Book review: 'Never Pay the First Bill'

Marshall Allen was on a mission when the Lord called him home earlier this year.

The award-winning investigative reporter waded through the swamp of U.S. health care for nearly two decades trying to help fellow Americans who are stuck in its mud. He emerged as an expert in dealing with the billing aspects of the industry, which, at some point or another, could affect any of us.

While his death is a loss, he left us with a great deal of wisdom on how to deal with health care billing through his Allen Health Academy curriculum and newsletter as well as his book Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win (Portfolio, 288 pages).

Dedicated to “anyone who’s been pushed around by the American health care system,” Never Pay the First Bill was written as a warning that bills from health care providers aren’t always accurate and that we should always take a close look at them. It also exposes “hidden tricks” that the health care industry uses “to make your money disappear.”

While some of Allen’s book is addressed to people with health insurance and to employers, members of health care sharing ministries can benefit, too. Allen explained the inner workings of provider billing so that patients know whom to call and how to work with those providers when there’s a problem with a bill.

And problems are common. Allen wrote that “experts who review medical bills for a living say most of them contain some type of mistake” (emphasis in original). “Somehow, the errors don’t seem to work in the patient’s favor,” he added sardonically. One patient advocate told him that “she probably catches errors in about 80 percent of the medical bills she reviews for her clients.”

In the chapter “Never Pay the First Bill,” Allen offers steps to take when you receive a medical bill, including:

• Obtain an itemized bill (which Samaritan members have to submit anyway for a Need to be shared).
• If necessary, obtain the relevant medical records.
• Examine the itemized bills and the medical records to see if both reflect the care the patient actually received.
• Make sure the bill is priced fairly by using such tools as Healthcare Bluebook™, available in Health Resources on your Samaritan Dashboard.

For instance, getting an itemized bill and obtaining medical records can help you track down whether the provider is billing you for something they actually did or gave you. Make sure that the billing codes and medical records line up, since the former are supposed to come from the latter. “Refuse to pay anything that’s not documented in the records,” Allen wrote. Then he warned about “upcoding,” which involves a provider charging for a level of care more complex than that which was actually given.

Medical providers get paid much more for each level of care they provide. It’s also a major source of fraud. If a doctor or hospital claims the care they provided was more complicated than it was, we end up paying more.

Sometimes, fixing such a problem is as simple as reaching out to a provider and asking them to adjust a code so it’s accurate.

Other chapters in part one deal with debt collectors and going to small claims court.

Part two offers tips on “Avoiding the Need to Fight,” with tactics that health care sharing ministry members most likely are already familiar with.

One chapter focuses on avoiding unnecessary treatment. Allen cited a study by the Washington Health Alliance that found in one year, 600,000 patients in that state underwent a treatment or test they didn’t need at a total cost of $282 million. The author encourages patients to ask whether a procedure or treatment is necessary, whether there are other options that may be less costly but just as effective, and whether it can wait until you’ve done more research or gotten a second opinion.

He also talks about “inelastic demand,” which is treatment you absolutely need, such as for diabetes or showing up at an emergency room with chest pain. It’s inelastic because the need for it “doesn’t change if prices go up or down.”

“That’s why the medical industry can get away with charging us so much and continue raising the prices. You and I will pay anything to save our lives or the lives of those we love.”

And the health care/health insurance cartel will exploit that.

Dealing with an inelastic situation is where Allen encourages patients to follow the lead of the health literacy company Quizzify and add a clause on informed consent documents like the following:

I consent to appropriate treatment and to be responsible for reasonable charges up to two times the Medicare rate.

Allen also encourages patients to check around and find the lowest prices, which many Samaritan members do very well already!

While advising readers who have health insurance how to navigate billing complications that show up for them, Allen also exposed those companies in a chapter titled “You Might Save Money by Not Using Your Insurance” and notes that “In recent years people have found they sometimes get a better deal if they don’t use their insurance plan.” In some cases, patients with insurance were able to get a better deal on treatment by paying cash rather than submitting a claim to their insurance company and having it applied to their deductible, or finding out their insurance company had negotiated a price that was higher than a cash price would be.

That means, Allen wrote, that “many insured Americans are functionally uninsured.”

Allen’s concluding encouragement is to “stand up to the bullies” in the health care system.

They think it’s okay to hide prices from you even though they know you can’t afford to pay the bills. They tolerate the middleman and markups that drive up costs because often they are the middlemen doing the markups! They don’t care if your bills contain errors that drive up the costs. They just expect you to hand over the money and will send bill collectors after you if you don’t pay up. … At some point, you have to say ‘Enough is enough’ and tell the bully he has pushed you too far. Now it’s time for him to back off.

Never Pay the First Bill is a great reminder that sometimes the health care system gets it wrong and needs to be challenged. Sometimes it expects payment that isn’t legally or morally proper.

We can and should stand up to it.

And, whatever you do, never pay the first bill.