Fight and WIN Against Insane Healthcare Costs with Marshall Allen #409

Marshall Allen is a journalist who investigates why we pay so much for healthcare here in America, while simultaneously we receive so little in return. He is the author of “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win” and he is also the founder of Allen Health Academy, which produces a curriculum of short on-demand videos to equip and empower employees to navigate the healthcare system. Marshall has been investigating the healthcare industry for 15 years, including over a decade at ProPublica. He also teaches investigative reporting at the Newmark Graduate School of Journalism at the City University of New York. We highly recommend that you listen to this episode if you’re looking for practical ways to reduce how much you’re spending on medical costs!

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Episode Transcript

Speaker 1 (00:00):
Welcome to How the Money. I'm Joel and I'm Matt
and today we're talking fighting and winning against insane healthcare
costs with Marshall Allen. Yeah. Today on the show, we're

(00:28):
talking with Marshall Allen. Marshall is a journalist who investigates
why we pay so much for healthcare here in America
while at the same time we get so little in return.
He's the author of Never Pay the First Bill and
Other Ways to Fight the health Care System and When.
He is also the founder of Allan Health Academy, which
produces a curriculum of short, on demand videos to equip

(00:50):
and empower employees to navigate the health care system. Marshall,
he's been investigating the healthcare industry for fifteen years, including
over a decade at Republica. But we're really excited to
dive into the different ways that we can fight and
win against insane healthcare costs. Marshall. Thank you for joining
us today on the podcast. It's an honor to be

(01:10):
here with you, guys. Marshall, We're so glad to have you.
The first question that we ask everybody who comes on
the show, though, Matt and I, we really like craft
beer it's something that we splurge on right now, even
while we're trying to save and invest well for the future.
What is that in your life? What's the thing that
you splurge on while you're trying to be good with
your money? Also, you know, guys, I I hate to
say this, but I'm really really quite boring in this way.

(01:32):
And so I even had to run this by my wife.
I was liken, what is the thing that I splurreg on?
Because there are things I splurge on, but then I
try and do it in like a really frugal way. So, like,
I am a total coffee lover. I love great coffee,
but I have found that the best way to do
that at an affordable price is to roast my beans myself.

(01:54):
So I yeah, So I order my beans from a
website called Sweet Maria's. It's in Oakland. They send you
the raw beans, you can roast them up. It takes
about ten minutes to do and then your beans are
totally totally fresh and stuff you would have paid like
a pound for fresh roasted coffee, I can get for

(02:14):
like five dollars a pound. So um, I hate to
not I mean, so it's a splurge, but it's I'm
doing in an economical way. Another one is like, yeah,
I love a great steak, but I'm like, man, if
I go out for a steak, And this is this
is spending so many years as a journalist, right, so
journalism does not pay well. I don't know if anyone
ever told you the pay is so bad. And I

(02:35):
always had a family as long as I was in journalism,
so I've got kids, and I'm like, Okay, i gotta
figure out a way to make the best steak I
can at home. So I love a good steak. Um.
And then the other one, this is totally boring. But
I'm a writer and books. I mean that's I'll buy
books just like I love books. I'm actually in the
process of moving now, and I have to contemplate getting

(02:56):
rid of some of my books, even though I don't
I don't read every thing that I buy. I really
love to buy books, so those would be my three.
That sounds like an existential crisis, trying to figure out
which books you should part with and which ones you
should kid. My excuse to my wife is always, look,
I'm a writer. I don't have to get rid of
any of these. It's my it's sort of my my justification.
Nice Okay, So Marshall, you shared your secret on how

(03:18):
you get really good coffee at an affordable price. You
roast your own beans. How do you do that with
with with a nice steak? Is there a secret? Is
there a a source that you have where you buy
the really good ribis? How do you make it work? Well?
I don't actually like raise the cows in my backyard,
that's what you mean, and slaughter them myself. I don't
go that far. But um no, it's really just a

(03:39):
matter of getting a good kind of meat. I just
go to the grocery store though it's nothing dramatic or
nothing secret there, and just learning how to make it properly.
You know how to sear it on both sides so
that you kind of locked the juices in, how to
cook it to the right medium, rare consistency. Um so
it's perfect every time. So it's it's just maybe learning

(04:00):
how to do it more than especial technique is so important.
And so last little follow up here you're talking about coffee,
what is your favorite method of brewing? Do you like
to do the chemics? Do you do pour over do
you do an aero press that I could. We could
do an hour just on this subject alone, because I
feel like every morning for me is the pursuit of
the perfect cup of coffee. But my standard go to

(04:23):
method is the chemics. I feel like you can get um.
You know, the French press uses too much coffee, so again,
it's just not the most economical way. The chemics is
nice for making it for me and my wife, so
I go with the chemics. That's exactly the same here. Yeah,
all right, enough about food and Marshall's splurges. Let's get
into talking about insurance and healthcare. Marshall, what led you

(04:45):
to spend your time and to spend your energy covering
the issue of the American healthcare system in the first place. Well,
I started covering healthcare when I went to Las Vegas
to become a reporter at the Las Vegas Sun. This
was in two thousand and six, and when they hired me,
they hired me just as a general assignment kind of
investigative reporter. And I had never covered health care before.

(05:07):
In fact, I thought the subject sounded totally boring, but
they asked me to cover it, and I started writing
about it. And I found really quickly that when you
write good stories about health care, you can get right
at two things people care about more than anything else,
their health and their money. Because every health care story
you're talking about people's quality of life with regard to

(05:29):
their physical health, but more and more we're talking about
their quality of life with regards to their financial health.
And so I found that as long as I could
lock into one or both of those subjects and the
stories I wrote, my stories would get huge tractions. So
even though like a pro publicam for the last few
years before the pandemic, I was writing about health insurance,

(05:51):
that sounds like the most boring topic in the world.
Like if you told people I'm gonna write stories about
health insurance, their eyes would totally glaze over. But if
you look at all those worries, I did in a
series I called the Health Insurance Hustle, which because I'm
showing how we're getting hustled by the health insurance industry
in every single story, I could say, this is why

(06:11):
you reader pay so much for healthcare. It's because of
these games. It's because of this type of deception that's
in the industry that your deductibles are so high you
can't afford them. Your premiums are so out of control
you can't pay for them. And this is why we
have right now one in five Americans with medical debt

