How to Erase Medical Debt & Avoid Overpaying

Katie: Welcome back to The Money with Katie Show, Rich People. I'm your host, Katie Gatti Tassin. It's no secret that I have beef 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 grift, at least we can learn how to fight back, right?

We've covered health insurance at a macro and micro level before. So 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 avoid overpayment. Our guest today is Braden Pan, founder and CEO of Resolve Medical Bills. Resolve negotiates medical bills on their customers’ behalf. So Braden is a real Jedi of billing departments. And at the end of today's episode you'll hear from Jeanne Pinder, the founder of ClearHealthCosts. 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 are gonna 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 three primary factors that drive sky-high medical bills. It's estimated consumers spend $149 billion per year thanks to hospital price-gouging. 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 healthcare 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 out-of-pocket expenses are basically due to these three 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 chargemaster 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. And they found that on average, hospitals charge four times their own costs for care services, then insurance companies and hospitals negotiate discounts on those prices. On average, providers charge the consumer three and a half 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 Pike Roast. 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 $7.50 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. Here's Braden explaining a bit more about how it works. 

Braden Pan: You've got the chargemaster rates; these are the list rates that hospitals have. You have insurance negotiated rates. These are the rates negotiated between hospitals and insurance companies behind closed doors. And 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. And 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 chargemaster 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 'cause most people don't pay them, and if you are paying them, you're not really price shopping. You're going to the hospital because you got hit by a car, you're getting taken in the ambulance, you're not price shopping, you're not looking for the best deal. You're looking to get healthcare services right now. I also want to note that you're talking about, why do the hospitals charge four and a half times their costs? That's an industry average. There are hospitals that charge 20 or 30 times their actual costs on their chargemaster rates.

Katie: This type of obfuscation of price and value then bleeds into claim denials and overbilling. 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.

Braden Pan: Healthcare tends to be a really jargony 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 I'm going to use and I'll explain the breakdown. So you've got your chargemaster rate minus your insurance discount is your allowed amount. So let's just say you go in, you get an MRI, and the chargemaster rate is $10,000. Expensive MRI, but round numbers are easier to deal with. Then insurance negotiated a 70% discount. So they negotiated a $7,000 discount on the MRI, right? So the insurance discount is $7,000 and then the allowed amount is $3,000. That's the amount that the hospital's allowed to charge for that service for that insurance company. 

Katie: Is there ever an event where if I were to go to the doctor and I'm getting something done and I am going through insurance, and so they're saying, “Oh, she's got UnitedHealthcare, cool, I'm gonna really inflate my price because we know UnitedHealthcare is paying,” and then United Healthcare is like, “Well, we're not covering that, so here's your discount, though. We'll throw you a discount, then the rest is gonna 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? 

Braden Pan: 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 gotta go to your doctor's office's website or go to the hospital website before you actually go in for a service. You've gotta 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 chargemaster rate for those codes, the 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, 'cause you've gotta go through a ton of data and you have to know exactly what service you're getting around that comparison. 

Katie: 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…? 

Braden Pan: On the hospital site. The site that I have that I referenced is Healthcare Blue Book. Those will do broad scale averages, but hospitals are, well, they're required by law to post this information. That being said, they don't always do so. 

Katie: 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? 

Braden Pan: You as a consumer won't get very far with that approach. Initially when this requirement went into play, the fine for not complying with something was like $300 bucks a day. And a lot of hospitals were like, “We're a multimillion dollar organization, we'll just pay 300 bucks a day. Doesn't matter.” Now those fines have gone up, the government's made it more costly to do so, but not every hospital has caught up. 

Katie: For the record, this is where Jeanne'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 (EOB)—the document the insurance company is gonna 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 gouging, an 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. 

Braden Pan: The first is you wanna make sure all of your details are correct, your name is correct, your date of birth is correct, your insurance ID number is correct, the provider you went to is correct. 'Cause if 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 denials and realize that a date of birth was just transposed and all we had to do was switch a couple dates around, resubmit, wait two months, and get coverage. 

The second thing you wanna look at is what we'll call the accounting aspects. That's the list of all the services you have. You should see the chargemaster rate, you should see the insurance discount, and 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 be getting. 

The final thing that you wanna look at is look for any denials. Understand if any of those services on your EOB were denied coverage by your insurance company and if so, why? And that's where you could start an appeal to get things covered. 

Katie: 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. 

Braden Pan: 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. And so, 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 wanna 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 up and say, “I think this was a medical emergency. If you agree, can you resubmit this?” And have the doctor create a note. Or if you're running the, if you want to manage the appeal yourself, you could say, “I am 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, the 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's a different ICD-10 code that should be used. Those are generally the two biggest things that we tend to see.

Katie: And a couple important follow-ups here. You wanna 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 gonna 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 wanna 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 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. 

Braden Pan: 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 bills you for the difference between the chargemaster rate and the allowed amount. And so basically again, the chargemaster 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 chargemaster rate. 

Katie: 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.

And 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, the No Surprises Act may have your back no matter what hospital you are at. 

