BWF 38 | Healthcare System


Marshall Allen is the second two-time guest of Benefits with Friends. He and Lou previously discussed his book “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win.” This time, the conversation focuses on Marshall’s project aimed at empowering the American Healthcare Consumer: The Never Pay Pathway. The Never Pay Pathway is an educational platform with 16 videos, averaging 5 minutes. The videos will help the listener analyze medical bills, contest inaccurate and unreasonable bills, win appeals, avoid unnecessary care, and much more. They are also now available to insurance brokers and HR Leaders for continuing education credits. So, don’t waste your time and tune in to this episode with Marshal and Lou today!

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The Never Pay Pathway – Empowering The American Health Care Consumer With Marshall

Thank you for joining us. We took a little bit of a hiatus during the summer. We have a great show and a great guest for you. Let me bring Marshall Allen into the show. How are you, Marshall?

I’m doing great. It’s great to see you, Lou.

You are my second twotime guest on the show.

I’m honored.

When you and I chatted last, we talked a lot about your book, Never Pay the First Bill. If you don’t have this book, I recommend highly that you go out and purchase it on Amazon and maybe on your website too, Allen Health Academy. We spoke. I‘m a big supporter of yours. I‘m trying to draw some attention to the great work and hard work that you’ve been doing by putting an educational video platform together to help American healthcare consumers. We talked for a second or two before the show about a particular situation that one of our members found themselves in. I wanted you to reintroduce yourself to the audience. Tell a little bit about you and The Never Pay Pathway that we’re going to talk about.


BWF 38 | Healthcare System


Thanks so much, Lou. I appreciate you having me here. I’ve been on a campaign, a quest, or a journey to make it a goal to educate employers and working Americans about all the ways the healthcare system is taking advantage of them financially, and most importantly, what they can do about it. I spent seventeen years as an investigative journalist covering healthcare. I still consider myself a journalist although that’s not my full-time day job now. In the last few years, I have been at ProPublica doing investigative reporting. I’ve written hundreds of stories about patients and everyday people getting screwed by the healthcare system.

Your audience knows this, but the financial side of the healthcare system in the United States is preying on employers and working Americans. It is a system that is designed to exploit sickness for profit. I wrote all these stories as an investigative reporter. That led me to write Never Pay the First Bill. What has been so satisfying about Never Pay the First Bill is this. I especially encourage people to go on Amazon and read the reviews. A woman posted a review about how she saved $21,000 on a surgery that had been wrongly coded on the bill. She read my book.

The book shows how to analyze and understand your medical bill, how to get an itemized bill with the billing codes, how to check to make sure that the itemized bill is accurate, and how to make sure the bills are fairly priced for each code. It warns people about things like upcoding, which is an epidemic in healthcare. People then learn how to look at their bills, how to push back, and how to contest them. I write about hospital financial assistance policies, which many people do not even know exist and can completely forgive bills.

What do you do when your insurance company denies payment? I have a chapter about that. What do you do if you have medical debt in collections as, unfortunately, about 100 million Americans do? The book covers that. I heard someone describe it as The Art of War for healthcare. That’s what the book is. What I love is that the book has proven the concept. We have shown that at least when the patient is ready to learn, they will knock down walls to fight for what’s right and to stand up for what’s right.

I even have a chapter in the book about how to sue in small claims court to defend yourself. It’s extremely effective, and I help people do that all the time. I always encourage people to reach out to me if they need help. I’m always available at People can message me. I’m getting messages every day from people who I’m helping and people who are having victories, and then I write those up in my newsletter.

We have proven the concept, Lou. People think that employees can’t learn to navigate the healthcare system. They can. Writing the book then led me to launch Allen Health Academy. Allen Health Academy is a health literacy company. I like to tell people that healthcare literacy is financial literacy. We have a lot of talk about financial literacy, how to invest your money, how to manage your money, and how to look at your checkbook or the statements from your credit card companies and make sure you’re not getting ripped off.

