open a restaurant and you want to charge five hundred dollars for a steak. If you put the price on the menu and it's a five hundred dollar steak and people want to come in and buy it, there's nothing immoral or unethical about doing that.

But if you overprice a health care procedure that somebody needs to survive and you don't show them the price up front, but you hit them with that outrageous price after they have gotten the procedure they needed to save their life, that's where the profiteering becomes to me a moral and an ethical issue.

None of this is illegal or much of it is not illegal, but it's not right. I believe it's not right to charge someone more than you should when all they're trying to do is get the care that they need to save their life or to heal their body or to take care of their sick child.

So this same profit motive that drives a lot of the American economy, when it's applied to health care, it becomes really unsavory and extremely harmful to the American public. And in other countries, are there ways people solve this that don't involve the government getting into health care, which I know is a pretty hot topic here?

I haven't done enough research to speak authoritatively about what's happening in other countries and how they do it. But what I can tell you is this, they're spending about half as much and they have much, much better outcomes in terms of the health of their people. They get the same high quality medical care, their disease burden is much lighter, their life expectancy is much longer.

And so we are doing it in the most expensive and not, we're not getting our money's worth when it comes to health care. So I don't know exactly how they're all doing it enough to say the tactics they're using that we should employ. But what's clear is we're not doing it right here.

Yep. So, you know, you mentioned imaging as a big way to save, what are some other kind of easy big wins for saving on health care before, you know, ultimately, I want to jump into what happens when you get that bill. But before you get a bill, what are some of the best ways to start to preventatively save on your health care?

So there are some principles that listeners can keep in mind to hack the health care system. First of all, realize that there is extreme price variation in our health care system. So if you need a knee replacement, you could spend as low as say $20,000 at one facility, or as high as $80,000 at another facility.

It's that extreme and the quality is not going to be that different. If you need a medication, you could get a branded medication, or you could get a generic medication in many cases, that's the exact same chemical composition as that branded medication, but at a much, much lower price.

And so with each of these decisions, if you know in advance, okay, where's the best place to get this? Where's the most value based place to get this? Where's the highest quality place to get this? Then you can begin asking some questions to pursue the best value care, which by value, I would define that as the lowest cost and the highest quality.

And how do you research those costs? So let's say I do need a knee replacement, and I haven't listened to this podcast knowing that $20,000 to $80,000 could be the range. How do you price kind of compare without the information? Hospitals are now required to post their prices on their websites.

There's a federal government regulation called the Hospital Price Transparency Rule. And they're required now to post their prices for all their different procedures. And that includes the cash prices. So in other words, if you have no health insurance, or don't want to use your health insurance, you just want to pay cash, they have to post the Medicare prices, they have to post all the negotiated prices for all the different insurance companies that do those procedures in those facilities.

So if you know that in advance, let's say you need a colonoscopy, which is a very common preventive procedure that people in your audience are going to need to get at some point in their lives. You can look now in hospital websites, and if they're following the federal government's rules, they will have their prices posted.

And so you can check the prices at local hospitals, you can call ambulatory surgical centers and talk to them and get the prices there. And that's a good way to identify prices. Another place that we can look for prices, there's a lot of now technology companies that are producing prices and making these a lot easier to look up.

So look for some of these startups that are producing prices. There's one called turquoise health, there's one called health cost labs, just Google health care prices. And a lot of these startups are popping up and they're providing prices up front. Another tactic, call and ask, call and ask for the cash prices, especially because often the cash prices are even less than what you would pay with your insurance plan.

And so it does take some legwork up front, you might get some doors shut in your face as people tell you we can't give you the price or you can't get the price. But more and more, the prices are becoming available. And people are offering the prices. So you know, more progressively minded disruptive health care providers, hospitals and doctors are posting their prices.

So check out something like Surgery Center of Oklahoma. Surgery Center of Oklahoma is a surgery center that has just posted their prices just up on their website. And so if you're wondering what you should pay, you might want to consider going there. Of course, that might require some travel, you might not want to do that.

But you could at least check their prices and see how those prices compare to prices in your community. And are these prices, let's say I go to the Surgery Center of Oklahoma, and I need a procedure and I see a price, are the prices in my local area, if I call my doctor or local hospital, are they negotiable such that I can say, well, it's so much cheaper here?

Could you do it for less? Yes, this is another principle that applies to healthcare. So let's say principle one is, there's huge price variation, and you might be able to get a better deal somewhere else. Principle number two would be everything is negotiable. So when they there's a really crazy way they do healthcare pricing.

I mean, it makes absolutely no sense. But when they charge you something, they make up the charges. It's an outrageously high amount because what they want to do is take those charges and then apply insurance company discounts. So usually UnitedHealthcare or Blue Cross or Aetna will apply a discount.

And then that's how they get customers. They say, look, we get you the best discount at the hospitals in your community or with the doctors in your community. But those initial prices that the hospitals or doctors post are fantasy numbers, they are not grounded to anything in reality. And so the negotiated price that the insurance company pays, it might be 1/10, or 1/5, or 1/3 of those initial charges.

And that's why even on your your particular bill, the $7,000 bill from your doctor, that might have been a $7,000 charge. And then that charge got negotiated down by your insurance company and resulted in a lower payment. Yeah, in fact, I the first bill I got from one emergency room is 9000.

And then I refresh the page like two days later, and it was down to 5000. And I was like, Oh, how did that like, I just somehow that $4,000 disappeared. And it was because I guess the Cigna negotiated price that I had was much lower than the original price the hospital charged.