(06:31):
in collections. I mean, this is a crisis of a situation.
And so when I found that I could really angle
the stories that way, even though I'm writing about something
that seems so boring. I mean, my stories would get
picked up, lots of page views, lots of interest. I'd
get lots more letters and emails. Not letters, I'm not
getting letters in the mail, but emails and phone calls

(06:54):
from readers, postcards, you know, things coming in over the
over the wire. But you know what I mean. I mean,
I got so much feedback from readers that, um, I
just continued to dig in and dig in more on
that subject. And you know, the word crisis, I think
it's overused, but I think it's actually appropriate in this

(07:14):
scenario when we're talking about the health care system and Marshall.
In your book, you actually talked about one of the
best experiences that you had in the health care system.
But there was like this twist, this ironic twist in
your story that that awesome experience wasn't here in the
United States. Can you kind of tell us like how
that went down? Yeah, you took away my punchline though
by by giving exactly well, so here's here's here's how

(07:37):
it happened. My wife, she unfortunately has gotten migraines her
whole life. And so we were traveling. We're actually in
Kenya where we used to work there. We did Christian
youth work in Kenya for three years. So we went
back and took our kids back there in twenty nineteen.
And this was right before I got the book deal
actually to write this book. And unfortunately, my wife to

(08:00):
migraine and it was after hours, and so we couldn't
go to a doctor's office or urgent care clinic. So
we had to go to the Nairobi Hospital, which is
the big hospital there in in Nairobi. And you know
here in the States, if you go into a hospital
emergency room, I mean you're just bracing yourself for like
these surprise bills, these out of network bills. You know,
they don't give you a price up front, and so

(08:22):
they're gonna you don't know what it's going to be
when you get it in the mail, you know, And
here at the Nairobi hospital. I go in and my
wife is there and they say, okay, well that'll be
you know, I don't remember how much it was thirty
dollars or something for the doctor to see you, and
they've just printed up an invoice for him for me
and had me pay it right on the spot. And
I was like, what is going on here? How is
it that they're able to give me a price up front,

(08:43):
whereas in the entire United States you can't get a
price up front. Then we go back to the doctor
and I'm thinking, okay, here's where they're gonna overtreat us.
You know, they're gonna say they need to do a
scan of her brain to make sure there's not an aneurysm.
The guy was like, hey, it looks like she just
needs some pain medication, and my wife and I like, yeah,
that's exactly right. So he's like, you can get it
on the pharmacy. From the pharmacy on your way out,

(09:05):
and I'm like, okay, here's where they're going to get us.
Because drug costs are marked up, you know, you don't
know how much it's gonna be. There's all these secret
spread pricing and rebating and American drug prices. Well here
they just were like, pay us thirty dollars and get
your drugs. And I paid them thirty bucks and I
left the hospital and my wife got what she needed
and we It was It was the most remarkable experience

(09:28):
because we actually engaged with an emergency room in a
hospital without feeling like we were being financially exploited because
of our desperation. And unfortunately in the United States, what
happens over and over again is that the system knows
that we need care and we can't control when we
get the care that we need. So unlike other financial purchases,

(09:50):
like if you buy a TV or go on a
vacation or buy a new car, those are like things
we can control. We can shop around, we can side
not to buy the thing, we can buy a cheaper
version of it. But with healthcare, when you're sick, you know,
if you're a diabetic and you need insulin, you need
that to save your life. And unfortunately diabetes and insulin

(10:11):
is a tragic example. The Senate Finance Committee just put
out a report last year that showed the drug makers
and the pharmacy benefit managers. These are the insurance companies
that manage pharmacy costs. They have been jacking up the
price of insulin year after year after year without showing
any improvement in the drug itself, and so unfortunately people

(10:33):
are diabetics are just required to pay hundreds of dollars
a month for something ten years ago would have cost
a fraction of that cost. And so it's it's really
a system where the business side of the industry has
identified that people need care and they will pay any
price because it's about saving their life, for saving the
life of their kid or their loved one, and so

(10:56):
they take advantage of that and they're exploiting us. And
there's a lot of decay option in the industry. There's
lots of financial pitfalls, and so the book um really
breaks down how do identify these pitfalls, what they are,
and then how to navigate around them. And then if
you get hit with a bogus bill where it's overpriced
or it's inaccurate, I show in the book step by

(11:17):
step how to identify those errors and over charges in
your bills, and then how to contest them and how
to fight back. Yes, yeah, and it actually we're really
excited to dive into some of those practical steps when
it comes to making sure that we're not just completely
getting hosed over by hospitals on different practices. But yeah,
this just goes to show that as great of a
country the US is, we definitely have some some broken

(11:41):
industries in our lives. And when it comes to insurance, Marshal,
You know, most of us are used to shopping around
for the best price and things, but there are multiple
important factors when it comes to shopping for health coverage. Uh,
And so how can individuals and how can families know
that they are choosing the right insurance plan for them? Well,
so that's a tough question to answer because everybody is

(12:02):
in such a different position when it comes to the
type of coverage that they actually need for their family.
It depends a lot on their financial situation, and it
depends a lot on um how many times they feel
like they need to go to the doctor or to
the hospital if they have chronic conditions or not, or
if they're pretty healthy. Many times for most people, um,

(12:24):
working Americans, you're in an employer sponsored health plan, so
you're also limited that way. Your employer will present a
set of options to you and then you have to
choose from those options that covers about a hundred and
fifty five million Americans are in that category. Then you
have UM, maybe five percent of all working Americans are
in like the exchange plan type of insurance plans. Those

(12:46):
are the individual healthcare plans that came through the Affordable
Care Act, which often people call that Obamacare. So these
are the Obamacare plans. Those can be really expensive UM
and subsidies are available for a lot of people depending
on their income. But if you're priced out, if you
make just too much to get those subsidies, that those
are extremely expensive types of health plans to get. And

(13:10):
I've even seen a lot of people now using UM
some of the sharing plans, you know, like there's Christian
healthcare sharing ministries, and then there's others that are not
faith based at all, And these are these are plans
that are not insurance, but they are basically people coming
together and agreeing to pay each other's medical bills. And
they always have different types of rules and restrictions, and

