Air Date: 8/16/21

The Upgrade by Lifehacker

How to Not Go Broke When You Need Healthcare, With Journalist Dan
Weissmann

Jordan Hey, and welcome to the Upgrade, the podcast from the team at Lifehacker, where
we help you improve your life one week at a time. I'm Jordan Calhoun, editor in chief of
Lifehacker and filling in as guest host today while Meghan's on vacation is Lifehacker's
health editor, Beth Skwareckii. How's it going, Beth?

Beth Hey, good to be here.

Jordan Today we're digging into this impossible uniquely American problem.

Beth We sure are. And that problem is navigating our nightmare health care system and
avoiding the outrageous costs that seem to come with everything health-related.

Jordan That's right. And we're doing that with help from journalist and a fellow podcaster
Dan Weissmann.

Dan Weissmann Medical debt is one of the major causes of bankruptcy. Medical debt is
the number one reason people are in collections. It's you know, it's our credit rating, it's our
everything. Like this is not small potatoes. So learning everything you can and dedicating
real time and energy to learning this and to practicing it. Like, if you can do this, you can
do anything.

Jordan Dan, is a radio producer and journalist based in Chicago and the host of a podcast
called An Arm and a Leg, which dives into the costs of the health care system.

Beth Dan has also worked as a staff reporter for Marketplace and Chicago's WBEZ and
has won awards for his investigative reporting, feature writing, and his production and
hosting work in radio.

Jordan Beth, I imagine at some point you've been to a hospital. At some point you've
probably had a medical bill. At some point you've probably like dealt with all this
bureaucracy. What's the most frustrating part when you sort of step back and look at our
health care system?

Beth To me, it's the fact that when you go and get care, whether it's an emergency or
whether, you know, you have something like a surgery coming up and you know, you're
going to have to do something, all you know is that it's going to be expensive. You don't
know how much it's going to be, even if you ask, sometimes they can't tell you. And even if
they tell you, you don't know what kind of bill you're going to get on the other end.

Jordan Yeah, absolutely. For me, I mean, fortunately, knock on wood, I've never had to go
to the emergency room for myself. I've never had a surgery. I've never had a broken bone.
So I've been really, really lucky. And you know, that is true as of today. All of these things
could happen, you know, an hour from now or tomorrow. And the thing that scares me the
most is, to your point, the not knowing part like that, knowing that it's going to be
expensive, I, I don't know if I were to, you know, need stitches. I don't I don't know, even
know what's reasonable, to be honest. Like, if I were to get stitches, is that a fifty dollar
thing or is that a five hundred dollar thing or is that a five thousand dollar thing? I honestly
have no idea.

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Beth And I cannot tell you. I...and you know, I've been lucky, too, that every time I've, you
know, had some major medical issue or maybe not even that major. But every time I've
had a medical issue, I've had good enough insurance or I've been able to, you know,
cough up the money for my copay or whatever it ends up being. But but it definitely
happens that people delay care or will even avoid care because, like, they don't know
what's going to happen or, you know, maybe something's bad and you're like, well, let me
wait a day and see if it gets worse. So it's not just like an economical or a personal finance
problem. It's like this is an issue for people's health, too.

Jordan Yeah. Actually affecting us. Well, I have a feeling Dan Weissmann's going to be
able to help us all in navigating that. So let's dive into the interview.

Beth Can't wait.

Jordan So, Dan, welcome to The Upgrade.

Dan Weissmann Thank you so much for having me. I'm super happy to be here.

Jordan Oh, man. We have so much to cover here. And I'm going to start with probably the
biggest question possible and we're going to hopefully be able to zoom in from there and
get more practical. But I want to get like the big juggernaut question out of the way, which
is: when it comes to our health care system, the landscape is completely fucked, to be
candid. So how did it get like this? But can you just summarize for us? Give us an idiot's
guide to how it got to the landscape that it is, and then we'll talk about how to navigate that
landscape.