That's exactly how it works. And so you saw that in real time in real life with yourself. But it just goes to show the charges are not the charges. The price is not the price. And when you know that in advance, as a consumer, you can have confidence knowing I can ask for a better deal, I can ask for a price reduction.

And by the way, if you ask them, why are the prices this high? They can't explain to you why the prices are high to begin with. So a third principle that could be applied to the overall kind of broad way we look at healthcare is stop assuming any of this makes sense.

It doesn't make sense. We assume there's a level of competence and rationale behind things like healthcare pricing in the United States. There's not that would be the wrong assumption. There are so many errors in medical bills. And by errors, I mean charges for things that did not occur. So you have to look at an itemized medical bill when you go to a hospital, you have to see what are all the individual items that they charged me for and how did those add up to my total bill.

Often when you look at those itemized charges, you'll find things in those itemized charges that did not actually happen. So it's really easy in that case, to go to the facility and say, hey, billing manager or billing department, I'm looking at this itemized bill. And I'm seeing that these different things that you charged me for, I did not actually receive the services.

So you need to remove these from my bill. It's incredible how common that is. In fact, if you talk to experts who review medical bills for a living, they will tell you that most of them contain some type of an error or an overcharge. Yeah, I'm looking right now.

I had a case of shingles, but I didn't know it at the time. I'm so sorry to hear that. By the way, that is a pain. Yeah, so I didn't know it at the time. I went to the emergency room one night because it was just the worst pain I could imagine.

And they couldn't figure out what it was. They ran the blood tests, the urinalysis, couldn't figure it out, sent me home, said take some ibuprofen. And the next night, it was even worse. And so I was like, I don't know what to do. So I had gone to one Sutter Health Hospital the first night.

I said, I don't know what to do. But so I drove to Stanford, a different hospital. So two things I noticed. So this was an interesting experiment for me, because I went for the exact same circumstance to a different hospital within two days, two days of each other one day of each other.

And I got a bill and I they did most of the same work. And so a couple things that I noticed that I'm curious to get your take on because these could be a great examples for people. So one was, when I went to one hospital, it was labeled emergency room visit high severity.

And in the next hospital, it was emergency room visit moderate severity. And based on what I could tell, they charge different amounts based on how severe the circumstances is that something I could call and say, this wasn't actually high severity, right? I you didn't see me for three hours.

Clearly, this was not a gunshot wound. Can we get this drop to medium or low severity? I love this case study. I love that you have this a B comparison in real time. Same patient, same ailment, two different facilities, you are perfectly illustrating all of the absurdity or some of the absurdity in our healthcare system.

So let's dig into this a little bit. When you go to the emergency room, or when you go to a doctor visit, they have five different levels of severity that they code for the visit, one being the least complex and the simplest type of a case, five being the most complex type of a case, and then 12345 in between.

So when they code it as a severe case, they are getting a much higher reimbursement for the service that they provide. But they aren't allowed to just put whatever number they want on the case. They can't just be like, well, it seemed serious to me. So I called it a level five.

There are actual criteria that are used to assign these codes. And so this is why I encourage people when you get your itemized medical bill, get the billing codes. Make sure that you have, it's usually a five-digit CPT code. It's called Common Procedural Terminology. I know this is getting a little wonky here, but this is going to help you a lot, okay?

So get the CPT codes. And if you don't get them from your hospital, your insurance plan will have that information. Just call the customer service number on your insurance plan and say, hey, I had a question about this particular visit. I went to Sutter Health. I went to Stanford on this date.

Can you please just tell me what the different billing codes are for each of the charges? Take that five-digit code, Google it, and read the description of what the code describes. And it'll tell you what it describes and what the requirements are for them to bill that level of a code.

A level three, four, or five billing code requires medical decision-making of some level of complexity. So in other words, if you have a little slice on your finger, it's not a complicated thing to determine what do we need to do with this slice on the finger. The decision is to put in some stitches.

So it requires medical decision-making of complexity, moderate or extreme complexity, depending on the code. It requires an examination. If you have a level three, level four, level five, that requires actually an extensive examination of the patient. It also requires an extensive problem-focused history to be taken of the patient.

So if you went to the doctor and they didn't do a thorough examination on you, they didn't take a complete history on you, and there wasn't medical decision-making of any type of complexity, they should not be billing a level three, four, or five office visit or emergency room visit.

Yeah, yeah. And I'll say one thing I was actually really impressed by was I logged into the Cigna website, and I could get details and download the kind of EOB explanation of benefits. And then I separately logged into both Stanford and Sutter's kind of My Health portal and got similar data.

As much as I found some of the data to be crazy, I was at least pleasantly surprised with how much access I had. That's awesome. And the information is right there for us. But we do have to take that active, engaged step to look at it. And if they're not providing it to you transparently, then you need to ask them to provide it.

But it's your right as a patient to have this information. It seems like with every business, you get to a certain size and the cracks start to emerge. Things that you used to do in a day are taking a week, and you have too many manual processes, and there's no one source of truth.

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Again, go to allthehacks.com/viori and get yourself some of the most comfortable and versatile clothing on the planet. One more tip that I'll share that I just recently learned was, I have an iPhone and I logged into the health app. And I was able to go in and log into a handful of medical institutions I've been at.

This includes Stanford, Sutter, LabCorp, and UCSF, and all of the visits I've had have all been imported. So now I can go in and say, "Gosh, how is my blood pressure tracked over the last X months?" And I see it from every single visit I've been to. So I don't know if Android has the same thing.