There are all these tactics about financial literacy, but what people don’t talk about is the amount of money that you can lose is exponentially higher than some hidden fees on your bank account or something like that when you talk about healthcare costs. I like to tell people, and it’s true, “You can save hundreds or even thousands of dollars per healthcare encounter if you know how to navigate the healthcare system and if you know about price variation and can get a better price on a medical service, an image, a lab test, or a drug you need.”

That also led me to create a series of health literacy videos. The videos are called The Never Pay Pathway. This is a video curriculum that is designed for behavior change. We don’t need people to understand a few tips and tactics. We need people to reframe the way they engage with the healthcare system. I’m talking about employers and the employees. It’s a curriculum of sixteen videos. They’re about five minutes each. It’s about an hour and fifteen minutes of content. Those are found at Individuals can subscribe. Employers can subscribe. If people are interested in licensing the videos, we can do it that way.

What I’m looking for is employers that get it and organizations that get it and understand, “We value educating our employees. We’re giving them this blank check to go out and spend our employer’s money on healthcare, but what are we doing to equip them and to train them so they can navigate the system?” I’m proud also that the video curriculum, The Never Pay Pathway, has been approved for continuing education credit through NABIP, which is the National Association of Benefits and Insurance Professionals. That’s the big broker association. Brokers can watch the videos and get continuing education credit.

It has been approved for continuing education credit through SHRM, which is a big association for all the HR people. HR people can watch the videos, complete some assessments, and get continuing education credit as they get educated to navigate the healthcare system. What I’m seeing is that the HR people, the brokers, the employers, and the employees need to be educated. The Never Pay Pathway videos bring the education to scale in a way that the book doesn’t. Maybe people like the book. Maybe people like the videos.

I’m also in the process of creating a chatbot that is going to be effective in helping walk people through the various strategies and tactics. I’m developing new products. I’m having a great time doing it, but it’s an immense challenge. I’m not going to lie. It’s a challenge because people don’t feel motivated to learn about how to navigate the healthcare system, and I get that. I understand it because it feels overwhelming and complicated. We have been conditioned. We have been groomed.

That’s my word too.

That’s the word I’ve heard you use. I’ve used that word too. We have been groomed to be passive. We have been groomed to trust that the healthcare system is looking out for our best interests. What you and I know and others have discovered too is that we should not trust the financial side of the healthcare system to be looking out for our best interests.

We should not trust the financial side of the healthcare system to be looking out for our best interests. Click To Tweet

In many ways, its like preventative care. If you would avoid it, you have a good chance of running into something much more significant later on. If you don’t take the time to understand your rights, the healthcare ecosystem, the health insurance ecosystem, your rights as a patient, and all of these transparency regulations and laws that were passed, it’s not getting to the end user enough, and because we have been groomed, a lot of times, people have thrown in the towel, including businesses. I love what you said about this unlimited credit card that employers are giving to their employees because it’s the company’s money that they’re spending, and they could spend it so much more wisely.

Think of the savings. Our experience so far has been a savings of about 30% on the medical claims and 50% on the Rx claims. Whether you’re a fully insured employer or a self-insured employer, you’re retaining that money. You no longer have that waste within your plan. If you can help your employees, which are your little army of healthcare purchasers for a business, to do it smarter and incentivize them to do it, that company can thrive. The people can thrive. You can reinvest that waste.

You mentioned something like upcoding. Most people wouldn’t even understand what upcoding is, but it’s so prevalent in healthcare. What that means is that doctors, hospitals, and facilities get paid more when they put different modifiers on a claim to make it look like they did more work than they did. They spent more time with the patient. It was more serious. Emergency room visits are very popular for doing this. They’re throwing things in there. You go in for a Band-Aid or walk out with a Band-Aid, but it’s as if they did major surgery on you because no one is looking. No one has their eyes on the road and hands on the wheel. No one is watching out for this spend. It’s so easy for the healthcare system.