Dan Weissmann OK, there's a great big fat book called The Social Transformation of
American Medicine. People have summarized it for me. So it is really, really long.

Jordan So you can summarize someone else's summary.

Dan Weissmann I'm going to do my best. I'm going to do my best. So it's one hundred
and some years ago, things were really, really different. No FDA, hospitals were places
poor people went to die. People who weren't poor got medical care in their homes, even if
they were, you know, they were super sick. You know, we...The germ theory of disease
was a thing, but antibiotics were not a thing. And and the practice of medicine and I like
somewhere in the kind of turn of the 20th century ish, give or take a decade or two or
three. You know, the idea of medicine as a science. You had the germ theory of disease.
We were starting to wash their hands, but there was still just a lot that hadn't come
together yet. So medicine became professionalized and kind of scientific-ized. That's a
word, right? And there became over the course of the early 19th century, more things that
there'd be more things that doctors could actually do for you. They could prescribe you
antibiotics, stuff like that, and there became an interest in like the government, you know,
the early 20th century was like under like Teddy Roosevelt was like, hey, there's a bunch of
stuff we should protect people from, like poisoning their food and medicines that can kill
you. And so they're starting to become so that's one that's one part like medicine started to
transform into something they could actually, like, help you more. And the American
Medical Association kind of formed a medical schools formed as ways to like make
medicine more of a guild, right, of like, oh, you know, this person is a doctor. They've
studied the right ways they can help you. These people are quacks. So that's one side.
And that became a kind of an interest group. Antibiotics came, insulin was discovered.

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That was a big thing. Medicine became more useful. And then in the 30s, I believe it was,
boy, I'm really authoritative, right? In the 30s, health insurance was invented by a hospital
essentially in Texas where they were like, huh, you know, it would be nice that we can do
people some good. You know, we only get money when people get sick and come to us,
and it'd be cool if we had more of a steady stream of income. And they're like, how about
we have a scheme where people pay in advance and then when they get sick, we take
care of them. And this eventually became and they sold that to like the local board of
education. The teachers became the first people health insurance in that location. There
were other there are other things like it that popped up, but that became that evolved into
Blue Cross. So health insurance became a thing. And then essentially after World War
two, we had a situation where there had been a great big labor shortage. And kind of
during World War two, this happened where the labor shortage because people were like
shipping off to war. And and it was a big competition to get people to actually work for you
here. And the government was like, well, we can't have inflation, we're going to cap wages.
But then there was a workaround like, what else could we offer people? How about this
health insurance thing? That became a thing. So health insurance that you get from work
became a big thing. And then one thing to note about health insurance you get from work
and how it worked was it became a thing you got that employers could give you that not
only got around the wage caps, but that the employer could deduct that was not a taxable
piece of income for you. So we kind of worked good for everybody. Then after World War
to other countries like, say, England, we're like, hey, we should have some system for
taking care of everybody. And people said that in us, too, like, hey, this would be a good
time to think about, you know, health care for everybody. How do we provide this now that
health care is a thing like you can go to a hospital and get well, we can give you drugs like
penicillin. Insulin works like lots of important scientific discoveries. We're like really making
medicine, kind of like we should do this for people. There was a question like, oh, well,
what do we have like a national program to do this universal coverage? And interestingly,
the American Medical Association was like, no, man...

Jordan Hard pass.

