Why You Should Never Pay the First Bill, with Marshall Allen

June 23, 2021
Lindsey Logan

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For episode 14 of our podcast, we were joined by Marshall Allen, an influential journalist for ProPublica, and first-time author of “Never Pay the First Bill: and Other Ways to Fight the Health Care System and Win.”

Marshall has been reporting on the healthcare industry for over 15 years and is known for digging deep into why Americans pay so much for healthcare, yet get so little in return. He is also one of the creators of ProPublica’s Surgeon Scorecard, which published, for the first time, the complication rates of about 17,000 surgeons who perform eight common elective procedures. His work has been honored with an array of journalism awards, including being a finalist for the Pulitzer Prize for local reporting.

Our hosts for this episode, Steven Cutbirth and Haden Marrs, discuss several topics with Marshall, including resources to help educate consumers on healthcare billing, corruption in the healthcare system, and Marshall’s own experiences fighting wrongful medical bills.

You can listen to the whole episode here or on Spotify, Apple Podcasts, or wherever else you listen to podcasts. If you’re short on time, we’ve included a few highlights from our conversation below:

Steven: “I’m really curious, how did you go from getting your master's in theology and working in ministry to ending up as a healthcare reporter at ProPublica?”

Marshall: “The truth is I had no plan for what I was going to do with my career. My wife had been a missionary kid and grew up in Kenya, and she had always wanted to do something international. So we ended up doing three years of youth ministry in Nairobi, Kenya. And then I came back, went to seminary, got a master's in theology. I thought I would stay in full-time ministry, but I actually started freelance writing during that time. And I had no training, but I had a lot of instincts and I liked to talk to people. I have a very strong justice streak. And so I found that journalism really appealed to me and I found that you could really make a difference in people's lives. I really stumbled into healthcare journalism when I was in Las Vegas and they asked me to cover the healthcare beat. And my first words were, ‘I can't imagine anything more boring than writing about healthcare.’ I mean, I really thought it sounded hard. But as soon as I started doing it, I found that I was digging deep and focusing on the things that people care most about, which are their money and their health. And so I've done a lot of stories about patient safety and the quality of healthcare. And then I've dug deep in the last few years on why we pay so much for healthcare in this country. And a lot of the injustices surrounding that, a lot of the inequities that are surrounding that. Then with my book, I really wanted to show what we can do about it. Like what can we do as consumers? What power do we have? And so that's kind of my mission right now with the book.”

Haden: “I'm sure you have tons of tips and tricks that you have learned. What is one of the biggest tips that you would have for an individual or a company on how they can engage in the fight for healthcare correction?”

Marshall: “When dealing with the billing department, ironically, you want to build empathy with the people who are in the system. They do have a lot of power to resolve things in a fair way for us, so if we build a relationship with them, if we try and be their friend, rather than just someone who shouts at them on the phone, or complains or gripes, and say, ‘Hey, how can we work together to get this solved in a way that works out well for both of us?’ When you're dealing with a medical debt collector, ironically enough, you want to build a relationship with them too. You don't want to run away from them. Don't criticize them or tell them, ‘How could you, you slime ball, coming after me for money?’ You want to actually build a relationship with them. Help them empathize with you. Help them see that you would love to pay them, but don’t have the money. Maybe the amount was reduced that they claim you need to pay, you could come to an agreement where they might get some money. But, being nice and being friendly does not mean that we should be weak.”

Steven: “A lot of people don't know this, but they actually can ask for the cash pay price, or use tools that might show that to them and get a better price. Could you hit on that a little bit?”

Marshall: “One of the recommendations I make in the book is how you should always ask for the cash price. Because, even if you have insurance, there is so much behind-the-scenes horse-trading that goes on when setting healthcare prices. A hospital might say to an insurance company, ‘We're going to give you a deal on MRI, but we're going to get a higher price on emergency room visits.’ You might be a patient who went there for an MRI, and you get lucky. But, you go into the emergency room and you completely get screwed. I'll give you the most outrageous example of this that I've seen so far. I got an email from a young woman named Gabby in New Jersey, and she had gone to her local hospital. She got three stitches in her finger. She was covered by United and her health plan paid about $3,000 and then she had a $2,800 deductible. So, almost $6,000 for three little stitches on her finger, almost $2,000 per stitch. That was the insured negotiated rate. I started helping her and started working with her. She got an itemized bill, so we could see in the billing code that the biggest charge came from her emergency room visit. I looked up the code for that emergency room visit on the hospital website and the United negotiated price was $5,805 for this level three emergency room visit. That was the discounted price. The Blue Cross price was like $700. The Medicare price was $230 and the cash price was $256. So in other words, if she would have gone in paying cash, she would have paid $256. But instead, she was covered by United, and her negotiated, discounted, special insurance price was $5,800. 22 times more than if she just would've paid cash.”

To hear the whole conversation, click here for the full podcast episode. You can also hear more from Marshall by following him on Twitter at @marshall_allen. You can also check out his website to order his book and keep up with his great work.  

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