So essentially what happened is somebody somewhere along the line made up a number and then
that's been inflated by 10 to 20% every year since then.
Welcome back to the money with Katie Show Rich People.
I'm your host, Katie Gattitasan.
It's no secret that I have beefed with the US Health Insurance Marketplace.
If you've listened to this podcast before or been in a room with me for more than seven
minutes, you know this is an issue that really aggravates me.
So today's episode is all about navigating medical debt with rich girl finesse because
if you're going to face dystopian large scale drift, at least we can learn how to fight
back, right?
We've covered health insurance at a macro and micro level before us.
Before we get into this one, we will link a few things in the show notes for you.
Number one, our big deep dive into healthcare in the US and why it is such an egregious
scam.
That's a good little precursor to all of this.
Number two is our rundown of expensive open enrollment mistakes to avoid.
Number three is how to get the most bang for your buck from your HSA, aka the tax
advantaged sorry medical debt might bankrupt you consolation prize.
And finally, a post about the basics of budgeting for healthcare using your deductible and
out of pocket maximum as a guide.
Now today's discussion is focused more narrowly on what to do once you have medical debt
and everything you need to know about avoiding over payment.
Our guest today is Braden Pan, founder and CEO of Resolve Medical Bills.
Self-negotiates medical bills on their customer's behalf.
So Braden is a real Jedi of billing departments.
And at the end of today's episode, you'll hear from Jeannie Pinder, the founder of Clear
Health Costs.
She's a journalist on a mission to build a free, searchable database of procedures by
zip code so consumers can shop around ahead of time and hopefully avoid the type of debt
that we're going to be discussing today.
Ideally, our elected officials would do something about this, but as long as the health insurance
company lobbyists are still summering in the Hamptons with Congress, we have to continue
taking matters into our own hands.
So let's do some table setting.
Roughly 3.2 million Americans, this is about 1% of us spend more than $20,000 per year
out of pocket on medical expenses, according to a recent report from Resolve, and 18 million
Americans are forced into bankruptcy or outright poverty as a result of medical expenses
each year.
This is not to blame any specific individuals because the system was constructed for profit
maximization, which means it's working exactly as intended to the detriment of regular people.
There are 3 primary factors that drive sky high medical bills.
Its estimated consumers spend $149 billion per year thanks to hospital price scouting,
incorrectly denied insurance claims at another $63 billion per year, and finally, billing
errors cost us $46 billion annually.
And if those numbers sound crazy high to you, same.
I did a little further digging and found out that the total annual health care expenses
in the US have ballooned to $3.3 trillion while the total out of pocket costs in the US
each year are $350 billion.
So if we're eyeballing it, roughly $250 of the $350 billion in out of pocket expenses
are basically due to these 3 drivers.
We'll let that sink in while we take a quick break.
So we know we're either going to need medical care or we've just received a bill.
Where do we start?
When breaking down your medical bills, we should begin at the beginning of your bill with
the various rates that providers can charge us for services.
Also known as the charge master rate, you can think about this like the MSRP for a given
procedure.
Braden and his team used data from the center for Medicare and Medicaid services to compare
hospital costs versus the amount they charge consumers.
They found that on average, hospitals charge 4 times their own costs for care services.
Payment insurance companies and hospitals negotiate discounts on those prices.
On average, providers charge the consumer 3.5 times more than what the insurance company
pays.
If Starbucks were run like our health insurance system, you would carry coffee insurance
for your morning, Grande Pygrost.
Instead of paying $3 for your purchase at the counter, they'd bill your coffee insurance.
A few weeks later, you'd get a bill in the mail declaring that the cost of your coffee
was $10.50.
But don't worry, because your plan discount saved you $3, which means you only owe $750 until
you hit your caffeine deductible.
It would be absurd.
Suffice it to say, the coffee insurance middleman provided no incremental value to that transaction,
but Starbucks was in on the heist, knowing they are also going to make a lot more money
than if they had to just charge you the real cost directly at the counter.
Sanders Braden explaining a bit more about how it works.
You've got the charge master rates, these are the list rates that hospitals have.
You have insurance negotiate rates.
These are the rates negotiated between hospitals and insurance companies behind closed doors.
I'll note that the same hospital will have vastly different rates negotiated with different
insurance companies, and an insurance company may have a vastly different rate negotiated
with hospital A and hospital B down the street from hospital A.
Then finally, you have the Medicare rate.
That's the rate that the government set.
