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Fake medical bills format for Planning

have you ever experienced that incredibly scary moment when you get a massive medical bill in the mail and you don't know what to do well at the end of this podcast episode here on YouTube we are going to help you not have that feeling of uhoh have that feeling of fear when you get a huge medical bill in the mail by the end of this video you are going to know what to do when you get a big medical bill we're going to be talking to Dr Virgie brigh Ellington she is an internal medicine physician she went to medical school at the University of Michigan she trained at Harvard Medical School she became an internal medicine specialist she became a medical director at Etna and then her life changed when she became a patient and then when she became a patient she saw what the medical billing process was like from a patient point of view and made it her mission to educate patients about how to read the jargon how to read a medical bill how to assess that medical bill to make sure it's accurate make sure you're not getting overcharged she made it her mission to teach ordinary patients people like you and me how to navigate the very complex and confusing world of getting really big medical bills so enjoy this conversation that we have with Dr Virgie brigh Ellington hi Dr Virgie hi Paula so good to be here I am so happy to have you here you're very very passionate about medical debt specifically medical debt and uh medical financial literacy how did you become so passionate about this topic so Paula I've been a board certified Internal Medicine physician for longer than I want admit like 20 plus years and I was a health insurance executive for a decade and so I was a medical billing expert I had a complete 360° review of how the US healthare system worked or so I thought until I became a patient and discovered my Hospital roommate Mia had been tricked into signing an agreement to pay a bill that I was pretty sure Paula she didn't actually owe but I was definitely sure was putting her and her entire family into debt for the rest of their lives and I was just outraged I mean true story I tell this all the time literally the I just saw the curtain dropped I saw pure red I was just outraged because I knew she had been tricked into this and it was deliberate and so I thought you know what Virgie don't get angry don't get mad get to getting do something and that's how Crush medical debt was born there's a 100 million Mia in the United States and it doesn't have to be this way so that's my mission this is what we're going to do right tell us the story of Mia so she was tricked into paying it's called a a balance bill yes you got it a balance bill so MIA had been she's a young young lady she's mom of two young toddlers so she can't work outside the home right now because her kids aren't young enough to go to school and her husband works at a 24hour diner so very modest income right okay so she was telling me we we're talking and she says you know I'm really afraid about the bill that's going to come from this Hospital stay she said she had been in the hospital about a year prior for this same symptoms and it's unfortunate she had been having symptoms they concerned about her having like a rare cause of a stroke or something so they kept her in that year for like a week and on her last day the day she was being discharged she said a hospital representative representative came into to her hospital room and said before you can leave you have to sign this and she said I didn't know what it was I have insurance I don't know why they said I had to sign this but she said it sounded like they said said that I had to sign it because if what my insurance doesn't pay that I'll pay it and that's when it hit me I'm like oh my gosh they deliberately tricked her into signing a balance bill so a balance bill is when you have insurance and you're in network provider so in network means that they've agreed to have accept whatever the insurance company pays for their services as payment in full so for example I use just to keep the math simple let's say that the provider for certain medical service charges $100 and the insurance company says well you know what Dr provider Dr physician if you want access to our millions of patients in your as potential patients for your practice panel then you're going to accept what we're going to pay you is payment in full and that's a contract agreement between the physici I or the provider hospitals usually do this large medical centers usually not single solo partitioners we think of historically but the medical center or the provider practice will say okay yeah we'll agree to that balance billing is when they actually send out the bill to the patient and the bill says hey you know we charge $100 for this service your insurance only paid $10 so you are on the hook for the balance the remaining $90 so these proportions sound really weird and like outrageous but Paula they're not the insurance company only will pay a fraction of what the retail what I call mrsp right manufactured retail sticker price it's just a total madeup number and the higher the number the provider quotes the insurance company is to try to get more of that fraction that they know they're only going to get so that's balance billing and the reason why patients don't know about it is because a Balan billing disagreement is between the provider and the insurance company so the insurance company knows that there are providers that will still try to trick patients to believing they know they owe rather the balance but because the patient isn't aware that they're in the middle of this contract and they they are not Contracting directly with the provider they don't know wow so what what could person do let's say you're you're in the actually I'll go through two potential scenarios scenario a you're in Mia's position in which you're in the hospital you've been there for a number of days you've already had Services provided and someone tells you hey you can't leave before you sign this what should a person in that situation do we'll go over that and then the next question I'm going to ask is what do you do if you show up for an appointment and as part of the intake forms you see that so but we'll start with what happens if it comes at the end well if if you really want to be snarky a gentleman showed up for his wife was being discharged from some procedure and when he arrives he was told like Mia was told before you can leave you have to sign this agreement