The insurance companies are not doing their part to help control it. You think about the way credit cards work. I‘m a victim of credit card fraud. Someone got my credit card. They bought a PlayStation at Costco. Luckily, there’s a speed bump. I got an email. I get a notification every time someone uses my Amex card. Why shouldn’t insurance companies be doing the same thing before we pay this bill?

Was this done? Here’s a text message, “This describes the service that was rendered on this claim that we received from this physician. Does this sound right to you? I’m going to make this suggestion because I haven’t heard that before, “Hit yes or no. Did you have this done?” Say, “This means this. Here’s an explanation of what that code is.Why couldn’t insurance companies do that? Let’s work on that. I want to work on that together with you.

That’s a great point, Lou. The insurance companies do not have the incentive to protect the money because it’s not their money. In most cases, it’s a self-funded employer. They’re the administrator that’s paying the claims but it’s not their money. It’s coming out of the employer’s coffers. In a fully insured plan, they’re a middleman that takes a cut of the percentage of the total. It’s typically about 15%. They need for that total to expand year after year so that their 15% cut results in an increased amount of revenue every year. They do not invest a lot in fraud enforcement.

BWF 38 | Healthcare System
Healthcare System: The insurance companies do not have the incentive to protect them because it’s not their money in most cases. It’s a self-funded employer.


Your idea is a great one. They could put that technology in place if it was something that they cared about. I have three chapters in my book that are devoted to employers, and one of those is about fraud and some incredibly absurd cases that show how little the big insurance companies care about policing fraud. I’ve talked to more than a dozen fraud investigators who work for the big insurers. They will tell you that they can identify fraud all day long, but when they take it up to the general counsel for their insurance company, the insurance company sides with the doctor or the hospital because they want to keep them in their networks.

The loyalty of the insurance companies is not to their members. The loyalty is to the doctors and the hospitals that are in their network so that they can say, “We have a broad network. All these people are in our network.” They don’t want to crack down on these things. The employers need to be engaged, and that starts at the front lines with the employees. There’s no one who’s more aware and able to verify whether something happened or the degree to which it happened than the patients themselves. They can check that.

That’s what I show people how to do for themselves in my videos and my book on how to check things, how to get that itemized bill, and how to check it and make sure that everything occurred. In many cases, that’s by obtaining your medical records, which is easy to do and which everyone has a right to get. You can check your medical records and say, “Do the medical records show the amount of time the doctor spent with the patient? Do they show that all of these different services were administered?” The medical records are the best record of what happened. The claim has been extrapolated from the medical record and can often exaggerate or incorrectly say what happened during that visit.

The exciting thing though is what you and other advisors and employers are doing. This is winnable. The subtitle of my book is Never Pay the First Bill: And Other Ways to Fight the Healthcare System and Win. Winning is what we’re talking about. Employers and employees should be paying a lot less for their health benefits and getting a lot more for their money, but they need to reframe and change their behavior with how they engage with the healthcare systems. That’s what I’m showing people how to do.

BWF 38 | Healthcare System
Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win

You’re empowering people. We’re trying to fight 30 years of grooming. It’s so true and sad because doctors are not bad people. Most doctors are excellent human beings who got into this profession to make a difference and probably to make a fair living too. That profession should be something that is congratulated. They should be looked at. They have educated themselves. They have the potential to do such great things for the communities that they serve, but they’re pawns in this healthcare system as well.

Managed care didn’t exist when I got into the business in 91. There was no real managed care. It was probably started already, but it hadn’t yet come to the Northeast. There were indemnity plans, Guardian, US Life, Home Life, and Chubb. Those were the big carriers back in the day. There was no network. The patient went to the doctor. You were responsible for paying the doctor, but because there was a relationship, most of the time, the doctor didn’t charge you upfront. They understood, “We want you to come back. This shouldn’t feel too businessy. It is very personal.