They try to do a cost plus model, so they try to estimate the cost to actually provide
a service and then add a little bit of profitability for the hospital on top.
So the charge master rate again is that list rate.
So essentially what happened is somebody somewhere along the line made up a number, and then
that's been inflated by 10 to 20% every year since then.
Hospitals are not really incentivized to be competitive with these, because most people
don't pay them.
If you are paying them, you're not really price-shipping.
You're going to the hospital because you got hit by a car.
You're getting taken to the ambulance.
You're not price-shipping.
You're not looking for the best dealer.
You're looking to get health care services right now.
I also want to note that you're talking about why the hospital is charged more and a half
times their costs.
That's an industry at average.
There are hospitals that charge 20 or 30 times their actual costs on their charge master rates.
This type of obfuscation of price and value then bleeds into claim denials and over
billing.
Nearly 20% of in-network insurance claims end up being denied.
And according to a recent study by Becker's Hospital Review, it's estimated that up to 80%
of all hospital bills contain errors.
It's funny.
The errors almost always seem to benefit the hospital, not the patient.
But in the case of the pricing you see on your bills, you probably see an insurance discount
and the allowed amount.
Here's the difference.
Health care tends to be a really jargonian industry, and so they use all these insider
terms to try to make things more complicated than they actually are.
There's a simple equation that I'm going to use and I'll explain the breakdown.
So you've got your charge master rate, minus your insurance discount is your allowed amount.
So let's just say you go in, you get an MRI, and the charge master rate is $10,000.
Expensive MRI, but ground numbers are easier to deal with.
And insurance negotiated a 70% discount, so they negotiated a $7,000 discount on the
MRI.
So the insurance discount is $7,000, and then the allowed amount is $3,000.
That's the amount that the hospital is allowed to charge for that service for that insurance
company.
Is there ever an event where if I were to go to the doctor and I'm getting something
done and I'm going through insurance?
And so they're saying, she's got United Health Care, cool, I'm going to really inflate
my price, I guess we know United Health Care is paying.
And then United Health Care is like, well, we're not covering that.
So here's your discount that will, you know, throw you a discount, then the rest is going
to have to go towards your deductible or whatever.
If I were just a cash pay customer, would they have looked at me completely differently?
And are there instances wherein you might actually get a lower overall cost by doing
cash pay?
Is there a way to know ahead of time?
Yes, there are instances where the cash pay discount will actually be more than the insurance
negotiated discount.
It is possible to know ahead of time, but it's not super, super easy.
In order to figure this out, you've got to go to your doctor's office's website or go
to the hospital website before you actually go in for a service.
You've got to figure out exactly what service you're getting, including the specific HCPCS
codes that you're going to be getting for those services provided.
And you should be able to download the charge master rate for those codes, insurance
negotiated discounted rate for those codes.
And if the hospital has a cash pay rate, you can see the cash pay rate for those codes,
and you can compare across that to see what is a better deal.
Now it's not the easiest thing in the world because you've got to go through a ton of
data and you have to know exactly what service you're getting around that comparison.
There is a specific site that was in the resources that you guys sent us where you can plug
in those codes and it'll tell you, is that what you're referencing or are you saying
that on the hospital site?
On the hospital site.
So the site that I have that I reference is healthcare blue book, those will do broad
scale averages, but hospitals are the required by law to post this information.
That being said, they don't always do so.
Is that something where if they were not on, you could ask and say, hey, you're legally
required to share this information or are you not likely to get much with that approach?
You as a consumer won't get very far with that approach initially when this requirement
went into play, the fine, we're not complying with something like 300 bucks a day and a lot
of hospitals were like, we'll just, we're a multi million dollar organization, we'll
just take 300 bucks a day, doesn't matter.
Now, those fines have gone up, the government's made it more costy to do so, but not every
hospital has caught up.
For the record, this is where Genie's database to be discussed later in this episode might
come in handy.
So put that in your back pocket.
Regardless, it's clear this field is notoriously hard to navigate as an individual consumer.
But if you have insurance coverage, your explanation of benefits, the document, the insurance
company is going to send you after you receive medical treatment with the purported benefit
of making costs and coverage clear can begin to give you clues about what specifically has
gone wrong, whether that's straight up price scouting and incorrect denial of coverage
or a harder to spot error like unbundling or upcoding.
You'll also need to get your hands on an itemized bill, though as Braden will highlight
for us later in this episode, sometimes that's a little easier said than done.