(13:32):
you have to be very careful to check the references
of any of these plans to make sure they're actually
paying the bills like they say they are. But I
actually know some people who do these plans and they're
very they're they've been very happy with them. And if
you're relatively healthy and don't feel like an obvious need
for ongoing care, those those plans might be might be
a good option. Yeah, it seems like that there have

(13:54):
been more incentives recently when it comes to getting healthcare
on the exchange, Like so many people qualify for a
much lower rate, uh, when it comes to getting healthcare
that way. But yeah, I'm with you. Some of those
health sharing plans for people that don't qualify for those
lower rates on the exchange, they've almost become like the
only place they can turn, it seems like. And um, yeah,

(14:14):
what what do people need to consider and look into
before they sign up for one of those health sharing companies?
Because yeah, I mean if the premiums are three a
month versus a month, I mean, that's a huge difference.
And most people can't afford some of those policies that
you would buy on the exchange. Right. The other issue
with the exchange plans is that you're often going to

(14:36):
have a pretty sizeable deductible there, and not that deductible
is the amount of money you have to pay before
the health plan kicks in and pays anything. So there
are a lot of people on these high deductible health
plans right now, and they are paying the first dollar
of almost every single thing um that they get care for.
So you're paying your premium every month, and then you

(14:59):
expect your health plan to cover something for you, but
you have to pay that deductible, and sometimes that deductible
is three thousand dollars, five thousand dollars, even ten thousand dollars,
and so effectively you're uninsured until you've paid out a
pocket that amount. But with investigating the health sharing plans,
I would get references, so I would talk to people

(15:21):
who are actually on the plans and ask them how
well it's worked for them. I would look up the
reviews on Google, on Yelp, I would look up the
Better Business Bureau reviews for each of those plans, and
you can find out pretty quickly if things are scammy,
because it does show up pretty fast um on on

(15:41):
online reviews. So I would check all those things. If
you just want to start exploring as a journalist, I
would often put in the name of a company or
an individual in quotes on Google, and then I would
just put PDF after it, and if you would, you know,
like to look for a PDF file with that name
in it. And it's a amazing how many times that
will pull up some type of a disciplinary action or

(16:05):
some type of a regulator action, some type of public
document often gets pulled up that way. So that's kind
of another little trick. Were searching to see if folks
have been have been disciplined. Yeah, you just got a
nose around a little bit and see what you find.
Very cool. Yeah, our family, Marshall, we we've actually been
with Meta share, which is one of those sharing plans,
and in our case, we all we do we definitely

(16:27):
do have a very high deductible where we are. It's
technically called like a forget. Like our annual household portion
I think is what it's called, but it is ten
thousand dollars. But in exchange for that, our monthly premiums
essentially the equivalent of what they call it premium. It's
only two fifty bucks, uh. And so we're experiencing dramatic
savings month a month, and because of that, we have

(16:48):
taken that into into account, and our emergency fund is
quite large to make sure that we are able to
cover that cost for it to arrive. And I guess
if you're looking at some of these expensive plans on
the Exchange without any subsidies, and if you're paying a
whole lot month month, but you're also being forced to
pay a very high deductible, you're kind of getting short
changed on both ends. Uh. Like you said, it trit

(17:10):
down to how you use the plan, right, Yeah, And
another thing you can do is combine what you're doing
there with a direct primary care relationship. We're seeing more
and more doctors now moved to direct primary care, which
means you pay a monthly cost for unlimited care, often
from that doctor. And so this is for your primary care.

(17:32):
You know. This is so that your family still gets
your annual checkups, you get any vaccinations or anything that
you need, any type of like standard healthcare that your
family needs is going to be really well taken care of.
And you could probably get that for round a hundred
to two hundred dollars a month. Yeah, those are definitely
becoming more popular and for good reason. Um are We've
got more questions we want to get to with you, Marshall,

(17:53):
including how to shop around for a specific procedure in
advance of that procedure being done. And then I'll so too,
like once once a bill comes your way, how do
you fight it in order to save money. We'll get
to the nuts and both of that stuff right after
this break. M all right, we are back from the break.

(18:17):
We're talking with Marshall Allen about healthcare costs. Uh. And Marshall,
you know, even though we're seeing near term healthcare costs
on the rise, you say that there are ways that
we can spend less of our hard earned money on healthcare.
What are some of the biggest levers that we can
pull in order to reduce that cost That's a great question.

(18:37):
I mean, the main thesis of my book is that
for a year after year, now for decades, we have
been paying more and more for our healthcare and getting
less for our money. But if you look at the
data about how overpriced and wasteful our health care system is,
we should be paying a lot less money and getting
a lot more for our money. So that's really the

(18:58):
argument in my book. There's no justification for these high
healthcare costs. And once you know that, then that empowers
you to give you the conviction you need to push back.
So I think the number one easiest way to um
save money on healthcare is make sure that you are
not getting care that you don't need. It's it's unbelievable

(19:20):
how much care is actually deemed unnecessary in our health
care system. It's maybe of all the care that's provided
is found to be unnecessary. And so the trick, of
course is, well, how do you know what's necessary and
what's not right. You don't want to you don't want
to avoid getting the care that you need. And so
one way to think this through is recognize the incentives

(19:44):
that the health care system is operating under. If your
doctor or your surgeon, or your hospital only gets paid
when they perform an operation or they provide some type
of treatment, then their incentive is going to do be
to do more, because that's how they get paid. And
that's just something that all of us as human beings,
are susceptible to the incentives that drive us. Right, and

(20:05):
so when your doctor is recommending something that's discretionary, let's
say it's a test or a treatment, or a procedure
or a drug, and you're not sure, you know, you're
just trying to figure out whether what's going on. Maybe
it's not an obvious case where something should be done.
Ask the doctor this question, Ask the doctor what happens
if we wait? What happens if we don't do this

(20:28):
right now? In fact, I have this happen. It comes
up almost every time I go to my dentist. My
dentist is always always trying to get me to do
X rays. And I'm sure your dentist is always trying
to get you to do X rays too. Right, well,
how much of my teeth really shifted in the last
year or two years or six months? And so ask