You could assign payment to the doctor or get the payment sent to you and pay the doctor. A lot of times, the doctor would say, “Don’t worry about your out-of-pocket cost.Probably people have this relationship with their autobody shops these days. Mine doesn’t particularly do this, but they will waive the $500 or $1,000 deductible because they make a lot of money, and they want a repeat customer.

Doctors want repeat customers. Managed care destroyed the patientdoctor relationship. All of the different attempts at compensating doctors completely failed. They’re misaligned with what’s in the best interest of the patient now. Doctors are forced because so many of them work for the healthcare system. We’re forced to see a patient every 7 minutes, and 5 of those 7 minutes are in my experience spent with their back to the patient typing the medical notes. We have to get those notes in the system. This is everything I did. If they don’t do it, then they spend four hours after hours doing this.

Are they even paying attention? How many people can type and listen to the patient at the same time? My hope is that managed care will disappear in the next 5 to 10 years. We don’t need managed care. It has completely failed. There are no discounts. If you don’t have managed care, you don’t have insurance companies that have to have that hospital in their network. You just pay the hospital.

We are at an exciting turning point with the price transparency that has come out now because of the Hospital Price Transparency Final Rule. The hospitals have been required to disclose their prices for cash prices, Medicare patients, and all of their discounted prices. They give that to different insurance plans. I’ve looked at these across the country, and the variation is ridiculous and inexplicable.

A patient covered by Aetna would pay for a colonoscopy. Colonoscopy is a good one to look at because it’s a standardized procedure. It’s also a great metaphor for what’s happening to American consumer healthcare. A Medicare price for a colonoscopy might be about $1,200. You would have Aetna, Cigna, United, and those other types of commercial plans. They might pay $2,000, $5,000, or even $10,000. On average, the private insurance companies are paying 2 to 3 times the Medicare rate but on other items, they’re paying 10 or 15 times the Medicare rate.

This is standard procedure in healthcare but it’s price discrimination against working Americans and employers because there’s no reason that makes sense why a working person should pay 2 to 10 times more than a person who’s retired and on Medicare. In a lot of cases, what you also see is that the cash prices are lower than the discounted insurance company. You see that all the time.

I wrote about this in my newsletter. I also want to plug my newsletter. It’s This is a regular health literacy newsletter that I put out. I wrote about cash prices. It’s in about half the cases. A group from Johns Hopkins did a study, and they found that the cash prices were lower than the discounted insurance prices.

This myth that we have all been taught on how we have been groomed to believe that we need the big insurance company to get us the best price is a myth that we need to stop believing because in many cases, you can get a better deal with the cash price. You start to ask, “Why am I paying these massive premiums every month? Why do I have this massive deductible if I can’t even get the best price when I use my insurance plan?”

We've been groomed to believe we need the big insurance company to get us the best price. But that's a myth that we need to stop believing. Click To Tweet

What we’re seeing now that is exciting, and I know you and others like you are putting these things into place, is direct contracting. The doctors and the hospitals are on the front lines providing the services. They’re not getting all of that money. A lot of that money is going to the insurance companies, the other middlemen, and medicine.

When you direct contract with a physician group, an orthopedic group, an imaging group, or a lab group, you can cut the middleman out of the picture and negotiate a price. It’s a fair price that’s paid on time without big disputes because a lot of times, the medical clinicians are not getting paid by the insurance companies. They have to fight for that money. That money gets clawed back from them. They’re not happy with the insurance companies.

We need more employers to engage directly through direct contracting with frontline clinicians to provide the care that people need. When they do that, they can bring the price down for the employer and the employee and bring the payment up for the frontline clinician. We are seeing a lot of exciting changes happening. We need more people to be educated about it and have the courage to push back. It takes some courage and engagement. What we need people to do is wake up, get engaged, get empowered, and move forward.