But, you know, I'd encourage you if you're on an iPhone to see if your medical organizations support this, because it was a really fascinating way for me to get easy access to my own data. That's really amazing. And we're going to see more and more of that as time goes on.

Technology is getting more integrated with healthcare. And that's going to give us a lot more opportunity to be engaged. One other thing I noticed looking at this, and I'm looking at right now. So one hospital did a comprehensive metabolic panel that was $145. And the other hospital did a comprehensive metabolic panel, same exact code for $995.

Is that is that something normal? Is that kind of crazy discrepancy for the same codes? Something that people should expect to see? And is there any obligation for people to charge a fair price? There is no obligation for them to charge you a fair price. So you are identifying right here with an excellent case study, the absurd amount of price variation.

Now, let's pretend that you were paying all this out of pocket. So if you went to the one facility that charged you $900, you would be obligated to pay that amount of money. And for many of our policymakers, many of our decision makers in healthcare, they have the money to just pay the overcharges, they have the money to pay the high premiums and the high deductibles.

And so for them, their time is worth more than their money. And it's such a hassle to figure this stuff out. They just pay the bills. What they do is they ignore the massive amount of the American population, the majority actually, that cannot afford to pay a $900 bill.

The Federal Reserve did a study of the amount of money people have in their savings accounts, and they found that 40% of Americans do not have more than $400 in their savings account at any given time, the median American family of four makes about $70,000 a year. So for those families, they are being put into debt and into bankruptcy by these medical bills.

And so I always encourage people like maybe you or like myself who can afford to pay a higher medical bill, when you stand up for yourself, and when you push back against these absurd medical bills, unjustified medical bills, you are not just standing up for yourself, you are also standing up for this entire population of Americans who might not be able to stand up for themselves.

They might not have the resources to push back, they might not have the education or the knowledge to push back. And so I believe that we who have more need to see this as a justice issue where we can stand up for the people who are getting hit with these outrageous charges, and they're unable to afford them.

Think about it this way. It's a basic metabolic panel. This is an extremely common blood test. So you you just named two name brand facilities Sutter and Stanford. Okay. You're telling me that one of them is not able to do it at the same price as the other one?

Yeah, it blows my mind. It blows my mind. So okay, so this is really interesting. And I'll caveat that I know myself, and I think I know a lot of our listeners pretty well, any one of us might be able to pay this bill, I can promise you, especially for myself, I have no interest in paying ones even one cent that I can afford if I don't have to love it.

So you know, we talked a little bit about how to search for the prices in advance. A lot of times we make the mistake or we don't ask or you're in the emergency room, I probably could have paused and said, Hey, before you draw my blood, how much are you going to charge me for this metabolic panel.

But a lot of times all this happens after so you get a bill in the mail. And even if you have an insurance plan that is good, oftentimes you might have 10 2030% coinsurance. So that $900 metabolic panel might not cost me $900. But it might cost me $300.

And maybe it could cost me $100 or a lot less. So I'm curious if or even $30 I guess it could be the difference between these two bills is probably $45 and $300. So what do we do when we get those bills and want to push back and I'll throw one other egregious example I got was when I broke my foot, they left me with a walking boot.

And that walking boot I found to be not the best walking boot. So I went on Amazon, I found what I thought was the best walking boot and it was like $52. And then I get the bill in the mail from Pacific Medical Inc. Sorry, guys, I'm throwing you under the bus.

They deserve a solar air walker. And the price was $335 a marginal product that, you know, was not good that I replaced with an excellent $50 product cost 335. But it's too late. I already have this boot, I'd washed it, I've worn it. What do we do when we get these egregious bills, even if we only have to pay 10 2030% of them?

How do we what do we do after the fact? You're beginning to make my blood boil here, Chris. I love it. I love it. Because it gets me fired up because it's affecting all of us. It's affecting all of us. We are all afflicted in the United States by this ridiculous healthcare pricing.

And you're just citing examples yourself from your real life in the past year. But this is happening to all of us all the time. And we have got to push back on it. So let's talk about how to push back. Okay. I have a whole chapter in my book about how to sue in small claims court, when you have been price gouged, or when you have been charged for something that's erroneous.

And I believe that this is a game changing tactic that does work. I documented lots of cases where it's worked. And I am now helping a lot of patients with these problems right now. So our small claims court system exists to protect individual consumers from unfair transactions by big corporations or other more powerful individuals.

And it's a it evens the playing field because right now what would happen is this, you call the hospital, the billing department and you say, hey, you guys just charge me or this company, the device company, you guys charged me $300 for a boot that was a piece of junk.

I got a much better boot on Amazon for $50. That's no good. So I would first start with trying to negotiate a better price on that bill. Now they would probably tell you this is the price that your insurance plan has agreed to pay us for this. So you are contractually obligated to pay it.

And if you called your insurance plan, they would review it. And they would say, yes, this bill was paid in accordance with your plan. In other words, we have an agreement to overpay them for this piece of crap medical boot. So you as the consumer, they'll just look at you and shrug.

And they go, that's the price that your insurance plan agreed to pay. And that's the plan that your employer picked for you. And so therefore, you get sent the bill. I don't believe that is a fair way that working Americans have been treated. I believe that we have a three-party transaction here, or even a four-party transaction.

We have the device company, we have the insurance plan, we have the employer, and we have the employee, you, in this case, who is the patient. How is it fair that the device maker and the insurance plan come up with a price, and then they just tell the employer and the employee to pay it?

That makes no sense. That's not fair. It's something that we have tolerated for too long. And now we have got to push back and contest. So you start by saying, I just found this product on Amazon that's better than the product you gave me for $50. I will pay you $50.