(20:49):
the question what happens if we wait? What happens if
we don't do these X rays right now? Are my
teeth going to fall out of my mouth? Um? Is
there going to be a dramatic shift in my mouth
that six months from now you won't be able to
give me the cleaning of my teeth? One exactly is
going on here? And and often what you find is

(21:09):
they don't have a really good answer for that question.
So ask that question what happens if we wait? And
what that does is it reframes the conversation. So instead
of assuming that we're going to do something, you start
exploring the option of not doing it and finding out. Okay,
am I gonna drop dead if I walk out of
here right now without doing this thing you're telling me.
Another thing you can check to avoid unnecessary care is

(21:32):
look at the recommendations of the US Preventive Services Task Force,
So any any listener can google that the US Preventive
Services Task Force, and the task Force is a group
of volunteer experts, all doctors, who are funded by the
federal government to do research and read the latest research

(21:54):
on things like preventive screening tests. So let's say for
a woman, it might be a mammogram, for a guy,
at might be a prostate exam. These are things where
they always want to do these screenings to say, well,
we want to make sure that you don't have breast cancer, right,
which sounds important, and if your doctor is telling you
to do that, you definitely want to take their advice. Right. Well,

(22:15):
the studies show that women it's not recommended to get
a breast examination mammogram if they don't have a history
of breast cancer until they're fifty years old. And yet
doctors will tell women starting certainly in their forties. Because
that's been my wife's experience that they should be getting
that every year or every two years. And if you

(22:36):
look at those recommendations, they actually do not say that's
that's a recommendation based on the best scientific evidence, because
what happens is they have a lot of false negatives
on those tests and it's extremely where rare for younger
women with no history of breast cancer to get it.
You can also identify it with just the manual examinations.
You don't have to do the scans, and so that

(22:57):
helps you avoid treatment you don't need, helps you avoid
over treatment. And they have these kinds of guidelines for
all different types of screening tests. So check out the
task force. That's great. I like that, and I think
I like what you're saying. There's a certain amount of
pushback that we need to give to I think we
just instinctively trust somebody like a doctor or a dentist,

(23:18):
somebody in a white lab coat, the man or woman
whoever's providing the service, and we just assume that whatever
they tell us is the next step we need to take.
But I I love that we should just push back
with a simple question that makes it easy for us
um to then make sure that whatever we're step we're
taking next is in our best interest? I want to know.
To martial the healthcare industry, it makes it so difficult

(23:42):
for us to become an informed consumer. Even with the
recent price transparency order from the federal government, it's hard
to know what the price should be for any sort
of service that we're looking to get. So when we
go see a doctor, how do we know if we're
being charged the fair price in the first place before
we actually sign up for that percere that we feel
like it's necessary. So most of the health care that

(24:04):
we get is discretionary, and by that I mean you
have time to actually decide where you're going to go
for that care. So another really key principle to keep
in mind is always realize that there's huge price variation
in healthcare, and so you might have, um, let's say
you have to get a CT scan or an X

(24:25):
ray or an m r I. If you're a doctor
or nurse practitioner or whoever, that clinician is routes you.
Let's say they work for a big hospital chain in
your town, and so they're going to route you and
refer you to an imaging center affiliated with your hospital. Well,
research has shown and people in the industry know that

(24:46):
any time you go to a hospital for a lab
test or an MRI or any type of a scan,
the prices are going to be way higher and I
mean exponentially higher than if you go to an independent
imaging center or an independent lab. And so if you
just need some type of lab test or scan, identify

(25:08):
an independent imaging center and call and get the prices there.
And you can also check out a company called Green
Imaging dot net. Green Imaging dot net, look him up online.
They do scans and they do direct pay contracts with
imaging centers, and so you can get a scan. I
talked to one guy he needed two m r I
s before he got back surgery. He was told that

(25:30):
it would cost nine thousand dollars if he did it
through the hospital mr I center. He went to Green
Imaging and he got both of those scans for about
nine dollars. So just like in the blink of an eye,
he saved more than eight thousand dollars. And he was
on a high deductible plan. He had a ten thousand
dollar deductible, So for him, he saved eight grand just

(25:52):
by avoiding the hospital mr I center and so that's
not something you would ever expect, right, it's the same
m R. I. So why would it cost so much
more if you go to one location than another? And
this is also why you don't ever want to go
to an emergency room. If you just have the sniffles,
go to your primary care doctor or go to an
urgent care center. But if you go to that hospital

(26:14):
um emergency room, they are going to build you much
much more money for the exact same service you could
get somewhere else at a lower price. Yeah, just like
with music, it pays to uh find out the independent bands,
find those in these labs, find those in the imaging centers,
because you can save you can save a lot of money.

(26:35):
Catch them before they're big, you know, like I I
knew them way back when the only charging nine. So
Marshall your book, it's called never pay the first bill?
Got it? We know that that that should be kind
of the action that we take there, But can you
explain why it is that we actually shouldn't pay the
first bill. We've talked about how to get that discount
ahead of time, but after we received the bill, why
shouldn't we pay that first bill? Well, when I say

(26:58):
never pay the first bill. I mean, I'm obvious they're
not saying never pay your bills, But what I mean
is the principle is never pay the first bill until
you have checked to make sure that it's accurate and
that it's priced fairly. So when you get that medical
bill in the mail, the first thing you need to
do is make sure your insurance plan, if you have insurance,
has processed it correctly. So your insurance plan gives you

(27:20):
what's called the explanation of benefits also known as an
e o B, and that has a breakdown of how
much the build charges were, how much the agreed upon
amount was that the insurance plan has agreed to pay,
and that should be some kind of a discount off
of the build charges. Again, this is just the crazy
convoluted way we pay for healthcare in this country. The

(27:42):
price is not the price. They give this really high
build charge amount and then the insurance company is supposed
to give you a discount off of that. So anyway
you look at the build charges, you look at the
price that the insurance company negotiated for you to pay.
You have a deductible that's going to be factored in there.
Maybe you might have coinsurance. That's the amount that the

(28:03):
portion that you have to pay versus the portion that
your insurance plan pays, and then you have the amount
you owe the other last year. Maybe it's a little
more than a year ago. I got a bill in
the mail for two hundred and fifty dollars from an
urgent care center where my son had gone. And they
said on that bill that my insurance plan had paid nothing,
and I had not received any explanation of benefits from