So here's how he recommends making sense of the EOB.
The first is you want to make sure all of your details are cracked.
Your name is cracked, your date of birth is cracked, your insurance ID number is cracked,
the provider you went to is cracked because any of that is wrong.
You might end up getting denied coverage by your insurance for a very simple reason.
It's actually very common for us to take a look at insurance.
The NIOs had realized that a date of birth was just transposed and all we had to do is switch
a couple of dates around, resubmit, wait two months and get coverage.
The second thing you want to look at is what we'll call the accounting aspects.
That's all list of all the services you have.
You should see the charge master rate, you should see the insurance discount, you should
see the allowed amount or what the hospital is charging the insurance company, what the insurance
company will pay.
You'll also see what insurance will cover of that allowed amount and what is your responsibility
of that allowed amount and that needs to match up with the hospital bill that you should
also begin.
The final thing that you want to look at is look for any denials, understand if any of
those services on your EOB were denied coverage by insurance company and if so why and that's
where you can start an appeal to get things covered.
If the bill you receive is inaccurate because something was erroneously denied whether because
they're now claiming it wasn't covered or wasn't a medical emergency, here's how to
approach that.
You can always appeal that with your insurance company and so you have multiple levels
of appeal with the insurance company.
If you continue to get denied and you feel you have a very strong case, you can normally
escalate this to the state insurance commissioner or another third party agency run by the
state or sometimes the federal government to actually appeal this.
If you get denied because something wasn't a medical emergency and you think it was or
because it wasn't a covered procedure and you think it should have been, you want to
start reviewing your policy.
Review your policy benefits, understand what is and what isn't covered so that you can
make the argument and especially if something is denied for not a medical emergency and it
was then go and get the healthcare provider, your doctor on your side.
Have them explain why this was a medical emergency that'll give your appeal a lot more
power and make it a lot more likely to go through.
You call the doctor and say, I think this was a medical emergency, can you submit this
and have the doctor create a note or if you want to manage the appeal yourself, you
could say, I'm writing an appeal for this, I'm building everything out, is there any
way that the doctor can write a note basically saying this was a medical emergency?
You can also call, you can figure out what the diagnosis code was, ICD-10 code, which
will often be the driver between determining whether or not something was or wasn't a medical
emergency and so you can go that route and see if there was a different ICD-10 code
that should be used, those are generally the two biggest things that we tend to see.
And a couple of important follow-ups here, you want to take notes every time you call
write down the date, time, who you spoke with and their response and be kind to the person
on the phone, they're not probably going to be the one making the decision but you want
them to be an advocate for you.
So that's helpful if you're having issues with denials but there's also a chance you'll
be billed for treatments you didn't even receive.
Let's talk about straight up billing errors and how to approach them.
So as we noted earlier, there are two common ways billing errors happen, unbundling and
upcoding.
Unbundling is what happens when a procedure that has a single code is added to your bill
as well as all the codes for all the elements of that procedure.
While upcoding is what happens when you're billed for service that's more complex and
costly than what you actually received.
Now this is why your itemized bill is key and if you see things that you don't recognize
or you're unsure about, you can call the hospital and ask for your electronic medical record.
You want to specifically request that term because they're required by law to provide
it to you when you ask directly.
Focus on the most expensive big charges first and do not be shy about consulting emperor
or Google to figure out if the descriptions match what happened.
For unbundling specifically, Braden and team recommend a free trial of find a code, the
NCCI edits validator that's found in the tools menu under scrubbing and validation allows
you to enter all of the codes on your itemized bill and it'll pull from a database that's
designed to detect pairs that should not go together.
So if anything gets flagged, you can call the hospital's billing department and raise
the issue.
Another error that can be particularly surprising is something called balance billing.
Balance billing is illegal in some states as it's also referred to as surprise billing.
You get the sense that it's a bit of a, hey, let's just see what we can get away with
charging and some people are bound to not know their rights and just pay anyway.
Here's Braden.
I do want to point out that with the no surprises billing act that was put into place,
balance billing occurs much more rarely than it used to.
Now there are still certain instances where it can occur, but the majority of instances
where it used to occur, it shouldn't happen and you have recourse if it does happen.
And so in short, it's when the medical provider builds you for the difference between the
charge master rate and the allowed amount.
And so basically, again, the charge master minus the insurance discount is the allowed amount.
The hospital is trying to bill for that insurance discount amount because they're collecting
the allowed amount from the insurance company.