Wake up, get engaged, get empowered, and move forward. Click To Tweet

You mentioned small claims court. I don’t know percentagewise but I would imagine that when you present the details of what you’ve been charged, you know because of the transparency laws what those facilities accept every single day for Medicare and their posted cash prices. I want to talk about that. Whoever is making the decision probably would be a judge. It’s not going to be anything but that. That is going to side with the patient 99% of the time. I can’t imagine that they’re going to sit there and say, “You’re entitled to more because you did extra work.

Ninety-nine percent of the time, it doesn’t go in front of a judge because think about what happens when a patient sues in small claims court.

They will lose money.

That bill might be hundreds or thousands of dollars. That clinician, that hospital, or whoever is being sued is going to have to hire an attorney to defend themselves in most cases. The attorney fees are $500 to $1,000 an hour. Do you want to spend $500 to $1,000 an hour to defend a case where you’re wrong to begin with? Second, it’s only worth a few thousand dollars in most cases. That’s why small claims court is the most powerful tool for the patient to flip the power dynamic.

What I like to say is to give them the incentive they need to do the right thing. They shouldn’t have overcharged the patient to begin with but the patient needs sometimes to use some leverage of our judicial system through small claims court to sue or even to threaten to sue. In my book and my videos, I walk people through each step of how to do this.

It’s not time-consuming and difficult but you have to know what you’re doing and then you have to follow up with it. It doesn’t take a lot of hours but it takes a lot of time because you have to send that email to get that itemized bill. I show people, “Here’s how you get an itemized bill.” You cite the HIPAA law. HIPAA says we have a right to every single document that they have, any HIPAA-covered entity, insurance company, hospital, doctor, or dentist.

We have a right to the claim itself. We have a right to our medical records. We have a right to any decision an insurance company makes about our case. We have a right to all that information. You have to know to ask for it. You have to cite the HIPAA law but when you cite HIPAA and threaten to file a complaint for a HIPAA violation against a hospital or a doctor, they’re going to send you that itemized bill.

If you copy the general counsel or the compliance officer for the hospital and say, “I need this itemized bill,” you will get that itemized bill. If you don’t, you file a complaint with a federal government that investigates HIPAA, the Office of Civil Rights. I show how to do this in my book and my videos. I provide all the links in the videos. I have a template that I’ve drafted that people can use. They can fill in the blanks and use my template to make this request.

It takes some time because you have to wait for that to happen. You have to look up the email addresses. You have to send them the email but I’m showing people how to do it. They get that information. You have all the evidence you need before you file your case so that they don’t have a leg to stand on. What you see is that after they file a case, when it comes to that, you typically see the hospital attorney reach out to the patient and say, “Let’s settle this. We don’t need to go to court.” The case gets taken care of in a way that’s fair to the patient.

It’s extremely empowering. It’s fun too. What I’m trying to do is demystify this for people. People feel paralyzed by the complexity. They feel powerless because they have been groomed to think there’s nothing they can do about it but you and I both know there is a lot people can do. They have to change. That’s what we’re talking about, behavior change.

Not only is there so much you can do. You’re familiar with Health Rosetta. I‘ve been involved with the Health Rosetta. It’s a great organization. I‘ve been involved for years. Every year, we go back. We came back from Chicago. We had the RosettaFest. It’s not just advisors. Another word for brokers is advisors. I happen to be a Benefit Optimization Officer. People call me BOO.

There are people like you. There are doctors and clinicians. There are so many different ways to attack this problem. There’s a company called Slingshot Bills. Zoe Holderness has been a guest on the show with her partner. They’re recent college graduate engineering students. They were working for Microsoft and Google. They came across this problem. Theyre young and smart people who know numbers. Some didn’t make any sense. They hadn’t seen the cost.

Zoe herself received a bill. She’s like, “What is this? Why is this so expensive?” She started looking into it. Theyre doing a lot of different things. She’s getting so much deeper into the weeds now. With her brilliant engineering Georgia Tech education, she’s thinking of advanced ways of trying to attack this problem. You came from a publishing background. You’re an investigative reporter.