(28:26):
my insurance plan. So I knew something was off right there.
So I call my insurance company and they said that
the bill had not even been sent to them, so
right there, just by checking that bill, I was able
to see, oh, this didn't get processed by my insurance plan,
and so they need to send it to the insurance company,
not to me. So they sent the bill to the
insurance company right like that. In five minutes, I saved

(28:49):
two fifty dollars. If I wasn't paying attention, that would
have been something easily that myself or my wife could
have paid. And so I think I think people also
don't realize just how screwed up this billing system is.
You think that because Um, it's a doctor. You know,
he has his m D. You have nurses who are

(29:09):
highly trained, you have physical therapists. They're in fancy hospitals
with really expensive equipment. So they give you this aura
of competence, right, and they better because we're putting our
lives in their hands. Right. But on the billing side,
I mean it is a complete mess. Some of these
hospitals and insurance companies they're using I T systems from

(29:31):
like the eighties and nineties. I mean they have not
updated the programming on these things, and so instead they've
done a bunch of patches on top of patches on
top of patches. Their auto paying bills millions a day.
This is like a giant assembly line with no quality
control mechanism in place. And so if you know that,

(29:51):
then you know, okay, there's a good chance that there's
an error on my bill also a lot of times,
so so look at the insurance company E O B.
Then get an itemized medical bill. So hospitals will usually
just give you a bill that says pay this amount.
They don't even tell you. They don't give you a
breakdown on it, like if you went to the grocery
store and they just said pay this amount without telling

(30:12):
you the prices. No receipt, no receipt, right, it's like
having no receipt. You're like, well, come on, guys, like,
what is what did you bill me for? What did
you do? Well, when you look at those itemized bills,
and it is your right to have it, It is
absolutely your right to have that. When you get that
itemized bill, you can check and see, Okay, did they
do this, did they do this, did they do this?

(30:34):
Oftentimes you'll find things on there that they did not
even do. In fact, I just got an email from
a reader who said he went to his dentist. Again,
not to pick on dentist, but this is like the
dentist episode, right, But he said he went to his
dentist and he when he saw the breakdown in the charges,
there's a hundred and seventy five dollar charge on there,
and he couldn't figure out what it was. He called
the dentist and their billing department and they couldn't figure

(30:56):
out what it was for either, so they took it
off and he was again, He's like, in five minutes,
he saved a hundred seventy five dollars just by having
them remove that. Sometimes that gentle pushback does work, right,
or you know, just recognizing, actually, my insurance company didn't
get the bill, and I need to make sure that
they get it, and you know that they pay the
portion that they need to pay before I even consider paying.

(31:18):
But then you know what happens if you get an
outrageous bill and you're like, Okay, the pushback isn't working.
You even mentioned taking a more drastic measure like take
people to court, right? Is that? Is that another step
we should consider to Oh, I think this is the
game changing tactic right here. Guys. So anybody who loves America,
and I do love America, and I know our country

(31:40):
has problems, but I do love this country. There are
certain privileges we have in this country that other people
just do not enjoy. And small claims court is one
of these privileges because our small claims court system is
set up so that a powerless, weak individual can sue
using the power of our udicial system and require a

(32:03):
powerful company or individual to answer for the way they
are treating that weaker, less powerful individual. And so when
you get a bill, so let's say you I, you
analyze it and you can see that it's in error,
or you can see it's overpriced. So I also show
in the book how to check prices, and there's a
website called fair health Consumer dot org. Look up fair

(32:25):
Health Consumer and compare it to your itemized medical bill,
and especially you need to get the billing codes. I
show how to do that in the book. You can
look up and you can see is the price that
they charge me fair or not. Now, also on hospital websites,
they're required to post their prices, and often what you
see is that the cash price might even be a

(32:46):
lot less than the price that your insurance company negotiated
for you. So this has been standard in the industry, right.
Hospitals and insurance companies set prices, and then they tell
us to pay them, whether their fair prices or not.
Even if the cash price is less, they'll just tell you,
oh no, that's our negotiated rate, so you have to
pay it. And my argument is this, Look, why should

(33:08):
any one patient pay more than any other patient for
the exact same service at the exact same hospital. It
doesn't make any sense. And so just because they say
this is how it's always been, I'm sorry, I don't
care what kind of nonsense you all are, what kind
of world you're living in. I don't have to agree
to that. I mean, I'm involved here too, and not

(33:28):
only that, you're making me pay for this so small
claims court. If you identify a bill that's in error
or overpriced, you can file a case for like twenty
or thirty or forty dollars. In most states, you don't.
You have gathered all the information you need. You have
the evidence you need because in my book, I show
how to get an itemized bill, how to price it,

(33:49):
how to get your medical records and make sure they
document the care you received. It's easy to do this stuff.
It does take some steps, it takes some knowledge and learning,
take some initiative. But if they will not correct it
when you sue them, what you do is you create
a very expensive hassle for them, because now the hospital

(34:10):
has to hire their own attorney for hundreds of dollars
an hour to defend themselves against a case. I mean,
many of these cases are only worth a few hundred
dollars or a few thousand dollars, and the limits in
a lot of states are actually quite high. Like in
the state of Texas, you can sue in small claims
court for anything under twenty dollars. In New Jersey where

(34:32):
I am, there's a branch of circuit court here called
the Special Civil Branch where you don't have to have
an attorney to sue someone. It's just like small claims,
and you can sue for up to fifteen thousand dollars.
So the limits are quite big. Some states it's small,
like three grand, but still it's enough that covers a
lot of these bills, and so we are protected. So
then think about it. They now have to hire an

(34:53):
attorney to defend themselves. It's going to cost him a
lot of money. You are giving them the incentive that
they need need to come to the table and give
you a fair price instead of price gouging. You give
me the price. It's fair. I'm happy to pay a
fair price. But what I don't want to do is
just let you rip me off. And that's what I'm
trying to encourage people to do. Let's let's say let's

(35:14):
say the hospital reaches back out. But like before you
get to the lawsuit territory, right, you have not sued
them yet, because you're not at that point in the
in the hospitals like, listen, we we love you. We're
gonna put you on a payment plan. But what what
should you say when when that happens. Oh, that's always
their solution. That's always their solution, is to put you
on a payment plan. Sending people into debt is not