They want to get more money from you so they can get their charge master rate.
Fixing in network balance billing is more straightforward as it's almost always in
violation of the contract the hospital has with your insurance company, which means you
usually just have to follow three steps.
Number one, call the insurance company and ask them to walk you through your EOB and
hospital bill.
The representative should be able to walk you through your charges and confirm whether
you have been balance billed.
Number two is to ask them the best way to talk to the hospital about getting the balance
billing reversed.
If they don't handle it with the hospital on your behalf, you'll call the hospital
and let them know you're being balance billed and request that they correct it.
Number three, you might have to take them through the numbers carefully, but don't
get threatening.
This is usually a clerical error and they're willing to fix it.
And the last step is requesting an updated bill so you have it in writing.
Out of network balance billing is a little trickier, but if you got an emergency medical
service in 2022 or later, then no surprises act may have your back no matter what hospital
you are at.
As long as you got this service past 2022, you can't be balanced billed, even if you're
out of network in a few specific situations.
If you had emergency care, so you want an out of network hospital for emergency care,
if there was non-emergency care by an out of network provider, add an in network facility.
So you went to the hospital to get surgery.
It was an in network hospital, but your anesthesiologist was a separate provider and they were
out of network.
You can't be balanced billed by that anymore.
And those are the majority of reasons why people were balanced bill previously.
That being said, in order to protect yourself from getting balanced bill, you always want
to know if you're going for some sort of elective procedure or elective surgery, if the
provider is in network or out of network.
If they're in network, you can't be balanced billed.
If they're out of network, there is that risk and so you want to understand what the
cost will be.
So you need to talk to the provider, the insurance company, ask both of them what will be
covered and what won't be covered, and also ask the provider for an estimate of costs.
There's a settlement process that the insurance company in the hospital have to go through
to determine the pricing that's separate from you and you can only be billed the amount
that you would pay if you went to an in network hospital.
We'll let that sink in while we take a quick break.
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So by now, you know how to look for common issues like incorrect claims, denials, unbundling,
upcoding and balance billing.
But what if everything you're being charged for is correct, just way too expensive.
This is known as a price gouging situation and you'll need your EOB and itemized bill
to begin the three step negotiation process which we're going to break down in detail.
Number one, gathering the right information as Brayden mentioned, number two, analyzing
understanding and fixing the issue, and number three, the negotiation itself which requires
a lot of persistence and refusal to take no for an answer.
So we're going to talk through the full process today beginning with how to collect the relevant
documentation to make your case.
So you need the three biggest things you need to start to really understand how to begin
lowering your medical bills.
So your explanation of benefits is something that your insurance provider should send to
you.
If you don't have it, you can call your insurance provider and ask them for it.
Then you'll have a hospital bill.
The hospital should send that to you.
That needs to line up with your explanation of benefits.
Hospital bills come in many different formats.
There's often a lot of different numbers, but at the bottom, there's often alliances,
the amount you hours and throwing those lines.
That should line up with what your explanation of benefits is.
And if it doesn't, there's something there to investigate.
The final thing is your itemized bill.
This is your hospital bill broken down into its individual parts with line itemed out for
every service that you received.
Very, very rare that the hospital will initially send that to you.
You have to call them up and ask for it specifically.
Sometimes, they throw up a lot of roadblocks to actually giving that to you.
And so you kind of have to push really heavily for it.
You need to be patient with this, but you do need to be persistent.
So that itemized bill is crucial for dealing with price gouging because you need to be able
to see specifically how they're charging you for each individual service or procedure
on the bill.
If you find yourself being charged and exorbitantly high rate for something, it's unlikely that
the hospital's frontline employee will be willing or able to just lower the charge.
But there are two primary ways to push for a lower rate.
Number one is arguing that the amount creates a financial hardship.
And number two is pointing out that the prices being charged are far out of the ordinary.
Resources like Find a Code will link it in the show notes, allow you to enter the HicPix
or HCPCS or CPT codes from your itemized bill to see what the Medicare Reimbursable Rate
would be, which can give you a more reasonable range as your initial offer.
You might decide to submit a settlement offer, which is a more involved process that
prayed and explained.
So you see me to settlement offer, if you think prices are too high or you're being
price gouged or you just want to try to pay a lower amount than what's being charged,
right?
It's their little secret for hospitals that healthcare prices are very, very often
negotiable.
Hospital is really struggle actually to collect from patients.