Dan Weissmann Yeah, no thanks. And they they hired a firm. And this first happened in
California. Gov. Earl Warren was like, I like do this in California. And they hired this outfit
called Campaigns Inc that actually invented, like modern political campaigning, all the the
stuff that we are still used to seeing. And they you know, they poll-tested stuff and they
focus-grouped it. And they're like this idea of socialized medicine. That's a good talking
point, because this was right after World War II, is like the Iron Curtain had fallen and we
were being anti commies was a big thing, like calling it socialized medicine is a really good
way to make it sound like a crummy idea. And it worked and they defeated it in California.
Then Harry Truman wanted to do it and they were like, no. And they and the idea of
socialized medicine prevailed. There are other things to that. Like like unions had become
big enough like that. They were really in touch with management. They were like, and I'm
going to name a union or two, but I totally may be wrong about it. But a union like, say, the
United Auto Workers had relationships with the Big Three automakers and getting health
insurance for their workers was like a thing that they like to be able to say they were doing
for people. And so they were like not super warm to the idea, is my understanding. So
that's a big turning point in the in the late 40s, like health insurance is becoming a thing a
lot of people have become is the thing you get from work. And yet still it became very
popular. And so by the 50s, lots were getting health insurance from work. We have we
have insurance and now we get into this weird territory where people are no longer paying.
You know, people get sick, their insurance pays. And so we don't know how much
something costs. And the hospitals were like asking the insurance companies, like, you

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know, that surgery last year, you know, our costs going up. It's going to be ten percent
more this year. And the insurance companies were like, OK, I mean, at that point, the
amounts of money were not enormous enough because it's like the magic of compound
interest like this started out as a dollar. Now it's like a dollar ten. I could do it all at ten. And
in many ways what I'm doing is I'm charging premiums to other people that's covering all
this. That's my business. Right. I'm not actually paying this out of my pocket exactly like I'm
negotiating with you, the doctor, for next year's fees, not negotiating with you over here,
the client for next year's premiums. And I just got to make a match so I get some dough at
the end.

Beth To me, that that's just. The craziest part about our system that, like the people who
need health care, are not the people who pay for health care and the people who decide
how much you pay for health care, not the people who, like, get the health care. And sorry
to interrupt you, but that's just—

Dan Weissmann For sure. There's a lot of craziest parts. Yeah, for sure. But this but this.
But this insertion of a third party, that's also a money-making entity. [00:10:35]People
spend entire careers studying other models, what other countries do, because, of course,
we spend more per capita than any other rich country and we get worse outcomes. So
people spend careers saying like, "Well, you know, the New Zealand model..." "Well, no,
no, no. The German model adds this..." Like there's a million different ways to do it. All of
them work better than ours. [22.8s] But that's so what happened there. It's like prices
would ratchet up, insurance premiums would ratchet up. In the 60s, Lyndon Johnson was
president. And everyone's been noticing like this thing of health insurance coming from
where you work. That's cool if you're a working-age adult and have a job. But like, I don't
know, there are exceptions to that, like, say, people over 65 or people who are super poor.
And so we get Medicare and Medicaid. Now more people have insurance. And this
unfortunately, even there, it's like it's not just the third parties that have a profit motive.
Now, the government is a third party paying and it's also susceptible to to doctors and
hospitals and everybody else being like it just costs more this year. Sorry. So that's a big
deal. And then, you know, my my impression is that the way the way this is, the kind of
folklore is it's been passed down to me from very smart nerds. The next thing that happens
is like it's somewhere in the 80s, people start noticing that the compound interest has been
adding up. And this thing that was like adds a dollar or two in 1950 and it's 10 in 1951 is
now like one hundred dollars and like, holy crap, this is really adding up. And so now what
we're living with now is like 40 years of attempts to patch like, oh, the the incentive isn't
aligned right. We've got to have, like, managed care. How about this? I know your health
insurance premiums have been going up and we're starting to see these co-pays are
heard a little bit. How about this? We have a system where you go to one doctor, they're
your primary care doctor. They decide what you need. You don't pay anything has that. But
like on the back end, to make that work, we're building all these controls to make sure you
don't cost us money. And people got mad about that. Everything keeps ping-ponging. And
the thing one of the things is and this is where we are now in the early 90s, we get Bill
Clinton and Hillary Clinton decide to propose like, oh, how about a fix for this? And what
happens is essentially like what happened in 1948, except they're not proposing universal
coverage, they're just proposing some kind of elaborate patch. Is that the American
Medical Association, the American Association of Hospitals, all the big industry groups, the
big players all out of there like no thanks. That sounds like it's going to be a losing
proposition for us. There's going to be winners and losers and we don't want to be losers.
So that's what we get. And we continue to like, you know, when Obamacare passes, one
of the key lessons that team learned was like, we can't let this evolve in a way where any
of these big players, insurance, hospitals, doctors, pharma, see themselves as the losers.