to pay whatever Financial document and so the gentleman calmly walked to the lobby to the pay phone you know how long ago this was wow and he called a sheriff and he said you know my wife is being held hostage by this hospital I need help come right now wow so true story it actually happened and of course the sheriff shows up and you know of course the the gentleman's just trying to make a point like what the what I haven't gotten a bill I'm not going to sign an agreement to pay anything the not snarky answer Paula is no you don't have to sign anything before you can leave I mean if you walked into your grocery store and they said you know what Paula before you can leave you're going to have to pay for or the services you received okay but you know what you're getting and you have the bill they will show you what you're being charged for they show you the itemized Bill exactly they will show you an itemized bill right at a restaurant they show you an itemized bill they show you itemized Bill all of the services and or products you receive right at a retail store they show you an itemized bill you do not agree to pay anything until you get a bill a real Bill real and we'll talk about what a real bill is a real item bill is later but yeah all right and so what happens let's say you're going to a we'll say it's a preventative appointment you're going to your primary care or to a dermatologist or to an OBGYN and as part of the intake you see a form that says that that is essentially a balance Bill what should a person do in that situation so what I tell people is two things two situations in an emergency situation you're going to the emergency room you do not want to be there you feel like it's life limb at risk right lifethreatening they cannot deny care if it's an emergency right so when you and I tell people if you're in a position where you can actually read something you may be in pain you may be fatigued you know you don't have to feel that you have to read it but if you feel like you want to scan it meaning the document that they're asking you to sign two things by the way now it used to be a piece of paper now postco it's like um they'll show you what a sometimes they'll have a tablet that they hand you or they'll say hey just look at the screen and just sign this uh signature pad that's just connected to the customer service rep's desk no right you don't care how much pain you're in how tired you are how many people are behind you how nasty the customer service rep gets you're going to say I need a printed copy I can't sign this I only sign printed copies and often you'll get push back they'll say oh well this is just our privacy notices or Hippa practices or our covid uh hygiene practices okay fine give me a piece of paper print it out please then I'll look at it when you look at it you're going to scan through it if you're not in a position to read it and fully understand it much most of us aren't even when we're feeling well you're going to look for a scan through and look for words like responsibility financial payment exit out and write in I agree to pay Medicare rates H I agree to treatment and or to pay Medicare rates initial it and at the bottom then sign it but in an emergency situation the point is they cannot refuse care now to you because you you don't agree to sign a financial agreement or sign a form now once they get you stabilized then yes they can ship you out someplace else but you have to get cure an emergency situation now like you said in the case of if it's routine care then they absolutely have a right to say yeah we want our co-pay up up front or if you don't have insurance we want some kind of payment upfront they can demand that sure and you can decide if that's what you want to do so it's not a balance Bill upfront except if they're saying in that document that you agree to pay fully of what the difference between what they charge and your insurance pay so if you see something that says you agree to pay what your insurance doesn't then you're going to have to x that out and write in you know initially after the X initial make your initial and say I agree to pay Medicare rates or whatever you feel comfortable some people that do this work Paul say well you know Medicare is really really like the lowest retail rate that providers accept and you know they're they're saying they're going to go bankrupt if they just take Medicare rates from everyone there's some data that shows us probably not true then I say okay fine a lot of these folks say they'll say two times Medicare rates they AG great to pay okay I I start with Medicare Why not start with Medicare rates let's go through because there's so much to cover we we've talked about balance billing but there's there is just a lot like as I was reading this I was terrified by the end I was like remind me never to leave this chair so I don't risk rolling an ankle and ending up in bankruptcy yes it's it's a thing it's a real thing in terms of where to start for for those watching on YouTube Here's an itemized bill with CPT codes it's incredibly difficult to read yep it's you know I mean and they're they're counting on you not being able to read it so let's talk about that so let's just talk about it's overwhelming to think that we can check for mistakes and you know what we shouldn't have to check for mistakes but there are things that we can do to make sure that hey you know what I either ow this bill or I don't and what you want to do is make sure that you apply three steps of the only right way to pay every medical bill to any and every medical bill that you get for any medical service on unfortunately if you have to end up taking ambulance services Physical Therapy whatever it is any kind of Medical Services Dental Care you want to make sure that you apply the three steps and that step one is that you want to get a real Bill an itemized bill you hear that all the time when folks are doing this work saying ask for an itemized Bill and this is the thing often they're very happy to give you an itemized Bill and that's still not a real Bill a real bill has CPT codes CPT codes are to Medical Services what products are or I should say barcodes are to products in a store in a retail store so every medical service you can think of getting the United States every test every operation every ER visit every outpatient doctor visit all has its own unique CPT code and so when you get a bill unfortunately nine times out of 10 you're not going to get a bill with CPT codes it's not a real Bill if it doesn't have CPT codes or if it doesn't say CPT