You mentioned the cash price before. I want to go back to an example of how predatorial the healthcare system is. I‘m not going to go into any specifics about anything but we have a member who was going for surgery. They knew they were using a doctor who wasn’t part of their managed care network. Two days before the surgery, the physician’s office had this member sign a document signing their financial future away.

This mentioned the doctors that were going to be involved. We verified through the EOBs that these were the doctors that were involved. The estimated cost of these procedures was $100,160. There’s a little clause there that probably the member didn’t even notice. It says, “Details below reflect estimated cost assuming no insurance coverage would be provided for the services. The cash price is $100,000.

We have this account. We’re working with a great population health nurse navigator. Nurse Sam is involved with this great TPA PBM. The bill was $139,000 from one doctor, $139,000 for the second surgeon, and $49,000 for the assistant surgeon. We’re close to $300,000 already. The hospital was another $130,000. The hospital was paid in a network. That was part of the Cigna network. The hospital is taken care of but the doctors are out of network.

We’re talking about the cash price. The estimate was $100,000. When you look at the code that was used on the claim, the Medicare price is about $10,000 to $13,000 because there are certain modifiers that they didn’t include. You only pay one surgeon. You can’t bill two surgeons. Maybe there’s a moderate fire for something being bilateral, which in this case, it was. Maybe it doubles potentially. They haven’t summated it correctly, so we don’t know yet.

The assistant surgeon was paid $970. That was Medicare plus 50% billing $49,000 but I don’t know what the assistant did. I‘m sure all these doctors were brilliant surgeons. Here’s a member who now is looking at a balanced bill of almost $300,000 when the estimate was $100,000. They signed it two days before. I‘m looking into some of the laws because when you ask someone to sign a document like this, I believe you have to give them two days’ notice. I’m looking into that. I was told that by an attorney. I need to look a little bit deeper to see if the signature on this paperwork is even genuine.

This member probably doesn’t know about this bill yet because it has been denied by the TPA. We know that this person is going back to these doctors again for another surgery. Here’s the missed opportunity. I spoke to Health Rosetta about this. This member has a lot going on. We know a little bit about the person. This member has not engaged at all with our nurse navigator who‘s been trying to reach for two years and could have provided so much insight, help, and assistance to a passionate and great person.

That’s traumatizing when you think about the cost of that potential bill to that member. That’s bankruptcy-level billing. If the health plan is going to step in and the employer is going to cover it, that’s going to be a massive hit to the employer. Hopefully, that can get resolved in a way that’s fair because it’s not fair. I would love for any surgeon who watches this to please let us know how is it justifiable to bill $100,000 for a surgery that I assume took one day.

This wasn’t outpatient.

This wasn’t a month-long procedure. This is a day. How does anybody justify that kind of bill for one day at work?

The surgeons worked for one day. She was in the hospital for 2 or potentially 3 days. The hospital was paid. The surgeons are billing more than the cost of a home in the community that this person lives in.

It’s unjustifiable in my opinion but I would love for a surgeon out there to help us understand how this is morally okay. The point here is that this thing can devastate an individual or a health plan, and it’s all avoidable. This is why I encourage any employer out there who is willing to educate your people to please reach out to me. Go to and take a look at the curriculum. Let’s get in touch because it is possible to inform your employees on the front end so they understand why they need to stay in a network. They understand why they need to protect the compensation that the employer has allocated toward healthcare.

Here’s the case I made for employees on this. Lou, you know this is true. The money that the employer allocates toward their health benefits is employee compensation. That is the money that belongs to the employee compensation. When that money is squandered on medical bills that are hundreds of thousands of dollars higher than they should be, that employer has less money to give raises to the employees and less money to spend on health benefits in the next year. That’s why we have deductibles rising. That’s why we have premiums going up. That’s why health benefit plans are covering fewer services for the employees.