And so a lot of them will take the point of view that if we get something, it's better
than nothing.
And we'd love to work with patients to get something.
And so when you're building out a settlement offer, you want to have a strong reason for
why you're asking for a discount.
It could be that you identified errors in your medical bill and you think those should
be reviewed.
It could be that you see price gouging and you're getting charged $10,000 for a service
that you've done research where you know it costs the hospital $1,000 end of an average
insurance would pay $2,000.
It could be, you don't have the ability to pay $10,000 right now.
You're willing to pay $5,000 upfront exchange for selling in full, but it's going to be
almost impossible for you to pay $10,000 over time.
But essentially you want to build your case and put it in writing.
It's generally easier to put this in writing than to try to argue this over the phone, especially
given that the person that you're talking to on the phone, when you call the billing
department, likely doesn't have that much authority to settle or give you a significant
discount.
So you would start by sending this in written form to the billing department supervise it.
And then you can take it from there.
If you get a no, what we often do is you link in to start going up the chain and start
finding a director or a director of patient finance or a VP to start sending settlement
offers to.
A few things can make this more effective.
Many hospitals accept settlement requests, but billing department employees are trained
to redirect to other methods.
So you want to be patient, but firm and asking where you can submit your letter.
Then a day after you submit it, you're going to call the hospitals to confirm it was received
and ask how long it will take them to respond.
Now, this may require multiple calls, but by making it clear that you are going to be
absolutely hell on wheels to deal with and you are watching this process like a hawk,
they're going to be less inclined to lose the letter and hope you forget.
And if you're overwhelmed listening to this, same.
And I'd urge every single one of you to go out and vote for people who are not going
to shack up with Etna and make things worse for everybody.
But in the meantime, you may be wondering, can I just ignore it?
What happens if I don't pay and I just lose the bill?
I will say that can work, but there are risks, right?
So financially, the hospital could send you to collections.
You're not going to get sent to collections every time, but a lot of hospitals will
send you to collections.
You have to deal with calls from collections agencies that's not really that much fun
to deal with.
If the bill is over $500 and you want to collections, eventually that can end up on your credit
report.
Now, there's been a lot of legislation passed to help improve that, but most of that really
only applies to bills that are below $500.
And at the end of the day, hospitals can still put leans on property, have court judgments,
get wage-garde instruments on you to recover those expenses.
Now, it's not going to happen every time, but it can happen.
And then health wise, there are some risks as well.
Like, you're never going to get turned away from emergency services, but other future healthcare
services that provider may decide to say, we can't see you until you pay your bill.
So there may be some risk there as well.
In conclusion, there are several primary reasons you might receive a big medical bill you
were not expecting.
It might be price-gouging from the hospital or provider.
In other words, charging $150 for dispensing an aspirin.
Your best ammunition to fight this is asking for an itemized bill and then cross-referencing
rates with Medicare reimbursable rates on fine decode and arguing your case with the
hospital directly.
The second is incorrectly denied insurance claims, so you went in for a medical emergency
that the insurance company does not agree is an emergency.
Your best course of action is getting a referral from your doctor, getting medical history
that shows something was a medical necessity and or getting a note directly from the doctor
showing it was medically necessary, all of which you would put in your appeal that you
file with the insurance company.
You can also ask for adjustments in diagnosis and treatment codes with the hospital's
billing department.
If you believe the procedure in question is, in fact, covered, including an explanation
with a note from your doctor helps.
And finally, we have billing errors, which fall under a number of possible categories
like being charged for a service that wasn't provided or being charged for the same thing
multiple times with different codes.
This is something you'd fight directly with the hospital billing department by requesting
an itemized bill and or electronic medical record, which you can cross-reference with the
fine decode NCCI edits validator to look for codes that should not exist together or
eyeball it for duplicates.
Now I was curious to learn a little bit more about the cash pay option, so I sat down
with Jeannie to ask her for a few more specifics.
Jeannie, you're the Foundering CEO of Clear Health Costs, and the first time you and I met,
you were telling me a story about shopping around for a medical procedure.
And now the concept of shopping around for medical care probably feels foreign to a lot
of our listeners who typically just go wherever we think our insurance will allow us and
hope for the best, but can you tell us more about that?
Yeah, we recommend that people always ask, you know, much is that going to cost me on
my insurance.
The occasion that I mentioned to you, I was looking for an MRI for a member of my
family.
And we were nearing the end of the year, we had not spent down our deductible.