or sometimes it'll say C CPT hix piix hcpcs it's a subtype of CPT code if it doesn't say that it's not a real bill I explain this Also Paula to let folks know that it is not a mistake I call it a mistake to be polite but they're really not mistakes they're only mistakes if we if we fall for it if we pay them it's a medical bill paying mistake that is often you'll see service codes and people will think well that's a CPT code no it isn't that's something internal to the provider we don't know what that represents the reason why you need CPT codes is because that is currency for care in the United States and Canada but basically we're talking about the United States okay this is the thing if insurance companies don't even think about getting a bill from a provider paying a bill that they get from a provider that doesn't have CPT codes they don't know what that is they're like well you guys sent us say communication but we don't know what this thing is it doesn't have CPT codes on it so it's not a claim a claim is a a bill from the provider to the insurance company so this claim doesn't have CPT codes on it what what we never received a claim from you if an insurance company doesn't pay for anything that is not a CPT Cod have you don't know if you're paying for an apple or a cow right right a CPT code for a cow is different than a CPT code for an apple right right so an insurance company says if they get something that says hey we pay you know we took care of your member and we provided this service they're like okay and it doesn't have CPT codes so why would providers send patients different bills than they send insurance companies payers because we fall for it it works 99% of the time because there's no basic medical financial literacy in the United States wow so that's the first step all right how do you recognize as a CPT code is it five digits is always five digits all right so it is five digits usually sometimes it'll be five digits Das two digits or it'll start off with a letter the thing is also some rarely they will run it as seven digits it'll be five digits and instead of the dash and two digits they'll run it as seven digits which is why I say don't worry about the number of digits just make sure it says CPT at the top Okay so just I want to keep it simple for us perfect perfect yeah so that's the first step in identifying okay I'm making sure no mistakes are made okay so you're going to call and you're going to ask for and when you look at this bill that you got in the snail mail open it up if it doesn't say CPT at the top or CPT slhck piix or something at the top okay and I don't care if it says service codes that's still not an an itemized bill it's not an accurate bill it's not a real Bill if insurance company is not going to pay it then you're not going to pay it either right you're call up you're going to call your billing providers or call your providers billing office and ask for a real Bill step two once you get the bill this is the where the money is literally no pun intended you're going to take each of those CPT codes and do an internet search Google what is the description for each of those codes just to make sure so like 99213 it represents a type of outpatient procedure or our office visit rather you're going to put that in you know just Google CPT 99213 or CPT code 99213 just CPT 99213 is fine and you're looking for descriptions of the services that you had so just make sure it sounds roughly like you had to make sure there's no upcharging like you're not charged for like a humoral fracture intervention as opposed to like an arm sling you had to go just make sure you're not getting upcharged and you know making sure you're not getting duplicate build that kind of thing you know mistakes happen right also while you're Googling Paul you're going to look for what Medicare pays for each of those Services each of those CPT codes because Medicare rates are the actual very most Fair the least expensive retail price for services provided in the United States so that's key that's what you're actually looking for so then you're going to take that to step three and you're going to call back the provider because what happens is you're going to think oh my gosh you're going to call back the provider and to say yeah you know you guys really helped me with my emergency hernia surgery I needed last month and you sent me a the original bill was $10,000 I have here but in my case I am willing and able to pay $33,000 because your research with medic what Medicare pays for that hernia surgery is $3,000 as opposed to $10,000 now $3,000 is still a lot lot of money so you're going to say you know what it you know accidents and emergencies never happen at a great time right so I there's no way I can stretch my budget I can't squeeze more than $50 extra out of my budget to pay towards this who can I speak with who can help me make a payment plan and that payment plan 50 bucks for $3,000 a lot of folks are thinking oh my gosh why would any they're not going to accept that it'll take forever literally years yeah five years to pay it off and my response is yeah and yes the reason why doesn't matter how long it takes you're asking for an interest free payment plan directly with the provider because they know that you're coming to them you're being proactive they don't have to chase you and maybe have to send it to collections and get only maybe at at best Pennies on the dollar MH and they know that that original number I call it a fantasy number or wishing number they're wishing and hoping and praying that you call for it right right so those are the three steps of the only right way to pay any medical bill that you get asking for a CPT code and looking it up in step two asking for it in step one looking it up in step two that takes care of a lot a majority of the foolishness that are quote unquote mistakes right okay step one find the cpg code step two look it up and find out was it for the right type of service and if does it sound Serv does it sound like yeah does it sound like you got that service does it does it sound Vaguely Familiar right and uh and if so what does Medicare pay for it and then then call your provider and say hey are you willing to build me at the medic no no no no great Point always ask open-ended questions never ask close-ended question a close-ended question is something that can be answered with yes or no oh so you're going to say who can I speak with who can help me make a payment plan right but but before the payment plan we first have to get to the Medicare rate yeah well the med you