What I’m showing the employees is the why behind why we need to get engaged. It’s because it’s their money. This employee thinks, “I don’t care. My employer is paying for it. The insurance company is paying for it.” I don’t know what that employee is thinking, honestly. I’m sure that person is going through a ton of trauma in their life. The videos are an hour and fifteen minutes of content. Require your employees to watch them. They get a certificate of completion to verify they finish the videos.

Let’s say it’s 100 employees in an employer group. I can provide you with a report that shows which employees have finished the curriculum and which haven’t. Require them to watch it. It’s an hour and fifteen minutes. You’re possibly going to save that employee a balanced bill of hundreds of thousands of dollars and a potential hit to your health plan of hundreds of thousands of dollars.

It’s obvious that this is a return on the investment. It’s obvious that this is the right thing to do. We should not be sending employees out with a blank check where they could get the balance billed in return. They’re going to have co-insurance in return. They have deductibles they have to pay. Employers have a responsibility to train their employees. That’s what I’m trying to do. I have a scalable training solution. Please reach out because it’s an urgent need.

Im co-sponsoring the SHRMLong Island. I‘m not the main sponsor. We’re not in that category but were the EVOLVE sponsor, which I love because we’re trying to evolve to take employers and their members somewhere else. What I’m planning to do is sponsor your course for up to ten HR directors or HR professionals who are there. They can sign up. We understand as benefits advisors how much work you’ve put into this.

Before I heard about your courses, I was in the process of thinking, “I need to do this. I do videos of my own, not in the same context as yours. Yours are done so beautifully. I can vouch for how impactful they are even though they’re twominute videos, which is important. People’s attention span is very low. You could read the book. There are a lot of people who read out there.

Having access to these videos and being able to go back to the videos and listen to them again from an advisor standpoint and an employer standpoint is the bread and butter that makes the members and patients understand why we’re building the health plans the way we are because we try to customize the health plans. It’s tough getting people to change what they’re doing. We talk about that all the time.

When you watch these videos, you understand now the approach we’re taking because most people in this path of managed care over the years have gone from a $0 to a $5 copay up to a $7,000 deductible. That’s because they have been riding this insurance train the whole time and letting it be. It is what it is. They have thrown in the towel. This is what you get by watering down your plan every year because your focus is on insurance premiums.

You are passing more out-of-pocket costs and using things like HSAs and HRA strategies, which have their place. I‘m not against them but you’re doing nothing to educate the member on becoming an informed healthcare consumer that has the capability of finding the best provider. Notice I didn’t say cheapest. When it’s life and death, you want the best provider. At the very least, that is what the American healthcare consumer deserves.

When my heart, my arm, my leg, or my eyesight is in jeopardy, I don’t want to go to a heart doctor, an arm doctor, or an eye doctor. I want to go to the best one. Why can’t we at the very least find those people other than Google searches? I want to see the numbers behind it, and we can do that now. That’s why we partially build the plans that we do but we also don’t want people to fall victim to medical bankruptcy, which is the leading cause of bankruptcy in this country by far. There’s nothing close to that.

Your book helps people understand how to navigate the healthcare system, navigate the billing issues, and avoid medical debt before it’s a problem because once it’s a problem, it’s a problem. You don’t want to discover you have clogged arteries because you avoided your preventative care. If you learn that taking preventative measures can help you avoid a heart attack later on, isn’t that a better approach? Make a little bit of an investment in time.

We’re trying to force it and encourage businesses to do this. Give this to your employees. Incentivize them in some way to do it. Encourage them to do it. Believe me. The reward that you will get will be lower healthcare spending, a healthier population, and fewer people dealing with medical debt. How many people are sitting at their desks at work and dealing with doctor’s bills, distracted by this unnecessary debt that they’re going through? If you could, share one of the most popular examples of what someone who goes on your website thanks you for. There probably isn’t one specific thing but if you had to choose one thing that would benefit the average person so much to know in advance, what would it be?