I happened to know that here in the New York area, that particular MRI could be somewhere
around $2,500 if I'm lucky.
The orthopedist gave us names of three radiology providers to call.
He gave us the number of the actual procedure, the procedure code, which is used to identify
in the billing system.
And I started calling the first company that I called, I said to them, I'm a cash customer.
I wanted to avoid getting charged the sticker price because the sticker price I knew could
be really high.
She said, you're uninsured.
I said, no, I'm a cash customer.
She said, oh, okay.
So I said, how much is that MRI going to be?
She said $900.
Then I called the second company that was on the list that the surgeon had given us,
asked them the same thing.
I'm a cash customer.
She said, oh, okay, that MRI will be $600.
I was getting ready to call the third company.
And the first one called me back and said, if you can be here by 7 o'clock tonight, that
will be $450.
So I'm like, so the prices are made up, yeah, so to be clear, you have health insurance,
but when you're contacting these places and they're asking you whether or not you're
uninsured, you are saying very clearly, I am a cash customer I'm paying cash.
Why is that?
I've been doing this since 2010.
So we've learned over the course of doing this that a lot of times if you put away your
insurance card and pay cash, you do better.
So we suggest that people try to find out if at all possible, how much is the cash price
going to be?
So they don't get one of those big nasty gotcha bills.
Any of your listeners may have had this happen with a medication where they found out that
a generic medication would cost much less if they went about it at Costco, rather than
putting it on their insurance policy.
So in an instance where they say, okay, it's $700.
How are you then making sure that that is still actually the lowest price?
Is there a way that you're able to compare to what you would end up paying if you went
through insurance?
Or is it kind of a, you know, that's a price I'm willing to pay, so I'm just going to
go with that.
Right.
So in this case, I called two places.
I was ready to call the third, but since I happened to know that $2,500 is not on
common price here because I know this stuff, right?
The other thing that you can do is there are databases, including the one that we're compiling,
that has a bunch of prices, that you can get a range of prices, and you should be able
to find that in your area.
Okay.
So yeah, that makes sense.
So when you say you're calling, are you calling the doctor's office directly and tell
me a little bit more about specifically what you're asking for?
So you need to have the number of the procedure.
It's called the CPT Code Current Procedural Terminology.
You can find that on our website.
If you go to our website and type in the name and natural language of your procedure, then
a bunch of procedures with similar names will pop up.
You pick your body part and you'll be able to see what is the procedure code.
In that case, you can then search.
I do call doctor's offices if I can also an insurance company quite often.
They'll do that circular firing squad thing where they'll say like, oh, we're the insurance
company.
We don't have anything to do with that.
It's the provider and the provider will say, we're the hospital.
We don't have anything to do with that.
It's the insurance company.
But if you act like a reporter, which is what I am, I'm a journalist, you can find information
if you look.
Also, anybody who's ever looked at a medical bill will remember that up in the top left
hand corner, there's a really, really big number.
And then in the middle, there are a bunch of other numbers that you don't really know
what they mean.
And down at the very bottom on the right, it will say, you may be asked to pay.
So you have this whole series of numbers that don't, any of them really make that much
sense.
The charge master price is usually the one in the upper left.
And it's made up.
I see.
And it's made up.
Yeah.
That's the MSRP.
Okay.
That makes sense.
This can be overwhelming for people.
And so knowing who to contact, what specifically to ask for when you're contacting them.
I have found a couple times now at the doctor's office for very basic things, just annual
physicals.
Or I remember one time I needed to get a COVID test in order to travel.
And you know, I'm like, how much will this cost?
And oh, there's no way I could possibly know that.
I'm like, really?
But you don't know what the visit should cost.
Well, you know, we talked about this.
So I don't know.
It's going to code is whatever.
So it just, it feels like when you're navigating this as the consumer that the deck is so stacked
against you that unless you kind of know that that medically is language, it can be very
challenging to get anywhere with anyone.
So I want you to tell the audience a little bit more.
We've referenced this database that you're building and how it can help them.
So let's hear about the website and the information people can find there.
Yeah.
So we're building a database of prices.
We usually go city by city.
So we're especially robust here in the New York area.
What we do is we have a phone survey where we call doctors, hospitals, labs, and clinics
and ask them for common procedures, what's your cash or self pay price?
That's right for somebody without insurance because we don't want that MSRP.
We don't want that charge master price because we know it's made up.