don't have to tell them that you did the research you know I I don't tell them I just say hey this is what I'm willing and able to pay I some people do they'll say well you know what I did my research and this is what Medicare pays for and this is what I can afford to pay then they'll say who can I speak with but you know Paul I always say ask who can I speak with who can help me if you can't help me they give you push back who can help me to make a payment plan because frankly most of us want to help and if not it's because we're not trained really don't give folks the opportunity to tell you no is my point so don't say can I make a payment plan no they will they look a payment plan you just have to let them know that you can't get blood out of the stone and this is what you're able to do and this is it is what it is right right okay that's a good to always ask open-ended questions because if you ask the ended questions then they could say no no exactly and you know if they're having a they're they just want to go home and drink their soda and play video games folks in the front lines doing that this and unfortunately you know this is they they don't want to have to do something that's outside of their process so of course the the automatic response is no right so every medical bill is negotiable Paula for this reason because the initial price you're given is just a madeup fantasy number so yeah everything is negotiable and you want to pay a reasonable rate for what you actually owe and that's usually the Medicare rate wow you talk here about some of the most common mistakes you talk about double or multiple billing so Char you know charging for the same service more than once we talk about wrong quantities getting charged for 100 tablets instead of 10 and then correct length of stay and right type of room for for any hospital care on the surface these might sound like obvious things to spot but in the moment sometimes you know double or multiple billing for example I mean any one procedure can have so many subcomponents within it and any one of those subcomponents might be multiple build it it's it's less straightforward than it seems so how can you really how can you spot that great great question so the thing is that's why you need a CPT code there a CPT code to a certain procedure like there's a CPT code for hernia surgery right there are different parts to some surgeries but you're only going to pay for one code you're not going to that's a great way that providers will try to trick you into paying more so instead of paying the flat rate you're paying allart itemized and like I say you know they're only mistakes if we fall for it so there I put mistakes quote unquote in parenthesis because there know what they're doing they're not mistakes like you know they're only mistakes if we fall for it if we don't know any better and that's what they're counting on they're counting on the average American doesn't have basic medical financial literacy like I said just doing the three steps you don't have to know fancy anatomical terms or medical terminology you don't have to be someone who's very quick with words and very assertive or not assertive assertive is good but not aggressive people think they have to be aggressive or be a certain way to be able to negotiate and what you're doing with the three steps is you're automatically negotiating every medical bill is negotiable and you want to make sure that you're paying the basic fair and that's usually that's always in this country Medicare rates what Medicare pays for the services so yeah you can get rid of a lot of foolishness like I say a lot of the games that are played but like you talked about the upcharge there's a CPT code for incision and there's a separate CPT code for suturing M Under the Umbrella of a CPT code for hernia if you get a bill and you see okay I had hernia surgery there's a CPT code for that okay I had that surgery and then you see another CPT code for incision and another CPT CPT code for suture well that's breaking out Services by definition you can't do a surgery right I can't have a Heria surgery if you don't do the incision and do the suture that's why you need the three steps you don't have to know fancy terms you just have to know what happened right just generally does it make does it make sense if I had to explain this to my grandma or my five year-old you know but this Mak sense no so what that the there's a fancy name for that is called incidental insurance companies don't pay for that foolishness neither should you incidental in in it is incidental to the overall overall procedure basically integral to during the procedure you can't do the hernia surgery without doing an incision in a suture right okay yeah okay so incidental like you can kind of think of it then as almost necessary necessary to the procedure integral necessary to the procedure how you're not going to build me separate for something that you need if you're going to do if I trust you to do my hernia surgery I'm going to pay for it I'm not going to pay you for if if I buy a car I I'm not going to pay you separate for okay we're going to break out the the seats right you know that's separate for the seats those are really nice seats yeah no we're not going to do that right right right right yeah and if something's optional like floor mats exactly okay yeah they'll they'll throw in the that's not optional you know but the car seats aren't optional to the car floor seats yeah I mean floor rather yes yeah yeah but but seats not so much exactly the seats are necessary the seat the the wheel the steering wheel is necessary and I use a car analogy a lot Paula because think about when you take your car to the car doctor right the car mechanic you know most of us don't know fancy terms the car mechanic terms and you don't have to to be able to understand what's in your budget and if they say okay well the carburetor needs to be fixed you know you need a new carburetor you'll be like okay well how much is that going to cost and they'll tell you well this and this well this is all I have in my budget what can we do and they'll say you know what we can get a used carburetor you know like we get stuff from junkyards or things like that everything is negotiable when it comes to medical bills and you don't have to know fancy terms if you don't have to know fancy terms to be able to afford your car and the repairs you don't have to do it for your human body either right right now what about so there's a section in here where you talk about medical equipment billing for somebody