(35:36):
the answer for a dysfunctional and ridiculously overpriced healthcare system,
and that's been their go to method. Oh, we'll just
put you on a payment plan. I talked to a
woman the other day. Um, in fact, this was at
a conference where I was speaking. This woman raises her hands.
She tells this, I've never heard anything like this. She
had a colonoscopy where they build her fifteen thousand dollars

(35:58):
for the colonoscopy. Fifteen thousand dollars, You talk about taking
it up the rear. This this woman was getting screwed
in more ways than one. So so the woman, of
course did not have the fifteen k to pay for
the colonoscopy. Now, just for for a little balance here,

(36:19):
you should easily be able to get a colonoscopy for
one thousand to three thousand dollars. So that fifteen thousand
is completely outrageous. So they said, oh, we'll put you
on a payment plan. She couldn't afford most of the
payment plans, so they put her on a payment plan
that lasted for ten years. Ten years that this poor

(36:41):
woman has had to pay this bill for this colonoscopy
that was outrageously priced. And so that's a case where
if she would have sued them in small claims court,
she would have said, look, I'm not there's this is
an overpriced bill. Imagine them justifying that in front of
a judge. That's gonna be a tough one to justice
I because it's totally outside the standard of what people

(37:04):
are paying. And there's actually in my book I talk
about the open price term. This is a part of
our law. It's part of our Uniform Commercial Code, which
is the law that governs consumer transactions in the United States.
And the open price term says, if you don't get
a price up front, then it's assumed that it will

(37:25):
be a price that is reasonable and that's set in
good faith. And so the health care system does not
have the right under our laws in this country to
charge us whatever they want. It's what they've been doing
and they've been getting away with it, but they don't
actually have the right to do that, and so you know,
when you make your case in small claims court, you

(37:45):
actually have a strong legal standing to make this case.
And so people just need to do it. It does
take courage and it does take initiative, but I encourage people.
You can reach out to me. You can look look
me up on my website more shell Allen dot com,
send me a message. I will. I am happy to
show you how this process works, and I lay it

(38:06):
out in the book. But I'm also happy to coach
people through it because every time I help someone through
the process. First of all, um, it's just delightful for me.
I've made this my hobby. It's really fun for me.
But also I get great case studies right that I
can share with other people. Um. And so it is
really really fun to see people pushing back, standing up

(38:27):
for themselves. It's very empowering. And then you see that
the bullies back off because they don't want to spend
that amount of money to defend these cases. You're making
it not in their interest financially to take you on.
And again, it's not so you can avoid paying, it's
just so that you don't get ripped off. It's just
so that you can pay a fair price. And and
specifically we want to get to some of those winds

(38:49):
here in a little bit after the break. But Marshall,
does it ever make sense as you're negotiating and as
you're trying to figure out what is going on with
your bill? Does it ever actually make sense to mention
the fact that, hey, well I understand that I got
a pretty good case here. Doesn't make sense to mention
small claims court when you're negotiating with the billing department.
Definitely it does. And I don't know that it's gonna work.

(39:09):
You know, it might, it might not. Um The other
thing that you should do is before you sue, and
I have a template for it in the book, send
a warning letter. So one thing that courts don't want.
They don't want us wasting their time. They don't want
us taking a thing to mess with our taxpayer funded
court system if it's avoidable, And so you send him.

(39:30):
You're gonna send him a thirty day notice before you
sue him, or two week notice or one week notice,
whatever you want. But you want to be able to
show that Judge I did everything I could to settle
this in a fair way without wasting your time, Judge,
and the hospital refused to give me a fair deal.
And so that warning letter does tell them, Hey, if
you don't correct this within a week or within two

(39:51):
weeks or thirty days, I'm going to sue you in
small claims court. So you definitely want to notify them
and tell them that you're going to do that, And
I think it is effective. What what what what about listeners
Marshall who have got their debt, has their medical debt
has been sold to a collection agency, And you actually
say that that might put us in a stronger negotiating
position once the debt is out of the hospital's hand

(40:15):
and in the hands of an agency, right, Like, how
do we then make sure that we're not that we're
getting a deal when it comes to paying off a
debt that's been sold elsewhere. Well, you're hitting on something
that to me is maybe the greatest shame of our
health care system. We spend twice as much per person
on healthcare than any other citizens of any other developed country,

(40:35):
or any other average spending a no developed country, and
yet we have one in five Americans, tens of millions
Americans have medical debt in collections and so I included
a chapter on that because we need to not stigmatize it.
If it hasn't happened to you, it's happened to someone,
you know, it's not it hasn't happened because somebody was
irresponsible or did something they shouldn't have done. In fact,

(40:58):
it's probably happened be because of an error filled or
overpriced healthcare bill that the person didn't even know they
could push back against, and so they ended up in collections.
But in a dark way. Like you mentioned, your leverage
gets better, and that's because they've given up on you.
Basically they think you're not going to give them anything,
and so that's that's the starting point. You know, So

(41:20):
when that collection agent calls, you do not ignore the call.
First of all, contest that medical debt in writing within
thirty days. Make them justify it again. I have a
template in the book of a letter that you can
send to them by certified mail, so that you need
to make them justify it because often their whole debt

(41:40):
collection system, they buy and sell so much debt so
many times that I mean they swap it like you know,
used to trade baseball cards when you're a kid. You know,
and so they can't even keep track of who actually
has the legal grounds to collect the debt. So make
them justify it. But let's say they do justify it,
and now you need to negotiate a payment. They're gonna

(42:02):
start like, let's say you owe a thousand dollars, They're
going to start at a thousand. You need to start
at zero because already you know, if it's coming to collections,
they think they're not going to get anything. So start
with zero and say, I'm so sorry, I can't afford
to pay you anything. So I know you'd really like
to get the thousand from me, but that's not gonna work.

(42:25):
I mean, my family has all these bills. Build a
relationship with them, help them to understand where you're coming from.
You'd like to pay it, Yeah, paying a picture for him.
Build a relationship. It does not do any good to
cuss these people out, even though you might want to.
And um, I talked to experts who said that when
they buy debt, they buy it for pennies on the dollar.