How do you feel about that? If you get stoned, well, does that work? I do. Yes, it does work. It often works. So it depends on how much noise you want to make. So you know how it is, the squeaky wheel gets the oil, gets the grease, right? So you may have to complain to higher-ups in the facility.

You may have to complain to higher-ups at your employer. You may have to complain to higher-ups at the insurance division. You may need to file complaints to the insurance division or the health division that oversees the hospital or the facility. You might have to make some waves. And it depends on how much it matters to you.

So for a $300 bill, you might be like, look, this is not worth it. I'm just going to pay the bill. You don't know me that well. Just the idea of paying six times, even if it was $5, I feel like the experience of fighting back might be worth it.

I think it's very worth it. And this is what I would encourage you to do. And I'd be happy to help you do this. Start with just a polite call to the billing department and see how they respond. Start by calling your health insurance company and see how they respond.

My prediction is that both of them are going to basically blow you off. They'll say this is what the plan has set as the price. And so therefore you have to pay. This was adjudicated according to the terms of the plan. So they'll basically say so the bill is the bill.

So then your next step then is to escalate it and say, I want a reduction on this. You have overcharged me and it's not OK. And so you do need to become confrontational at that point. And this is where a lot of people don't want to do that. Right.

A lot of people back away. But if you're the type, which I am, too, where I'm going to say no, not now you've got me more interested. Then the next step would be to contest it right to that billing department and ask for a supervisor. Always ask for a supervisor and go as high as you can up the chain to insist on a reduction in the price.

Now, I'm continuing to assume that they're going to blow you off. The next step would be take the sample letter that I have in my book, which is a 30 day warning to tell them if you don't correct this within 30 days, I'm going to sue you, as is my right in small claims court in my state for overbilling me and price gouging me.

There is actually a legal precedent that we can stand on to undergird ourselves when we take on these legal fights. And it's called the open price term. This is part of the Uniform Commercial Code. The UCC is the law that governs commercial transactions in the United States. The open price term says that as a consumer, if you go for some type of a transaction and they don't give you the price upfront, then it is assumed that the price that they give you is going to be fair and set in good faith.

Now, a $300 price for a crummy product is not a price that's fair and it's not a price that's set in good faith. So you actually have good legal grounds if your case ever goes to court to argue and win a case in small claims court. But think about what happens.

So you're going to send that 30-day warning notice. And the reason you want to do that is because you want to show the judge, if you ever go to small claims court, that you did everything you could not to waste the time of the court. You don't want to show up in front of a judge having filed a frivolous case.

So you want to show the judge, "I warned them I was going to sue them. I urged them to renegotiate and give me a fair price. They refused to do it." Often that 30-day warning letter will create enough waves that it will shake them up and get them to give you a negotiated price that's much lower and that's a fair price.

But if they don't, then you follow it up by filing a claim in small claims court. And in most states, it's about $30 or $40 to file a case. It can be done easily online within minutes. You've already done your research because you've gathered all your medical records and your medical bills.

So you have all the evidence you need. It's not like you have to do more work. So you file that case and now think about the problem you've created for them. And this is the part I have to admit I feel maybe a little devious and antagonistic here, but I love this.

Because now you're going to sue them for the difference. You've been told to pay or you've paid $300 when it should be $50. So you're going to sue them for $250. Now imagine they're going to have to hire an attorney to argue the case against you. You don't have to hire an attorney in small claims court.

They probably will or they're going to represent themselves, which will be a total pain for them. It's going to cost them hundreds of dollars an hour to defend a case that is only costing and only worth $250 to begin with. So when we sue them in small claims court, we give them the incentive they need to do the right thing.

We give them incentive. Now they have an urgent incentive to call you up and say, "Okay, look, we'll take $50." Or, "Okay, well, look, we'll take $100." And you say, "Okay, I'm overpaying it $100, but I don't want to go. It's a hassle for me to go to small claims court, too.

So I'll do it for $100." So small claims court is extremely effective. And I would be happy if that were something you decided to do, and I'd be happy to help you with it. Yeah. And I think you outlined how to do a lot of these steps in the book.

So it's not, there's a framework for the flow to follow from what I remember. Yeah, it is. I call it the Never Pay Pathway. Again, I'm not saying, when I called the book Never Pay the First Bill, I'm certainly not saying don't pay your bills. I'm just saying never pay the first bill until you have analyzed it and made sure that it's fair, and that it's accurate.

And if it's not fair, and it's not accurate, then we need to push back and demand a fair treatment. Yeah. And one thing that we haven't touched on, which I was just totally fascinated by, was I got a lot of bills from the hospital, from this medical device company.

And I was surprised that at times they would send me a bill before the insurance company has even responded. And the bill I got, I looked online a couple days later, and I was like, "This bill has already been paid by the insurance company." Wow. And so I could see myself in an alternate world.

And I'm thankful that we'd communicated and this was getting scheduled. So I had some ideas of what to do. But I got a bill at one point for $500 for some part of this visit. And bam, here's where I had to pay it online. Here's how to send in a check.

But I logged on online, it was already paid. And so is it normal for people to get bills that their insurance company will ultimately actually pay, that they might get tricked into thinking they need to pay? Yes, I've had the exact same experience myself, where I was sent a bill with all the amount due, $250, person responsible, Marshall Allen, date it was due.

Well, with that one, I realized they had not even submitted it to my insurance company. They had all the insurance information, for whatever reason, they did not submit the claim, they just sent me the bill. And so I was able to route that back to the insurance plan and get that paid in full.