like me who is just not familiar with medical equipment how do you even necessarily recognize the the terms of some of these name even with the CPT code you might not know hey I've got this stuff what is what's it called right what I would do is call call the provider and say I don't know what this is that's frankly that's what I would do never be afraid to ask questions and you know I find that the insurance companies if you're fortunate to have insurance insurance companies you would think that they're trying to get you off the phone you know calling number the back of your insurance card but they're always very helpful you know and say you know what I got this bill I'm a member of your insurance company and I got this bill from this provider and it says this CPT code the CPT code but what did they send you did they send you and your claim does your claim with your CPT codes match to what I got oh ask questions wow so compare notes yes compare notes with the insurance company yeah so the three steps First Step get a real Bill Second Step take all those CPT codes from the real Bill make sure you find out that you know that it sounds like what you got and what Medicare pays for it and then you call back and say okay this is what I can pay total it up while you're waiting for the first step if you haveen insurance I usually tell folks while you're waiting for that call your insurance company say hey oh by the way did my provider send you a claim a bill for this date of service and if they say no you're like okay yeah bet when you get the bill the real Bill you're going to call them back and say yeah I talked to my insurance company and this is before you build my insurance company by law if you have insurance the insurance company has to be built first before you can be expected to pay h right if they did say yes we got that then you can say okay I haven't gotten an EOB or explanation of benefits and they'll say okay you know they can be they'll mail it to you if you prefer or often it's online and they'll direct you online and just keep them on the phone while you're looking for it well I can't find it can you show me where on the site and then just go through it with them you'd be surprised with how helpful the insurance companies are if you have insurance for people who who you've seen kind of go down the this pass what are some of the places where they get tripped up or what are some of the the mistakes they make once they're actively engaged in this process you know I really appreciate that question people think that the hard part is when you call back the provider in the third step and say hey this is what I can afford to pay this is this is what I got who can I speak with that can help me make a payment plan or who on your team can help me make a payment plan but Paul is actually step one because that's again no pun intendent or maybe pun intended that's where the money is just shocked at the games that many providers billing departments have been trained to play to keep you from getting a real Bill thing is this the insurance companies have already contracted with this is what they're going to pay and not a penny more for services and the providers know that if they're going to get the premium money it's going to be from the patient either who are cash paying or or like most of us we don't have basic medical financial literacy so we going to fall into thinking oh this is a real bill this is what we owe no it's a Balan Bill no you don't owe any of it so do you remember I told you the story about Mia you know got me into this into this work and talking about this issues and this mission to crush medical debt that very same Hospital six months later tried to send me a balance bill for $90,000 wow almost $90,000 yes and that's so my point is this is a long answer to your question Paula they know what they're doing they're not mistakes they're only mistakes if we don't know better and we fall for it they're I call them medical bill paying mistakes so 80 to 90% of every medical bill in the United States have mistakes but they're only mistakes if we pay for them they're they're not really mistakes in the provids part they know what they're doing so what what did you do when you got the $90,000 uh balance Bill great question I call my best friend my lawyer best friend who always yells at me for calling you know out the contract lawyer for fraud the one who's always accusing you of asking for a defamation case I called her up and I was cracking up I was dying laughing because I knew I didn't owe any of the money and she said you know what Virgie you're the only person I know who's laughing when everybody else would be curled up in a fetal position in a ball crying and so this is a thing so I looked at it and I tell people the story because it was like broken up into three lines it was for emergency surgery and what was really cute about it is they didn't have CPT code up at the top but the first line said all right o services and Hospital impatient services like $365,000 second line said pathology services and it had five digits it didn't have CPT code next CPT next to it but I know because of my work okay this is CPT code for pathology Services right $19.95 wow wow third line okay Insurance last adjustments 200 and you know 70,000 something dollars so it left like almost $90,000 which is a third line patient responsibility or patient balance almost $90,000 jeez yeah that's oh that's really cute so they can say yeah there's a CPT code in there for the pathology whenever you have a a surgery and anything is removed from the human body it needs to get sent to the pathologist to make sure there's nothing hiding in it that kind of thing like you know malignancy or something right so they charged whatever $1 1995 for the pathology service yeah there's a CPT code for that but the whole 265 or $365,000 all rolled into one wow okay so you have this bill only one procedure has a CPT code and it's for $19.95 and the rest of it is just oh here's $365,000 that you for some reason what do you do next in terms of actually battling it so 6 months earlier I had the I met Mia right so I've already started writing the book and I said you know what this is going to go in the book this is going to be good so I called the insurance company just to make sure just to see what they had to say what they received if they got a claim a bill from the provider and what they were charged it turns out they said yes we got a bill for that data of service from your from that provider and I said oh great you know so how much did they charge