(42:46):
So let's say it's a thousand dollars, they might have
bought your debt for it the most, say fifty dollars
and So if you can get them to take something
over fifty dollars so that they make a profit but
a massive dis count for you, then you can pay
that off and a huge discount. So the number that
I came to with one of the experts I talked

(43:07):
to was get it down to about an eight five discount.
So in other words, if you owed a thousand, you
know they probably bought it for fifty at the most.
See if you can get them down to a hundred
and fifty dollars, pay it off in a lump sum,
get that thing gone if you can, or get on
a payment plan for that reduced rate. But be warned there,

(43:28):
because you don't ever want to get on a payment
plan that you default on, because if you default on it,
then that debt is going to go right back to
that original thousand dollar number that you owed without any discount. Right,
So once you strike a deal, make sure you stick
with the terms of that deal. All right, marsh we're
gonna take a quick break. But after that break, we're
gonna talk about You've given some great examples already of

(43:49):
some wins. Basically, some examples of folks who have been
able to drastically reduce the cost of their medical bills.
But we want to hear some more of those. We'll
get to that, plus a couple other questions right after this.
All right, we're back from the break. We're still talking

(44:10):
with Marshall Allen about fighting and winning when it comes
to insane healthcare cost. A ton of good information already
on this episode. Marshall. You have this place on your
website though, where where people can share victory stories. I
love that because I think, like we need to hold
these people up as heroes who are fighting back insistent
saying healthcare system. But what are a couple of the
best ones you've received? Well, I mean, this has been

(44:33):
the most fun part of the book for me. Like
I really loved writing the book. It's been fun to
launch the book. It's been successful, it's selling well, so
that's really fun. But the most satisfying part to me
is these victory stories. And so again I encourage anybody
to go to my website and I have a form
on there that you can fill out. If you've had
one of these wins, please share it with me, because

(44:54):
I'm writing these up. I'm doing interviews with people who
have victories because what I want to do is um
kind of get rid of the idea that we can't
do anything about this. Like the subtitle of my book,
the book is never pay the first bill. In other
ways to fight the health care system and win the end.
Winning is the most important part. So let me just
read this. UM. I know this woman, and I helped

(45:16):
this woman myself, but I love this Amazon review. It's
a woman named Alexia Kalal is her name. She says
on her Amazon review. This book saved my family SEVN
d K and medical bills. This book and the author
are the real deal. My family was near financial ruin
when we found out our insurance denied my procedure and

(45:37):
the hospital tried to stick us with a seventy eight
thousand dollar bill. We were told by both the hospital
and our insurance that we didn't qualify for any assistance.
Thanks to Marshall and the information in his book, we
were able to push back against the hospital and insurance
company in an informed way that made them realize they
had to do something to fix this. We ultimately came

(45:58):
out owing nothing. Without this information, we wouldn't have even
known where they began, and we would have gone down
the path of filing bankruptcy if you were dealing with
bills large or small. The information in this book is
truly life changing. And she has a picture of her
bill from the hospital. It says total charges seventy eight thousand,
six hundred and twelve dollars balanced do on the account zero. Man,

(46:22):
about just hearing you read that. When you first read that,
you must have been like right, she called me, She
called me Actually, So this Alexia is a really um
wonderful young woman. UM. She and her husband Derek, have
two kids. They live in South Dakota. And she was
told by the hospital that they that her insurance company

(46:44):
had approved this treatment. Well, what happened is they actually
um center to the wrong message because what they said,
the insurance company had told them, well, it doesn't have
to be approved because it's an outpatient procedure, not an
impatient procedure. So she got the wrong information. But she
listened to what everyone told her. She got the procedure.
The procedure actually worked. It took care of the problem

(47:06):
that she was having. But then she gets a bill
in the mail because they said it was unapproved because
it was experimental. So I have a chapter in my
book about how to fight these insurance company denials, and
so I walk people through the mindset, the approach, the
evidence based argument you need to make, and also how
to get your employer involved. And in this case, she

(47:27):
was in her husband's employer sponsored health plan, and they
were able to get the employer to put some pressure
on the insurance company to to take care of this bill,
which they should have done in the first place. Insurance
companies will call anything experimental, and so sometimes things are experimental,
but but not everything is experimental. And so I really

(47:48):
love that example because she had the courage to do it.
Her back was against the wall, so she had to
do it, but she came out on top. And that
is a huge, huge encourage in and a huge when Yeah. Well,
one of the things that stood out to me is
that she said that she was informed, and that is
what you're going through your book. You even said yourself
to be able to make these evidence based arguments like

(48:11):
that is what we need to do when it comes
to making sure that we are being treated properly. Uh.
And you can't just be like it's too big, I
hate it, don't make it go away, like you have
to have an informed arguments, right, what I like to
show people because again, how do you get people engaged
in the topic of health insurance, right, or how do
you get people motivated to get engaged and activated with

(48:33):
looking at their medical bills? And the way I'm trying
to do it, quite crassly, is to say you could
save hundreds or even thousands of dollars if you engage
with this, if you boost your financial literacy in this,
in this healthcare way, right. I mean sometimes you think
about the first time when you're a young person, maybe

(48:53):
a teenager, and you got your first checking account, and
you got those first bank statements, and you have to
even balance a checkbook, and you're like, how does this work? Anyway,
I'm very confused by all these numbers. But you knew
that you had to learn how to balance a checkbook
and look at your bank statements or your credit card
statements because if you didn't, you could lose hundreds or

(49:14):
even thousands of dollars. Well, the numbers are even higher
in the health care system. If we don't engage on this,
we could lose hundreds or thousands of dollars per health
care interaction. I think again, people just don't realize how
overpriced the health care system is and how unjustified the
prices are, and how they want you to stay in

(49:35):
the dark so that they can can keep making you
pay more. It's completely unfair and it gets me fired up.
So I'm sure you can tell that that I I
don't like this. I do not like this at all,
you know, and it's it's ruining people's lives. It feels
like there's a gun to our head. But you're teaching
us the jiu jitsu to like to figure out how

(49:56):
to like quickly like take that gun away and then
knock it out of that that aggressor's hands so that
we are on a level playing field. And and and there's
just so many great tips in the book and we
got to talk about so much of it today on
on the show. So yeah, Marshall, I love the book
so much, and we will make sure that our audience
checks it out because it really it's going to save
them money. In the long hall um, where can our