And so another principle, another tactic is make sure that your health plan has paid the bill and adjudicated it properly before you send in any money. And you check that by looking at your insurance companies, it's called an EOB, an explanation of benefits. That document will show you what the charges were, what the allowed amount was for your insurance plan, how that was all processed will be done by the insurance company, and then it'll tell you what your amount is that you owe.

So it doesn't mean that you're not still going to get maybe price gouged. But at least you'll know how it was run through the insurance plan. And you can make sure that the insurance paid the amount it's supposed to pay. Yeah, my examples are interesting, because they're very relevant to me.

But are there some examples you have of people who've managed to have huge wins? Yeah, I have a whole chapter in the book on how to fight your insurance company when they've denied you the care that you need. And these are often like life and death struggles. Certainly it can be your financial life and death.

But I talked to a woman named Alexia. And I helped her and her husband, after she had an elective procedure done that her hospital told her they got cleared by the insurance company. So the insurance company would cover it, while the insurance company didn't cover it. And so she got stuck with a $78,000 hospital bill because of this procedure that didn't get covered.

While I walked her through the tactics in terms of how to fight an insurance company denial, and in the end, it took about a year and a half. This was a big battle for her. But in the end, her insurance company agreed to cover most of the bill, and then the hospital waived the other charges.

So her family went from owing $78,000 and consulting bankruptcy attorneys, to having owing nothing, having the entire bill forgiven. And so that's one tactic. Another, just even the youth pastor at my church that I went to in New Jersey, within weeks of reading my book, he started pushing back on medical bills and saved $815 just in the first few weeks.

I've also helped people with small claims court. And one thing I love to do is read the reviews on my Amazon page, because I'm seeing people throw in examples of saving $1,500 here, getting hospital facility fees waived, all kinds of things, where people are pushing back and fighting back and saving tons of money.

Yeah, I'm actually putting these things to use. There were a couple charges that they're like, Wow, this one x ray wasn't covered. And, and I planned to fight back and see what happened. One of those future reviews might include my outcome as well. One situation, I interviewed someone named Kevin Rose, and we were talking about the way people think about cardiovascular disease, and how some primary care physicians aren't as up to date on the latest research, which makes sense, because they're so busy seeing patients.

And one of the things he pointed out that right now we look at your HDL and your LDL levels, but there's a lot of data out there to support that another marker, which is your APO B numbers, which I think it's like your APO lipoprotein B, it might be a better indicator of cardiovascular disease.

But because the science hasn't caught up, oftentimes, those things aren't recommended by doctors are covered by insurance. And so in a circumstance where you're reading something scientific, that's that has journal data behind it, but insurance companies haven't caught up, is there anything you can do? For example, I went in and asked my doctor, could I get this test, doctor put in the order for it.

And then the insurance company ended up denying it and saying actually, this one blood test we don't cover that was not a case of it was too expensive, right? The charge was it was only maybe 100 and something dollars for the blood test. But there's data to support that it actually might be a better thing than the other things I know they cover.

So in that case, they probably were denying it because they were classifying it as experimental. And experimental is a category they put things in that they just haven't decided to cover yet. That does not mean it's experimental. And it does not mean that it doesn't work. This goes back to that chapter in the book about how to appeal insurance company denials.

And I actually have some examples. I have an example in the book, where I dig deep on the way to fight these appeals. And when is first of all argue with evidence, not emotion. A lot of times when you get denied some type of care, you try and argue, but I really need this or the patient is going to get really sick without it.

Or this patient's a young mom with three kids. And if she doesn't get the care she needs, she's going to die and the children will be left without a mom. Those are all true. You want to have an emotional component to your argument if it's there. But you have to argue with evidence.

And so in a case like yours, I have some memos on my website, my website is MarshallAllen.com. And you can follow a template. And I actually learned this template from a woman named Lori Todd, who calls herself the insurance warrior. This woman has fought hundreds of insurance cases, and won hundreds of them.

And the I really take my tactics from Lori, but I have some memos on my website that will show you a well informed and well reasoned appeal to an insurance company. And one of the key things is use that evidence from your studies, you mentioned that there are studies that show that this particular test is valuable for identifying this type of heart disease.

cite those, you'll see when you look at the memos on my website, they're pages long. And so you want to actually cite the citations. The other thing you want to look at is your insurance plan. It's called the summary plan document. This is the document that's actually a legal contract between you as the member and the insurance company that lays out the insurance companies, companies contractual obligation to cover the care that you need.

Now, a lot of times in that summary plan document, again, it's a contract. So you don't want to argue with emotion, think about it like you're negotiating a contract or fighting over the terms of a contract, they're going to have a thing in the contract that says that your doctor's medical decision making gets respected, not the insurance company's medical decision making.

So if your doctor orders the test and recommends it for you, you might be able to argue from that summary plan document that your doctor has determined that you need this test, that it's medically necessary, that there are studies that show that this study that this test you want to do is credible.

And so you need to then make that appeal and in an informed way, almost more like a legal argument to that insurance company to get them to cover it. Yeah, this comes back to something that that Kevin mentioned, which was, when you're looking for that primary care physician that you're working with, it's important to find someone that aligns with what you're looking for.

So instead of finding someone who's willing to put in the order for the test you want, find someone who actually believes in the research that you're interested in, and would back you up in that argument. And so I come back to what you said earlier, very earlier in this conversation, you said, it's really important to get the best care and the lowest price.