you or what what what was the claim for that CPT code or whatever I hadn't gotten asking them what to the point of asking what the CPT codes they received on their claim I just said how much were you build or was a company build it was something like almost 90,000 like basically the amount that they were billing me so remember I said the total number was 365 right BL and I was left with a balance of almost 990,000 it was like 89 something something something the exact same number was what the insurance company told me they rebuild so they were trying kind of play both in towards the middle they're like well if we don't get it from the patient we're definitely going to get it from the insurance company but maybe we can get more from the patient this is the way they get down they this is their their business model so wait so the insurance company wasn't build that 200 because it wasn't there a line item for like this adjust yeah the insurance they weren't build for that so apparently they were buil so this is the way the system works you're build for the services by broken down into CPT codes the insurance compy I didn't look at the EOB I didn't ask for the EOB for the CPT codes that the insurance company was built and what they paid the the hospital sent me a total F you know bill that said okay the adjustments is like the discount the amount that the insurance company says that they're contracted to pay that's what they said okay we'll pay that that's what the insurance company in response to the CPT codes they got and their claim from the provider said okay this is the amount we'll pay right so the point is is that yes they know that they're going to get this amount this 89,000 almost 990,000 from the insurance company but they obviously their business model to try to get the same number from the or trick the patient of believing they owe that they owe that amount and not the insurance company wow wow crazy so so then what did you when you reached out to the Prov to the hospital what did you do how did you know I call the provider how I call the I had a suspicion I had a sneaking suspicion I just wanted to see what they had to say for themselves right so you know I again you know I play I don't like to say dumb but you know I I definitely did not let them know that they were trying to put one over on the author of what your doctor wants you know to crush medical debt right so I just played like just you know the average patient they're using to put this over on right so I called them up just to see what they had to say for the book and I said yeah you know I got this bill 90,000 you know almost 8989 almost $90,000 and yeah you know I'm I'm confused what is this and so they're like yeah the the gentleman who answered the phone said yeah yeah yeah that's a lot of money you can't be expected to pay all of that can I transfer you to a team member who can help you make a payment plan that's all they had to say what happened next so oh this is a great story so about a year later so I I made a copy of it of the of the bill this this Bill and and you know compile the story for the books the books and printing and publication but but but I mean for for that because they're still billing you they're thinking that you're going to pay they're probably sending you notices no no no no I I swear Paula exactly that's this there's a story behind this okay so they send me this bill I laugh and I don't throw it away I need to keep this right documentation but I was like this is going to go in the book I make a copy put the original away and the book is in production it's about a year later my best friend and I are talking she was asking about something with there was a bill that she had gotten from when she had to have a procedure done and we were talking about that you know kind of thing and she said you know by the way what happened with that bill that you got that $90,000 bill that you got from the hospital from last year she said did you ever pay that I was like no of course not she says you mean you really just totally ignored it I said yes and she said are you sure like you haven't gotten any like notices or anything like that I said no and she said well how do you know like have you checked your credit report maybe it got sent to collections I was like who are you talking to I just refinanced my mortgage last last last month I have a 839 FICO score like no they know that it was a game they know that I just didn't fall for it I got one bill that was the only Bill I got they know that it's a game this was their business model wow yeah wow so but I'm I'm trying to figure out what the takeaway from that story is because you know it it doesn't seem like the takeaway should be just ignore your bills so that's a great point the takeaway that I like to say is you may not owe that medical bill frankly and that's why you have to know the three steps of the only right way to pay a bill right so we do the three steps and the balance bill that's what that's why I go into a little bit more into the book because there are some like I call them five general things and like mistakes that you'll fall for that without basic medical financial literacy that the system I hate to sound conspiratorial but the providers who are kind of a little little unethical they know it's they know it's not illegal but it is immoral and unethical you know and they know that many of us will fall for it because we don't have basic medical financial literacy in this country so in your case you received this bill it only had one very small CBT code on it or a CBT code for one very small fraction fraction of the bill and when you called the provider you made the decision not to ask for an itemized bill with CBT codes and in addition to that you also made the decision therefore not to move to the Second Step which would be then researching those codes finding a fair rate based on that research and then calling back and saying this is what I can pay those would be in a in the classic steps those would be the steps that you follow before you then say this is what I'm willing to pay let's get to a payment plan MH in your case though you you didn't do any of that you just called them and they were like yes we essentially they said yes we expect you to pay it yes and you essentially said no thanks and hung up and then that was the end of the story so so and okay so yeah sounds like a big leap the reason why I was able to say okay thank you very much you know I you know I don't need the payment plan discussion right now thank you very much is because I knew that it