Braden Pan: As long as you got this service past 2022, you can't be balance billed, even if you're out of network in a few specific situations. If you had emergency care, right? So you went to an out-of-network hospital for emergency care. If there was non-emergency care by an out-of-network provider at 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 balance billed by that anymore. And those are the majority of reasons why people were balance billed previously. That being said, in order to protect yourself from getting balance billed, 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 balance billed. If they're out of network, there is that risk. And so you want to understand what the cost will be. And 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 cost. 

There's a settlement process that the insurance company and 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 as if you went to an in-network hospital. 

Katie: We'll let that sink in while we take a quick break. 

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Katie: 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 gonna break down in detail. 

Number one, gathering the right information, as Braden mentioned. Number two, analyzing, understanding, and fixing the issue. And number three, the negotiation itself, which requires a lot of persistence and refusals to take no for an answer. So we're gonna talk through the full process today, beginning with how to collect the relevant documentation to make your case.

Braden Pan: So you named the three biggest things that 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 a line that says the “amount you owe” or something along those lines. That should line up with what your explanation of benefits says. 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. 

Katie: 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 an exorbitantly high rate for something, it's unlikely that the hospital's front-line 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 (we’ll link it in the show notes) allow you to enter the 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 Braden explained. 

Braden Pan: So you submit a settlement offer if you think prices are too high, you're being price-gouged, or you just want to try to pay a lower amount than what's being charged, right? It's a dirty little secret for hospitals that healthcare prices are very, very often negotiable. Hospitals really struggle, actually, to collect from patients. And so a lot of 'em 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 wanna have a strong reason for why you're asking for a discount. It could be that you identified errors on your medical bill and you think those should be reviewed. It could be that you see price gouging and you know you're getting charged $10,000 for a service that you've done research where you know it costs the hospital a thousand dollars, and on 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 up front in exchange for settling 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. And so you would start by sending this in written form to the billing department supervisor, and then you can take it from there. If you get a no, what we often do is use LinkedIn 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 too. 

Katie: 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 wanna be patient but firm in asking where you can submit your letter. Then a day after you submit it, you're gonna call the hospital 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 gonna 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, uh, 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 Aetna 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? 

Braden Pan: I will say that can work. But there are risks, right? So financially the hospital could send you to collections. You're not gonna 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's over $500 and you went 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 liens on property, have court judgments, get wage garnishments on you to recover those expenses. Now it's not going to happen every time, but it can happen. 

And then healthwise, there are some risks as well. Like you're never going to get turned away from emergency services, but other future healthcare services, the provider may decide to say, “We can't see you until you pay your bill.” And so there may be some risk there as well. 

Katie: 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 Find-A-Code 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 Find-A-Code 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 founder and CEO of ClearHealthCosts. 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? 

Jeanne Pinder: Yeah, we recommend that people always ask, “How much is that gonna 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 happen 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 gonna 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 seven o'clock tonight, that'll be $450.” So I'm like, cool. Okay, like surge pricing... 

Katie: 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? 

Jeanne Pinder: 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 gonna be, so they don't get one of those big nasty gotcha bills. Many 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 and bought it at Costco rather than putting it on their insurance policy.

Katie: 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, you know, that's a price I'm willing to pay, so I'm just gonna go with that? 

Jeanne Pinder: Right. So in this case, I called two places. I was ready to call the third, but since I happen to know that $2,500 is a not uncommon 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.

Katie: 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. 

Jeanne Pinder: 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 are 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 chargemaster price is usually the one in the upper left and it's made up. 

Katie: I see. 

Jeanne Pinder: It's made up. 

Katie: 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 gonna code as whatever.” So 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 medicalese language, it can be very challenging to get anywhere with anyone. So I want you to tell the audience a little bit more. You'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. 

Jeanne Pinder: 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 chargemaster 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 wanna tell me what your MRI costs? We make it really easy for you.” So that's kinda like Waze for healthcare, right? Let's say your doctor sends you for an MRI. We had one woman who told us her MRI was gonna 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. 

Katie: Geez. So you made a comment kind of almost offhandedly a couple minutes ago, which was, 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 a deductible is gonna 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, beyond the amount that is considered the top of the threshold—at least then things are gonna be covered. 

Jeanne Pinder: 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 15, 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 generics only. My local drugstore wanted to charge me $68 a month. I got it from Mark Cuban for $10, and I'm happy with not having that fall against the deductible. Right? But I will say, if your listeners wanna email me, that's jeanne@ClearHealthCosts.com. 

Katie: Oh my god. Thank you. 

Jeanne Pinder: I love this. 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.

Katie: Oh my goodness.

Jeanne Pinder: We've got 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?” 

Katie: Oh my god. 

Jeanne Pinder: And she made the bill go away. 

Katie: I have to imagine at some point these people are like, “All right, fine. I'll make it go away. Just leave me alone.” That is hilarious. 

Jeanne Pinder: Yeah. And there are lots of other resources too. There's Dollar For, 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 dollarfor.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 wanna help you with this problem and I'm one of them. 

Katie: 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. 'Cause 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 Jeann e'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. But 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.

That's 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 Henah Velez and me, Katie Gatti Tassin, with our audio engineering and sound design for this episode from Rosemary Minkler. Devin Emery is our chief content officer, and additional fact-checking comes from Kate Brandt.