One of the primary things that people come away with is the feeling of being empowered because people do feel helpless, lost, and confused. When they learn what they can do, and I show them how to do it, they feel empowered whether they have to apply it or not. I had a conversation with this woman who saved $21,000 on a hernia surgery because she checked the bill and learned how to check the bill.

BWF 38 | Healthcare System
Healthcare System: People feel helpless, lost, and confused but feel empowered when they learn what they can do and how to do it.


She had the courage. She said it took courage. She’s not accustomed to pushing back against doctors and insurance companies but she called the surgeon’s office and got clarification about it. She called the insurance company and got clarification about it. She figured out and showed them that it was a billing error that had coded her hernia surgery as cosmetic when it should have been coded as medically necessary, not cosmetic.

That reduced her medical bill by $21,000 to about $850. This is a working-class family. This saved a tremendous or indescribable amount of money for this family. Most American families don’t have more than about $500 in their bank account at any given time to pay an unexpected bill. The thing that she came away with was feeling empowered, “I knew what to do. I knew how to do it. I saw other people had done it, and I felt inspired by that. I had the courage to make these calls. I was able to show them and persist.” At first, they’re going to treat you like you’re an idiot. They’re going to treat you like you don’t know what you’re talking about.

You have to push through and break through some barriers sometimes. She was empowered. The other thing she said was, “I couldn’t believe how easy it was.” It took a few phone calls. It wasn’t difficult for her to sort this out but it did take persistence, courage, and some know-how to do that. That’s an exciting victory story. Those are the things I write up in my newsletter. I show people how to do this every day.

You have to push and break through some barriers sometimes. Click To Tweet

When you give an example like that, I think about years ago when people had comparable to now much lower out-of-pocket costs. These were paid but because of the progression of the out-of-pocket costs increasing and being passed on to the member, you have people who are responsible for a significant amount of that bill now. It’s much harder to get blood from a stone. The average person has $500 in extra money. Many people are living paycheck to paycheck. When they get a bill like that, they’re not writing a check.

That’s why we have 100 million Americans with medical debt and about 1 in 6 with medical debt in collections.

It’s part of the process. It’s a tough learning curve that we have been on for a long time but hopefully, we’re going to be able to break this curve. We will be able to show businesses why this is so important. I‘ve taken it already but can I take it again to get my NABIP? We won’t tell them I did it already.

You have to do the NABIP version, which has the assessment but you can fast-forward the videos and do the assessments if you want.

I renewed my license already. In two years, I’ll do it again but I am going back in to do these courses myself. I‘m hoping to get a lot of traction for you. This is great. Its so professionally done. Anybody out there, reach out to Marshall. If you’re in the New York metropolitan area or the SHRM conference that’s coming up, stop by my booth. I‘ll sponsor this. I‘m so excited about where the future is going to take us. I can’t wait to see where this goes. I can’t wait to see the next version of the chat component of what you’re putting together.

I’m excited about that too. Lou, I appreciate your support and your enthusiasm. Thank you.

You keep fighting the fight from your side. We will do it here. Thanks for being on the show. We’re coming up on time. I know you have a busy day. Have a great day. I appreciate you. Thanks a lot.


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About Marshall Allen

BWF 38 | Healthcare SystemMarshall Allen’s book, “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win,” shows individuals and employers how they can push back against the high cost of health care. It’s led to Allen Health Academy, which takes the principles of the book and communicates them through an engaging series of health care literacy videos for consumers. The videos are currently in production.

Marshall’s stories have been featured by the New York Times, Washington Post, USA Today, The Today Show and other outlets. Speaking engagements include AcademyHealth, the Association of Health Care Journalists, the Michigan Hospital Association, the National Patient Safety Foundation and Stanford’s Medicine-X.

Before journalism, Marshall spent five years in full-time ministry, including three years in Nairobi, Kenya. My Master’s degree is in Theology. I am currently working as an Assistant Regional Inspector General with the Office of the Inspector General – HHS.