Then we also scoop up data that hospitals are required to report under federal law.
Have these massive databases that they're supposed to be putting out there.
They don't like to reveal these numbers.
So they're kind of hard to find what we do is we scoop up all the data.
We harmonize it.
We put it in our database, type in your procedure and you get a list.
Then we ask people to tell us their prices.
So we're doing crowdsourcing.
You want to tell me what your MRI costs?
We make it really easy for you.
So that's kind of like ways for healthcare, right?
Let's say your doctor sends you for an MRI that we had one woman who
told us her MRI was going to be $4,458.
She looked in our database and found the same thing for $672.68 in network.
So she saved herself $3,786 by looking in that database.
So you made a comment kind of almost offhandedly a couple minutes ago, which was right when
you call and they say, oh, it's $500.
How do you know if that's a good deal or not compared to what you would get with insurance?
It sounds like the way that you know if it's a good deal is you go to this database and
you look up, okay, what's the average?
What are people paying for this?
Is this on the high end?
Is this on the low end?
The other thing that is kind of coming to mind for me as I'm imagining myself doing
this is I assume that if I'm doing cash pay, if I'm not involving insurance at all,
then that means that the things that I'm spending are not going toward any sort of deductible
or out of pocket maximum.
Is there a calculus that you're running here that you would recommend to decide whether
or not they go through insurance even if it's a little pricier because it means that
deductible is going to be hit and then insurance will start kicking in fully or I'm curious
how you think about this strategy within the broader context of, okay, well, if I have
health insurance and multiple things are going wrong, at what point is it worth it to just
bite the bullet and use it that way, you know, beyond the amount that is considered the top
of the threshold, at least then things are going to be covered.
Right.
Well, it depends on the person.
I know people who have a lot of health problems who just assume that by, you know, January
15th, they will have hit their deductible and everything will be covered.
I'm not like that.
Most of us are not like that.
The MRI that I bought for my family member was at the end of the calendar year.
We hadn't spent down our deductible.
I knew I could be on the hook for 2,500.
I have some medications that I buy now routinely through Mark Cuban cost plus drugs, which
is a generic only.
My local drugs they're wanted to charge me $68 a month.
I got it from Mark Cuban for 10.
I'm happy with not having that fall against the deductible, right?
But I will say, if your listeners want to email me, that's genie at clearhealthcost.com.
Oh, my God.
I love this.
Thank you.
And I love helping people and quite often, once we help people, we'll write a story about
it, put it on the blog so that other people can learn from the stuff that you have learned.
Oh, my goodness.
All sorts of things on there.
The guy who saved $2,000 by arguing a medical bill with the hospital, not on the phone and
not by fax, but he went to the hospital with a stack of papers and sat down across from
the billing supervisor and said, do you think this is fair?
Oh, my God.
I have to imagine at some point, this people are like, all right, fine.
I'll make it go away.
Just leave me alone.
Yeah.
That is hilarious.
And there are lots of other resources too.
There's $1.4, which is this nonprofit based in the Pacific Northwest.
Many people qualify for a discount or reduced hospital bills based on income.
And the hospitals don't make it easy for you to find this, but $1.org will help you figure
that out.
They have an online form.
You just fill in, answer a few questions.
There are people out here who want to help you with this problem, and I'm one of them.
Well, thank you.
I really appreciate that offer.
I think, hopefully, you don't regret making it when you get dozens of emails tomorrow
and you're like, oh, oops, because I will tell you, Rich Girl Nation, they are on top
of it.
And if there is a hack to be hacked, they're hacking it.
I appreciate the time and your willingness to help.
We'll link the resources mentioned today in the show notes as well as Genie's email address.
And hey, if you're not in the mood to play medical secretary for yourself, there are always
services like resolve that will do this for you.
I asked them how their pricing works and they have two models depending on the situation.
If you have past bills that you need help with, they'll charge 10 to 25% of the savings
found depending on the bill size.
If you have ongoing costs from recurring medical bills, they charge $49.99 a month to
manage plus 10% of any savings found.
And in the meantime, stick a Medicare for all sign in your yard and hope for the best.
Thanks all for this week.
I will see you next week, same time, same place on The Money with Katie Show.
Our show is a production of Morning Brew and is produced by Henna Velez and me, Katie
Gatti Tossin, with our audio engineering and sound design for this episode from Rosemary
Minkler.
Devon Emory is our chief content officer and additional fact-checking comes from Kate
Brandt.