was one of the five big mistakes or unquote 80 to 90% of the problems or mistakes that the providers expect patients to pay which mistake was it it was number five which balance billing that is what I call Double dealing so there's one number one mistake is is being a non-negotiated meaning not doing the three steps which has you automatically negotiating without having to know fancy words and be very aggressive number two is a care qualifier that means if you received your care at a nonprofit hospital that you are actually by law required to they are required to give you a a financial assistance application and even if you have like a huge income sometimes your medical bill is such a huge amount in comparison that sometimes it's completely wiped off number three is that you credit crunch meaning you put it on a medical credit card or some other credit card big big mistake right number four is you were dubiously denied which means that you have insurance and the insurance says oh no we're not paying for this and you think it should have been covered and so I talk about basically why you want to appeal things that you really think should have been covered and number five is being double dealed that is the category of balance billing right and so you recognized this to be a balance Bill yes exactly I actually did ask them just to see what they would do because I I I saw that this this Medical Center this is their business model so I did call later and say Hey you know was doing writing the book about this case my case I said hey you know what I didn't get a real bill for this particular date of service I'm like oh well we don't have that here I said well yeah you know by by Hippa law I am required to get a copy of a real Bill and they said well we continue to medical records They maybe they have what you want I said no actually the same information that you sent to the insurance companies that's what I need I need a real bill now you can actually there's a term for it it's ub04 ub-04 forms for people that don't have insurance or they have health shares where they get reimbursed right so you can ask for ubo4 form d04 form but I just but because most of us don't know to ask for a specific ub04 form I pretend like again that I was the average consumer the average patient and I said so I need something with CPT codes on it and they said okay all right they didn't they didn't end up transfering me to medical records the way she threatened she was trying to get me off the phone right trying to say no we don't have it and I said well can I speak to someone who can help me so she transferred me to her supervisor whoever I didn't ask to speak to the manager the supervisor I just said can I speak with someone if you know who can help me so she didn't end up sending me to the medical records department she sent me to p a person I guess was a manager and they said okay yeah we'll send you a detail bill so Paula I get in the mail later this big thick thing that it did say detail bill that means nothing itemized Bill detail bill means nothing if there's no CPT codes and Paula there were no CPT codes on it so what should I have done what do I tell people to do in this case because that's where you're going to get the most push back when you ask for a real bill with CPT codes they're not going to give it to you because they know that's where the money is eight to nine times out of 10 that's what we're dealing with so what would I do I call back and I have done this you know what as per hipa federal law I'm going to have to file a a hippo complaint if you can't help me what's your name again you know thank you so much for your help you know I call it a battle Journal document the date time who you spoke with and say well you know what I'm I'm going to have to file a Hipp aw if you can't help me get a real bill with CPT codes as per Hippa federal law and you have filed Hippa complaints oh oh yeah is that relatively easy to do like somebody who's listening to this can they go online and yes there's a federal office of civil rights Hippa is a civil right law so that's the actual it's very easy to do you know follow the prompts you know they use a lot of fancy to language like government language but it's easy to do once you hit the site and once you have the address site address URL right going back to the the five big mistakes you recognized that your bill was mistaken number five which is the balance Bill and mistake number four is dubious denials those denials in which you are in network but they're still denying it for for whatever reason and one thing that that that I learned from reading your book is that if you are out of network or if they claim that you're out of network even though you are actually a network if they deny you you could end up paying more than your annual out of pocket maximum which is anytime they deny you you're paying more than out of pocket max if you have to pay for it right you the providers coming after they say hey we're out of network oh sucks to be you but you still owe that you know you should have figured this out before it's unfortunate but unfortunately there are a lot of providers or that's their business model to say well we don't participate in any insurance so all insurances were out of network with so you're responsible for all of the bill that we decide to charge you that's where the no surprises act came into play that's why it was created to protect folks from doing all this research to find for instance a surgeon who accepts their insurance but the surgeon's hospital where they do their operation does not your X-ray does not the pathologist who reads to make sure it's not cancerous doesn't accept they're out of network and the anesthesiologist is out of network so that's where the surprise billing act came in to say hey if you are in network insurance but the facility says hey we're out of network we don't accept anything you're going to have to pay for it all out of pocket whatever we charge you that's it sucks to be you right if you can't afford it instead of the patient being in the middle and holding the bag and having to pay this now per this as of January 20122 the provider has to the out of network provider has to negotiate directly with the insurance company to get paid and they have to accept whatever the in network reasonable rate is right and that that bill was passed in December of 20120 and then went into effect of January 2022 exactly got it you remember that yes I do I do because that was a huge problem just just like you outlined you you think that you're going to a