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We can't let any of them decide that they're going to outright oppose it. So Obamacare is
built in a way that just just tries to balance it. And it's partly because partly because those
folks have lots of money to run TV ads, but also because they make a lot of political
contributions. They make a lot of campaign contributions. They spend a lot on lobbying.
According to one study I've seen, they spend as much on lobbying or more than any other
sector. So they have influence.

Beth So it sounds I mean, like the way that this feels to me as like a, you know, person
who just wants to stay alive and get health care is like there are these huge interests that
all have so much money and so much power fighting with each other over what care I get
and what I pay for it. And I have no control over it. There's like the government, there's the
insurance companies, there's the hospitals, there's, you know, the employer who is just
negotiating with the insurance company. And like, do we have any control? Like, how
much control do we have over what we are paying and what we're able to access?

Dan Weissmann Yeah, not nearly enough, right? I mean, you just said it the way I think
about it is, you know, when you need health care, it's like going to a casino. Except except
it's not a casino you get to choose whether to go to. And it's not a casino where you can
ever win. It's just a question of how much you'll lose. And it's you don't get to choose what
games you play. You can't just be like, I got twenty bucks in the slots you walk in, they take
your wallet in your passport and they're like, here, come over to this table and a table
where the World Series of poker is being played. And just like you said, you're being
played, the other players are the big players, the hospital's pharma insurance. Maybe the
government's in there to whoever else and they are all playing against each other
ruthlessly. And your chips happen to be on the table and they'll take as much or more than
you have because they see themselves as just playing against each other. And you
are—and, you know, this is a very this is like very exotic version of poker with its own rules
that they wrote very much. These are super, super, super good friends with the dealer. And
they're on all the committees that modify the rules. And like...you just sat down there and
you're sick!

Beth And they have all your chips.

Dan Weissmann Like you're not. Well, yeah. Yeah. You know, it's like you have, you know,
Covid or God forbid, cancer or whatever else. Like you're not you're not at your at the top
of your game with like the most time and resources to actually, like, figure out what the hell
is going on. So, no, I mean, like, we're screwed. It's like we live in hell. Yeah. For sure.

Jordan We have to try to be practical on his podcast.

Dan Weissmann Absolutely.

Jordan So here's here's what we're going to do next. OK, so we have this unwieldy
patchwork of a health care system and that puts the onus on us to try to find hack's and
ways around it to potentially maybe negotiate our bills or find workarounds that work for us
as customers and as people who need health care. Can you describe...Let's first talk about
those people who have a job that offers them insurance and you get to choose your health
insurance plan. But there's a bunch of plans and it's always that gamble that you feel of
like should I plan on paying a lot of money on the gamble that I will get sick? Or should I
plan on being the more conservative chooser and choosing potentially less coverage and
just hoping that I stay fine. Do you have any advice on choosing health care plans and
what people should take into consideration to make the best choices for themselves?