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To get all of the URLs, codes, deals and discounts from our partners you can go to allthehacks.com/deals. So please consider supporting those who support us. Do you have advice for people on how to find the best care? Whether that's finding the right facilities, picking where to go, finding the best doctors, are there criteria you use to try to identify where to get the best care?

First of all the answer is it's very difficult and it depends. It depends on the type of care you need but let's just throw out some examples. One of the key indicators of quality is volume. You want to know how often has this particular doctor or other clinician done the exact thing that you need to have done.

So let's go back to the colonoscopy example. If you want to find a doctor who does a really good colonoscopy, you want a doctor who's done enough colonoscopies to be skilled at it. You don't want to go to a doctor and find out that you're the first one that they've done but that's exactly how they learn, right?

They learn by doing these procedures on patients. I understand that they have to learn that way. I just don't want to be the first one doing the procedure on. So ask the doctor how many times they have done this exact thing that you need. Not something similar but the exact one.

Then ask them what their outcomes are. By outcomes, how well do the patients fare after the procedure? Do they suffer infections? Do they suffer internal bleeding? Do they suffer injuries? It's going to depend. The complications and the recovery is going to depend a lot on the type of care that you're needing.

So that's going to vary a lot. Is there a place to benchmark whatever results you get? No. This is the problem. There's not. And this is what's extremely frustrating. Extremely frustrating about our health care system. There is no publicly available data that I would say is reliable to tell you that one doctor or one hospital is better than another.

In fact, we spent years digging into this at ProPublica and you can Google our Surgeon Scorecard Project and we did an analysis of Medicare data looking at common elective operations like knee replacements and hip replacements and other types of procedures. And we identified looking at this data common complications related to these procedures.

And we published risk adjusted complication rates for about 15,000 surgeons all over the country in a searchable format. Now the data is dated. It hasn't been updated. So I wouldn't recommend going there right now and looking for current information. But we did this at ProPublica as a team of journalists because no one else was doing this for the public.

And what we found was really astounding for complications readmissions because of complications like bleeds or infections or other injuries related to the procedure. Some doctors had exponentially higher complication rates compared to others in the exact same hospital. So again, another principle I'd look at is hospital quality can't be judged by the hospital.

It really does come down to the individual clinician who's performing the procedure that you need. You need to make sure not that the hospital has done a lot of cases. Make sure that your particular doctor or surgeon or clinician has done a lot of those cases. And then when you ask about outcomes, if they are even tracking their outcomes and can give you an informed answer, that is a plus.

That's a mark in their favor because many doctors will not even be able to tell you what their outcomes are. They'll be vague. They'll say, "Oh no, my patients do great." Or, "Oh, the complication rates are actually quite low for these procedures." But they'll talk generally like the national or published complication rates.

I want to know what your complications are, doctor. And so you need to ask them specifically. And if they can answer that for you, that's a plus because most of the time, our healthcare system is like a giant assembly line with no quality control in place. So they're not checking the outcomes of patients six months down the road or a year down the road or two years down the road.

So if your doctor can even give you an informed answer, that's really a positive. And I would recommend pursuing that doctor as opposed to others. Yeah. One other thing I want to touch on is avoiding care. One of the things that I read in your book is that there are a lot of doctors that propose medical procedures or medical tests that you might not need.

And I'd love you to touch a little bit on how you can save money just by asking the right questions. I'm glad you brought that up because sometimes we get the idea that fighting back is like a real confrontational thing. Or like, "I'm gonna contest this medical bill." Or, "I'm gonna sue them in small claims court if they're overcharging me." One of the easiest things we can do that can save us the most money and the most risk of harm, avoiding medical care you don't need.

They estimate when they study the health care that's provided that as much as 25% of the health care that gets provided is not actually necessary. And this is things like having you do some type of an imaging test that you don't actually need or putting you on a drug that you don't need.

Or if you look at the studies about back surgery, it's really common that back surgery gets done on patients who would have done a lot better with physical therapy or chiropractic instead of an invasive operation. So I think that the best question to ask your doctor to make sure you don't get care that you don't need is, "What happens if we wait?" So let's say your doctor is offering you some type of discretionary test or procedure or drug.

If you ask, "Doctor, what happens if we don't do this right now and just wait and see or try something else?" it causes the clinician to reframe the conversation. So all of a sudden they're not talking about the risk of doing the procedure, they're talking about the risk of not doing the procedure or the test or the blood work.

Because every single one of these tests comes with a risk. Every procedure comes with a risk. There's no such thing as a low-risk elective operation, for example. I have talked to families who have had their children die because of low-risk elective operations that went wrong. And so I encourage people, ask what happens if we wait, see if waiting might be an option, see if there might be something less invasive that could be done or less expensive that could be done to see if these problems can resolve themselves in different ways.

And I think that will protect people from a lot of care that they don't need. Yeah, I've seen a couple doctors for something called a neuroma, which is like an enlarged nerve in my foot. And one doctor, their path was, "Let's try these cortisone injections and then surgery." And this other doctor was like, "Actually, I have a pharmacist that makes this compound that helps reduce the swelling of nerves." And it totally worked.

And on my right foot, the result was, about five years ago, I had surgery because one thing didn't work. And on my left foot, it flared up recently. And a $70 - it wasn't covered by insurance - but a $70 compound that was effectively like a lotion. It had the same effect in terms of no pain as a surgery, which was wild.

So I think sometimes it's searching online to read about these things. Sometimes it might be seeing a few doctors. But if ever the result is the only thing left is surgery, I would say maybe get a second opinion. Second opinions are also essential, right? Especially if it's something that's more invasive or expensive, make sure that you really need it.