provider who is in network and then it turns out that there are all of these subcomponents of whatever you're getting that are that all have their own separate networks well we are coming to the end of our time are there any final takeaways that you want to leave this uh Community with yeah you know most Americans are just one accident or one serious illness away even those of us with fabulous Insurance away from a lifetime of debt or worse you know and that's the bad news Paula the good news is it doesn't have to be that way you know we're on this mission to let folks know hey in this country basic medical financial literacy is not hard it's not complicated don't believe the hype don't feel that because you don't have formal education or don't understand all these fancy words it's not necessary if you can buy a car and if you can afford the repairs for the car you know how to pay for repairs and keep it in your budget you can actually save your your financial life and your your financial future wow all right well thank you so much for spending this time with us thank you so much for having me Paul you know I love talking with you it's been awesome thank you thank you what are three key takeaways that we got from this conversation well each key takeaway is a step that we're going to walk through so that you can correctly understand and address your medical bills key takeaway number one which is also step one is that big idea is to understand what it means means to get a quote unquote real bill so that you can analyze the details and look for information that will help you understand specifically what you are being charged for because if you're not aware of the correct details you won't know if you're being charged fairly and what you want to do is make sure that you apply three steps of the only right way to pay every medical bill to any and every medical bill that you get for any medical service unfortunately if you have to end up taking ambulance Physical Therapy whatever it is any kind of Medical Services Dental Care you want to make sure that you apply the three steps and that step one is that you want to get a real Bill an itemized bill you hear that all the time when folks are doing this work saying ask for an itemized Bill and this is the thing often they're very happy to give you an itemized Bill and that's still not a real Bill a real bill has CPT codes CPT codes are to Medical Services what products are or I should say barcodes are to products in a store in a retail store so every medical service you can think of getting in the United States every test every operation every ER visit every outpatient doctor visit all has its own unique CPT code and so when you get a bill unfortunately nine times out of 10 you're not going to get a bill with CPT codes it's not a real Bill if it doesn't have CPT codes or if it doesn't say like CPT or sometimes it'll say C uh CP t/h piix hcpcs it's a subtype of CPT code if it doesn't say that it's not a real bill so that is key takeaway step number one key takeaway number two or step two once you have a medical bill with CPT codes do your research to understand what each of those codes mean so that you know what you're being charged for step two once you get the bill this is the where the money is literally no pun intended you're going to take each of those CPT codes and do an internet search Google what is the description for each of those codes just to make sure so like 99213 it represents a type of outpatient procedure or our office visit rather you're going to put that in you know just Google CPT 99213 or CPT code 99213 just CPT 99213 is fine and you're looking for descriptions of the services that you had so just make sure it sounds roughly like you had to make sure there's no upcharging like you're not charged for like uh humeral fracture intervention as opposed to like an arm sling also while you're Googling Paul you're going to look for what Medicare pays for each of those Services each of those CPT codes because Medicare rates are the actual very most Fair the least expensive retail price for services provided in the United States so that's key that's what you're actually looking for finally key takeway number three which is step three is to know exactly what to say when you call your medical provider because it can be intimidating to ask for a significantly lower payment and it can be difficult to figure out how to make the situation play out in your favor she offers guidance to show you how to negotiate a lower payment that can be less financially stressful step three you're going to call back the provider because what happens is you're going to think oh my gosh you're to call back the provider and going to say yeah you know you guys really helped me with my emergency hernia surgery I needed last month and you sent me a the original bill was $10,000 I have here but in my case I am willing and able to pay $3,000 because your research with medic what Medicare pays for that hernia surgery is $3,000 as opposed to $10,000 now $33,000 is still a lot of money so you're going to say you know what it you know accidents and emergencies never happen at a great time right so I there's no way I can stretch my budget I can't squeeze more than $50 extra out of my budget to pay towards this who can I speak with who can help me make a payment plan and that payment plan 50 bucks for $33,000 a lot of folks are thinking oh my gosh why would any they're not going to accept that it'll take forever literally years like yeah 5 years to pay it off and my response is yeah and yes the reason why doesn't matter how long it takes you're asking for an interest free payment plan directly with the provider because they know that you're coming to them you're being proactive they don't have to chase you and maybe have to send it to collections and get only maybe at at best Pennies on the dollar those are three key takeaways SL three steps that we learned from this conversation with Dr vgy brigh Ellington thank you so much for tuning in my name is Paula pant this is the afford anything podcast if you enjoyed today's episode if you learned from it if you have any reactions to anything that was said here please share it with the community if you are on Spotify leave a comment you can do so directly in the app you can also reach out to me on Instagram at Paula pant p a p n and you can chat with other members of this community at afford.com Community thank you so much for being part of this community my name is Paula pant this is the afford anything podcast and I will catch you in the next episode