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Dan Weissmann One hundred percent. And and it's I mean, it's it's a super gamble. I,
[00:16:55]I talked with an economist who studies like how people choose health insurance,
and he found that he had a whole data set of people's choices they'd made who had a lot
of choices and most people chose wrong. And then he would set up like he could you
could tell from the choices available that some some other plans available were just
objectively worse for everybody. And they got chosen most of the time, which is bad. It's
bad. It's bad. And that's us. [25.1s] Right. Then he would like...That was like a natural
experiment. He like set up experiments where he gave people, you know, bring people in
like, hey, let's pretend you're choosing your health insurance. Here are the choices. What
do you choose? And he would set up and people would choose wrong. So the first thing
he was like, well, do people understand the terms and the math? Like, what's the
deductible? What's a copay? What is coinsurance? That's a tricky one on our quiz.
Coinsurance is when it's like co-pays. When you go to the doctor, they're like, it's 20 bucks.
Coinsurance is when you go to the hospital in, they're like the insurance is like, "We'll
cover 80 percent of that," 20 percent is your coinsurance. Isn't that nice? I'm a co-insurer
with Blue Cross. I'm a colleague with them. So so it's important to understand that. And
then right then you've got to do the math. And it's not just us like he would he would break
it down to like just four choices. And sometimes he would he would give talks to
economists, to health care economist and show them the choice he would give people
would be like, OK, which of these would you choose? Show of hands? And like a lot of
these economists would choose plans that are objectively bad. So, like, what does it mean
for a plan to be objectively bad? It means that it's a plan that's like worse for you if you're
well and worse for you if you're sick financially. Right. And so if you are lucky enough to
have a job with health insurance where you get choices and maybe one of them's not
worse than the other for you, there's a guy named Zach Tracer at Business Insider who
who kind of broke this down. He talked about how he chose his health insurance. And it's
the best metaphor. And he you kind of make a spreadsheet and you you run you run a
simulation, essentially, and you're like, OK, what is this look like? You know, if I have a
year where I'm well, what's my out of pocket? I go to the doctor for a wellness visit. Maybe
I stub my toe and I got it...but like whatever. Like everything's...I deal with that on my own.
What does it look like? What do I pay? And then the other scenario you run is like or
whatever normal is like for you. Right. Because maybe, maybe you have type one
diabetes and you got to pay for insulin out of pocket. You got to pay for an insulin every
month, like whatever normal is for you. Like nothing, nothing, nothing bad happens that I'm
not expecting. And the other one you run is like, what do I get hit by a bus. Right. Like
what happens if the worst and what you know, what's my downside risk basically under
this plan and then, yeah, you got to kind of choose like you. It may not you may not get a
clear answer. Like you might see one where it's like that one's a loser. So you just you're
just trying to steer yourself to a relatively sweet spot. Of course, like last time I did this,
which was last year. I mean, there's there's like extra lines. It's like, oh, here's your
pharmacy deductible, here's your pharmacy benefit. Here's your right. I mean, there's all
kinds. Here's a tier one network and you're tier two network. Right. Are the docs you see in
the tier one network where you pay less. Are they in the tier two or are they out of.
Network, you're smiling, right, because you're like, yeah, this...

Jordan We all have to deal with this like the silver, bronze gold plans and then the tiers
with it and all of it. So it sounds like the best thing approaching it is to get rid of the ones
that, you know, are going to be losers for you and try to optimize your odds for hopefully
getting the one, the best one out of the remainders, which you're never going to be sure
about, right?

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Dan Weissmann Yeah. And then, like, eat your fruits and veggies, do your workout like,
you know, get your rest hydrate. Do all the Lifehacker things and, you know, cross your
fingers, say your prayers. Yeah, exactly. Yeah.

Beth Now, are there specific red flags people can look at to know like this is a bad one
without having to spend an hour crunching numbers like...?

Dan Weissmann No, [laughs]

Beth Is that because any time there's something that looks really good or really bad, it's
because there's another line in there somewhere that that...?