And most care that we get is actually not emergency care. And so usually, you do have the time to take to do a little more research, to get a second opinion, just to make sure that what's being presented to you is absolutely necessary. Yeah, that makes sense. So one thing we didn't touch on that I want to jump into is for someone who works at an employer.

We could start with employer, but also, you know, I have a podcast. Maybe one day it's a full-time business and I'm looking on the exchange. How do you save money but also pick the right health care plan? There's a lot of options nowadays. Many employers, mine included, offer, you know, PPOs, EPOs, HMOs, high deductible health plans.

How do you help people think about those decisions? Well, it's really a hard answer to give in a general way because everyone's situation is so specific. So some people have kids. Some people have health problems or ongoing health concerns. Some people are very low risk and willing to take more risk themselves.

So it's a hard question to answer generally. But let me just give you a few things since we're talking about hacking the health care system that people can try. If you are a healthy person and your family is relatively healthy, you might not need the complete amount of coverage that's going to come with the highest premium and lowest deductible.

You might say, look, I can take more risk and it's a trade-off because you're going to save on your premium and you're going to maybe take the risk of paying more out of pocket down the road. But a high deductible plan might make a lot of sense for you.

If you're on the individual market, you might benefit by going with something more like a health sharing plan. There's these different health sharing plans. Some of them are faith-based. Some of them are not where it's not actually insurance. So this is the risk you're taking. It's not an insurance product.

It's an agreement that people have made to pay one another's medical bills. The premiums on those health sharing plans are much, much lower for a family or for an individual than your premiums would be on the health insurance market. And you might want to pair that with a direct primary care relationship.

So direct primary care are doctors, and this is becoming more popular, who are taking payment directly from the patient, say it's a hundred dollars a month or two hundred dollars a month, for all the care that you need. It's much more specialized in terms of the care that you need.

And they're catering to you more like they're paying customers so that you're going to get much more of their time and much more of their attention. So you might find, if you're looking at the individual market, that going on a health sharing plan and a direct primary care relationship with a doctor is going to get you better care at a much lower price.

It's just that there's more risk involved. So it's really hard to answer these questions in a way that's going to satisfy everybody because everybody has different needs and have different tolerance for risk. Yeah, a couple of things that I found going through this search process. So I'm very intrigued by, not in the individual market, working with an employer plan, but these cost-sharing programs are super interesting.

And I assume that if it's individuals agreeing to pay bills, that you actually probably are eligible for whatever the cash price is and you're not dealing with insurance negotiated prices. Is that right? Right. Yeah. And it's going to have more friction when you go to the doctor. Your doctor might be like, "What?

Health sharing plan? What are you talking about?" There might be more friction on that end. You might have to pay more of the money upfront and then get it reimbursed. So the hassle factor might be greater. But think about it this way. I mean, your premiums could easily be $2,000 a month for a family.

And you might be saving $1,000 or more per month on your premiums. And so look at it as paying yourself a salary of $1,000 a month by saying, "I'm going to engage with the health care system in a different way." And actually there's a lot of growth in these plans, in these health sharing plans and with direct primary care, because actually people are quite satisfied with them.

Some of them are scams. So again, you have to do your research. Make sure you're not getting ripped off. Check your reviews. Get references to actual patients who have used these plans and make sure you understand what you're getting into. But I have found I have several friends who are on these plans and they've had good experiences with them.

Yeah, that's so fascinating. In years that I've considered a high-deductible health plan, I think pairing it with an HSA is amazing because you can put pre-tax money in, you can take it out, it can grow. Oftentimes your employer will contribute to it. I think Google has one of the most interesting high-deductible health plans for employees because they give you enough money that you effectively meet your deductible for the high-deductible health plan.

So you get the low premium, but the risk is taken away because they're giving you this money and they're giving it to you in an HSA, which you don't have to use this year. You can use it forever. Yeah, so I love the HSA compared to the FSA, the flexible spending account, where it's use it or lose it.

I really get frustrated with the use it or lose it idea with health care dollars because what you end up having happen if you haven't spent your flexible spending account money is you're like trying to find, "Okay, what can I spend in the month of December to get rid of this money?" And it's just really, I don't like the FSAs, but I agree with you.

Those HSAs are good. And my book has actually three chapters in it for employers, and I'm hoping that employers will get more engaged with this because if employers can work together with their employees to design better benefit plans, they could save hundreds or thousands of dollars for every health care encounter for their employees, and then the employer saves exponentially more than that.

So the incentives really are aligned for employees and employers to work together to tackle this problem, and I actually have a much greater hope that they will be able to figure out our health care reform, and it can be consumer-driven, and it can be driven by the market instead of being driven by something like government regulation or politicians.

We haven't seen our politicians on either side of the aisle put real solutions in place that are helping the public, and so I just don't trust that's going to happen. So I think the employers and the working Americans are really our greatest hope. Yeah, yeah. One quick fun thing on FSAs, something to consider at the end of the year if you're running up with some balance that you can't carry over, I think you can carry over about $500 the next year, but if you have dollars you can't carry over, there might be things, maybe call a local shelter, see if there are medical products they need, you might be able to buy them with your FSA dollars before they expire, and donate things.

That's a great suggestion. Are there any hacks for saving money on prescription drugs? Yes, absolutely. I mean, one of the simplest ones is just look up GoodRx. Your listeners have probably heard of GoodRx.com. It's a coupon system where they will show you the GoodRx price at different pharmacies in your community.