(50:17):
audience find out more about the book, more about you
and what you're up to. Well, so I already mentioned
my website Marshall Allen dot com. Another thing I really
want to tell people about and encourage people to support
I have just launched a crowdfunding campaign on indie go go,
and that's to create a series of health literacy videos

(50:37):
that are based on the book. And so I take
all these principles that are in the book. I know
most people aren't going to read a book, you know,
they're not gonna take the time to get it and
read it. But if you can get this content, it's
like fifteen short, three to five minute videos. I'm raising
money for the production of the videos, the animation and
the graphics costs, and so people can go to indiego
go and look up the never Paid Pathway that's what

(51:00):
I'm calling it, or you can look at my name
UM so you can support that and share that if
you're interested. I'm trying to get the power of the
crowd to help fund the production costs and then um
share victory stories with me. You know, that's another thing
I'm so excited about. I'm seeing people achieve these um
individual wins and it's it's tremendously empowering. And I know,

(51:21):
and I know that your listeners know many people are
not in a position where they can stand up for themselves.
You know, maybe they're too sick. They're trying to fight
um there their cancer or something, they're trying to care
for loved ones. Maybe they're working a lot of jobs
and they just don't have time. And so I think
not everybody's going to be able to do this, but
those of us who can, like, you're not just fighting

(51:43):
for yourself. You know you're gonna have your own win,
but you're also standing up for all those other people
who can't stand up for themselves against a system that
has just become entitled to take our money without any justification.
And so I think when we rise up together and
push back, we are going to have a tremendous amount
of leverage to bring about change in our health care system.

(52:05):
And that's going to help us a lot in the
long run. I love it. That's so good, Marshall. Uh yeah,
thank you for meeting us here at the intersection of
money and healthcare. You were the right man to talk
to about that and we appreciate you joining us today.
Thank you so much. It's a huge honor for me.
Keep it up, guys, all right, Matt, I gotta say
that was a great conversation, and Marshall has been doing

(52:26):
the hard work for a long time now to know
first the problems that are in our health care system
and then how we as individuals can fight back against it.
Tons of great info in the book, and then just
a lot of great information in this conversation that I
think can help our listeners actually fight back against unfair
bills that they might receive from hospital, and then even
just how to proactively shop around and get the lowest

(52:48):
price on a procedure that you need. But yeah, what
what was your big takeaway from this combo? Yeah? I mean,
so one of the things he mentioned early on in
the interview, he talked about direct primary care doctors and
so basically these are essentially ends that you work out
and a lot of times individual doctors will have them.
I mean, the way I understand it, it's a lot
like a subscription service. Exactly, you pay a month and
month you have direct access to this doctor and you

(53:10):
get everything you needed taken care of. That's not something
I have ever had, but as our family grows, as
we kind of continue to have different issues that we
might want to have looked at, like, I feel like
I could see that becoming something that would make sense
for us. He recommended it. It's not something we've talked
a lot about on the show, but we are seeing
the rise in these relationships, and especially as more families

(53:32):
and individuals move to these high deductible plans to take
care of them if disaster or tragedy were to strict right, like,
if there's cancer or something like that, you're gonna hit
that deductible and you might end up paying you know,
five seven, eight thousand dollars out of pocket to hit
that higher deductible. But when it comes to some of
the kind of day to day doctor stuff, uh, these
direct primary care plans might be the path for folks

(53:55):
to take. Yeah, for sure, we're gonna see those continue
to proliferate, and it kind of cuts out the middleman
right now. It's just when your doctor as opposed to
some insurance company standing in the middle, and you get
kind of unfettered access to your doctor under some of
those plans, Like it feels like there's more of a relationship.
It feels like more like an old school doctor said, exactly,
you know where you might show up to your house
with a leather satchel, right right, I think you might

(54:17):
have to pay bonus, like you have to pay extra
for that if you come on horseback. How much does
that get to cost me? But little house in the
prairie style, that's what I'm looking for. Can you provide
that for me exactly? That would be nice. And then
you just like, can we barter? I'll treat you three
chickens if you'll take a look at this rash. How
about some steaks? Marshall would be down for that. Yeah,
what about you? Mail? What was your big takeaway? Man?
I think ultimately my big takeaway was it takes tenacity.

(54:40):
You have to arm yourself with the knowledge and then
you just have to kind of get that bulldog face
and you kind of got to go about the process
of attacking these healthcare bills. If you take it lying down,
you're gonna pay high prices exactly. And if you fight back,
you're going to see major price breaks. You're going to
see some of these bills completely forgiven. But you have
to be proactive and you have to be willing to fight.

(55:02):
And you know that's in the title of the book, right,
fight and win, And if you fight, you're gonna win
more often than not. Um, But you've got to be
willing to throw the first punch. You gotta have that
right mindset, and that's also what's going to allow you
to take the courageous steps to potentially sue them in
small claims core right. It takes that entire shift in mindset,
and I just appreciate the perspective that he was able
to bring today during this interview. Me and let's shift

(55:23):
gears and get to our beer. Today. You and I
each enjoyed Fade Away, which is a red corn logger
by Cruise Blanca. What your thoughts on this beer? So
I'm digging this brewery. I like what they're putting out.
This was um like a traditional logger, but with a
twist with the corn, with the red corn in there,
so it has gave it a lot of different flavors.
It really did from a traditional logger. I think. I agree.

(55:44):
It had like a lot more stuff happening. And I
think the biggest thing it had some a nice, little
like yeasty sort of funk going onto it, which I
really appreciate, almost like a says On. That's I wrote
that in my notes. It almost tasted like a like
an october Fest says on. It had some of these
additional flavors that you would normally get out of a
logger like it almost made it even tastes like it
was barrel age or wood aged or something like that.

(56:05):
But also with it it had this caramel and multi
flavor profile going on. I really enjoyed it. This was
another one that was donated to the show by Dennis
as well as our friends up there at Cruz Blanca.
Definitely have enjoyed their beers there out of Chicago. Yeah,
most definitely. All Well, that's gonna do it for this episode.
For folks who want the show notes including links to
what Marshall's up to, including a link to his book,

(56:27):
which we highly recommend, you can find those up on
our website at how to money dot com. That's right, man,
So until next time, best Friends Out, Best Friends Out.