Dan Weissmann Not necessarily, no. Well. So one like. No, not necessarily. Just like you
got to do the math and check it out. But the other thing is there are things that sound like
workarounds that aren't right. Like like especially if you're shopping on your own. You
don't—it's not your bosses offering you. And you're like, I'm on the Obamacare exchange.
What I do here? There are some tools for the Obamacare exchanges that can like...That
[00:21:51]in my state, Illinois, the health care gov site actually does an OK job these days.
And I've worked with it a couple of different years. And it was better last year than it was a
couple of years before of helping me figure out, filter out like this plan doesn't cover any
my doctors like that kind of thing, they're better than they used to be. And there's a there's
a tool and I don't like to endorse anything, but there is a tool called Health Sherpa. It's a
website that does a similar thing of helping you filter out Obamacare plans. So that's a
good thing. You could talk to people, though. You could call an insurance broker and they
might be like, oh, well, here's a better deal with a much lower premium. They might be
selling you what's called a non-compliant plan. It's not compliant with the Affordable Care
Act. And that is not good because, like, the premiums will be lower. But the things they're
not complying with are things like Obamacare says that certain things have to be covered.
Certain things have to be covered like, you know, maternity care, mental health, like
there's a whole list of 10 things. I don't know what all of them they are, but like you don't
want to be without coverage for all ten of those things. [63.8s] There's also things that like
pre Obamacare, you know, exist like they can say we don't cover preexisting conditions,
which basically means like life experiences. Right. Like, all of us have dings on us and
they're the things that we need coverage for. Often they might be like we have a lifetime
limit or we have a limit to how much we're going to pay for you. I mean, God forbid you run
into trouble, you know, with your body. You get hit by a bus, you are on your own. That's
bad. You don't want that. The other thing that I I've talked with the health insurance people
will offer sometimes what's called a HealthShare, which started as kind of health sharing
ministries. You know, I talked to one insurance broker was like I saw in Texas. People want
that. And I had to make a decision not to sell it because, again, it's not health insurance.
The person I talked to was like, well, yeah, I sell that, you know, it's not insurance. And I
was like, yeah, kind of like how going to the track is not a job because again, it's not
insurance, it's not regulated like insurance. The contract doesn't say like we will cover you.
It says like we'll do our best.

Jordan Yeah, yeah, yeah, absolutely. You had mentioned we had mentioned workarounds
a few times. I want to dive into those that that's what we're here for. So a couple of things.
One is, you had recently spoken on your podcast with someone named Marshall Allen who
wrote a book called Never Pay the First Bill. So I didn't realize that medical bills were
negotiable. So let's let's start there. Our medical bills, our hospital bills negotiable?

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Dan Weissmann Maybe, you know, if you're smart and lucky and and it works out for you.
But what I've been I mean, Marshall Allen is great. We've talked a bunch of times. And so,
yeah, I've been learning a lot. I spent a lot of last year exploring this topic. Like I kind of got
into I started out with this show thing, like it's going to be like, you know, like Planet Money,
but for health care and a little bit ticked off. And after doing it for a year or so, I was like,
you know, we really have to focus on self-defense because we're very vulnerable. And
during that next season, we focus in self-defense. I was like I talked to somebody who
was, I called a medical bill ninja who's super good at, like, finding the workarounds. And I
was like, we should start a dojo and we're still working on what that practically means. But
I spent a lot of last year once we got past like the like, oh my God, what is covid mean,
we're going to have to all pay, but really talking to who were who were good at like
wrangling. Right. Like a guy like our guy who hates the health insurance world and just
does everything he can for people he works with himself to kind of push back. And we
talked with a woman who he had learned from who worked for a health insurance program
for twenty five years for a very unusual job was like was rank was kind of arguing with
health insurance. A woman called me who worked for the health insurance company with
tips and, you know, your your wrangling both with your health insurance company often
and with the hospital or with the doctor's office. And I would say before going into the
specifics, because there's a million of them and they're kind of overwhelming.
[00:25:47]The most helpful person I talked with was a self-defense expert about how do
you keep cool in a tough moment because you get on the phone, you're trying to
negotiate. And it's very hard. I mean, this is in some ways, the thing that I learned from
talking to all those other people was. You get on the phone and nine times out of ten, well,
one, you're on hold for a really long time, you're getting mad and you're looking at the
clock and you're wondering where you have to be. And then you end up talking to
somebody who's not going to be very helpful, partly because, like, they may not know very
much, it's their maybe their job just to get you off the phone. Right. It's going to be
extremely frustrating and keeping your self together enough to actually see it through.
[41.4s] And, you know, you could cynically say, like, this is a strategy. You know, it works
for the other side for you to be pissed and decide it's not worth it and give up and just pay
or just live with it, whether it's a strategy or whether it's, you know, the way of the world,
whether it's incompetence or entropy or whatever, like it is what it is for us. [00:26:47]And
so I found the most important thing is to kind of have a strategy. And I know that you guys
have talked on the show about like having a negotiating strategy. This is key. And the
self-defense expert, because self-defense is not just hitting and kicking, right, it's kind of
learning to stick up for yourself and in all kinds of situations. And what she said was, you
know, you your strategy is, I'm quoting her to remain calm and confident while still being
very assertive and persistent. [29.3s]

Jordan I like that.