That's a great place to look. Also, see if there's a pharmacy that has a membership plan near you. One that I mentioned is called Good Shepherd Pharmacy. It's in Memphis, Tennessee. They have a mail order system where they charge $5 for a generic drug per month, which often if you're not on a plan, or let's say you're on a sharing plan, or uninsured, or self-pay, that could be a better deal for you.

And then check the prices at different pharmacies. Consumer Reports has done this. Other studies have done this, where if you need a drug, it could be hundreds of dollars more or less just at a different pharmacy in your community. So check the prices at different pharmacies, and you'll see that there could be huge variation.

Is there one that does better? Walgreens, CVS, Costco, that kind of traditionally is the best? I think one study I saw showed that Costco overall had the lowest prices, but when they compared the GoodRx prices to all the prices, the GoodRx prices were usually better. The caveat with GoodRx is that it's great for getting an individual medication, but if you're getting that individual medication at multiple facilities from lots of different pharmacists, then you're not going to have one pharmacist that sees all of your medications that you're taking.

That can be a little more risky because some of these medications can interact in negative ways with one another. And so GoodRx is good if you just want the one drug, but you really want to make sure that your primary care doctor or somebody knows all the prescriptions you're on, so they can make sure you don't have side effects from something that's interacting in a bad way with another.

You've spent a lot of time researching this industry, and it really shows I love the book. What's next for you? I am actually on a campaign to boost the health care literacy of working Americans and employers throughout the entire country. And so I have started a side company that I'm calling Allen Health Academy.

And this company exists to boost the health literacy so that people understand how to navigate these financial pitfalls of our health care system. And the first product I'm putting out is a series of videos, a video curriculum that I'm calling the Never Pay Pathway. It's just based on the book.

It's taking all of the actionable how-to hacks in the book and translating them into a series of short three to five minute videos, so people can learn how to get their medical records, how to get an itemized medical bill, how to look up the billing codes, how to price it, how to sue in small claims court.

Basically all the things that we've talked about in this podcast and more that will help people understand the health care system. It'll demystify a lot of the health care system. It'll show them how to protect themselves and how to save a lot of money. And this is something it's actually been supported by a really successful crowdfunding campaign on Indiegogo.

I had supporters and backers raise and contribute $55,000 to produce these videos so that they're really going to be engaging and interesting. And I'm hoping to launch those early next year. And so if people are interested in those, they can go to my website, MarshallAllen.com and sign up for my newsletter.

And that way you'll be informed when those videos come out. And my goal, honestly, Chris, is to, I want to roll these out to every employer-sponsored health plan in America. I want there to be an army of informed health care consumers so that they can contest these outrageous medical bills.

They can push back. I mean, if we had even 1% of the Americans covered by employer-sponsored or individual plans or people who are self-pay, there's about 190 million Americans in that category. If 1% of those people were to push back and demand a fair deal, I think that it would no longer be profitable for our health care system to prey on us financially the way it's been done.

If 1% of people demanded the prices up front and made sure they were fair prices, it would completely remove the ability of the health care system to hide the prices from us. And if we sued in small claims court, when we got one of these like surprise out-of-network bills or unjustifiably high medical bills, it would reduce the incentive to send us these outrageous medical bills.

It would be so expensive for them to do it. And so I think that we do have the power to bring about real change in health care, but we need to equip and educate the public and then show them how to use this leverage to really hack the system so that it benefits them and so that it can benefit all of us.

Yeah, I hope that the examples I've shared inspire a few people listening to go back and look at some of the bills you've paid and see if there's anything erroneous and see if there are any extreme overcharging and push back and see what happens. And so I appreciate all the feedback you've given, all the tips you've shared, all the hacks you've shared, and I hope it inspires people to save more.

Yeah, thank you. And one more thing I want to add, I'm available. People can message me on my website. They can email me. I do enjoy helping people with their bills. So if anybody has any questions or they feel confused, feel free to reach out. And I talk to people almost every day about these issues.

It's really become a hobby of mine, and I really do enjoy it and get a kick out of it. So I'd love to hear from anybody. Awesome. Hopefully people reach out if they need help. And thank you so much for being here. Thank you. I really appreciate the conversation.

That was amazing. I can tell you that the first thing I'm doing next is negotiating down the price of that crappy medical booth. But in all seriousness, I wish that none of you ever have to deal with what Marshall and I discussed. But as I learned this year, it's unfortunately likely that you will.

So I hope this episode was helpful. If you have any feedback or questions on this episode, another episode, or you just want to say hi, I'm chris@allthehacks.com or I'm @hutchins on Twitter. And to anyone celebrating this week, Merry Christmas from Mexico. See you all next week. I want to tell you about another podcast I love that goes deep on all things money.

That means everything from money hacks to wealth building to early retirement. It's called the Personal Finance Podcast and it's much more about building generational wealth and spending your money on the things you value than it is about clipping coupons to save a dollar. It's hosted by my good friend Andrew who truly believes that everyone in this world can build wealth and his passion and excitement are what make this show so entertaining.

I know because I was a guest on the show in December 2022, but recently I listened to an episode where Andrew shared 16 money stats that will blow your mind and it was so crazy to learn things like 35% of Millennials are not participating in their employer's retirement plan.

And that's just one of the many fascinating stats he shared. The Personal Finance Podcast has something for everyone. It's filled with so many tips and tactics and hacks to help you get better with your money and grow your wealth. So I highly recommend you check it out. Just search for the Personal Finance Podcast on Apple Podcasts, Spotify, or wherever you listen to podcasts and enjoy.