Dan Weissmann Yeah. She says, you know, [00:27:20]"It doesn't mean you have to feel
great about what's happening or you aren't upset about how people are treating you. It just
means that as a strategy, you're choosing to use this persona, this calm, confident,
assertive, persistent persona to try and get what you need." [16.4s]

Beth So can you tell us a little bit about what are some of the things you can get, like, if
you like, get this massive bill and you're like, oh, my God, I don't know how I'm going to
deal with this? Like, what are the things you can ask for and who do you ask for them?

Dan Weissmann Right, right. And this is...So now get ready to be overwhelmed. Right.
Because the to do is like keeping yourself grounded, like she had specific tips for, like, OK,

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if you need to, if you get overwhelmed, like again, you take maybe you pay attention to
your breath, maybe you ask yourself, what are five things I noticed in the room that I'm in?
Maybe you say a little prayer like this is super important to do that. Now get ready. There's
a lot. [00:28:15]So you get an enormous bill and your insurance looks like they're thinking
out on you a whole lot. What do you do? OK, let's see if we can remember all the steps,
one is call your insurance company about the bill to make sure that they actually recognize
what you're seeing as legit. In other words, your insurance company will send you should
send you what's called an explanation of benefits. [19.1s]

Beth That's the thing that says this is not a bill?

Dan Weissmann Right. It says, "this is not a bill." And it should line up with the bill that
you have. And every line item on that bill should be represented somewhere.
[00:28:44]And that explanation of benefits and it should say like, well, the hospital wanted
to charge you X, we talked him down to Y, we paid Z, you're on the hook for X, Y, Z, and
you want to first like, OK pour yourself that drink or that extra cup of coffee or five hour
energy or whatever it is, and like get that stuff, go through it, see if it lines up, if it doesn't
line up, you know, one call your insurance company and be like, "Hey, uh, they're billed me
for X. I don't see that they necessarily billed you for any of this." And if they're like, "we
didn't get a bill," like you can—Marshall Allen has this very tip, like, call the provider back
and be like, "hey, looks like you didn't bill my insurance." [34.5s] So that's one. And this is
like a maybe you got lucky in this way, right. And that maybe you got the information and
maybe you call them and maybe they the providers like, oh yeah, we'll do that. OK, then
you just you just one great. You can go home but we're not done yet. [00:29:34]You got to
call them and ask them for an itemized bill which you're entitled to it. You may, they may
send you a you like you went to the E.R. and I just got a bill with one line. I'm like, pay us
this much, OK? No, you can call them and be like and they are obligated to give it to you.
Although again, you may have to have this calm, confident, assertive, persistent persona
to get it. But you get this itemized bill. One person I've talked to says when she does this,
the bill gets reduced right away because she thinks they're embarrassed to show you that
they charged you thirty seven dollars for a Band-Aid. [30.0s] I haven't seen that happen,
but like, whatever worth trying. So that's another thing you do.

Beth Is that the same thing as a Super Bill?

Dan Weissmann Yes. [00:30:12]People call it a Super Bill. Right. With the Super Billl, with
the itemized bill, with all the charges on everything I'm being charged for and obligated to
give it to you. [8.2s] So now you have the Super Bill, you got this we have this garden of
forking paths. All right, here's one thing you can do. [00:30:28]If you've been seen at a
hospital, you can look at their charity care policy. If it's a nonprofit hospital, they are legally
obligated to have a policy for charity care where they say we can get financial assistance
on a sliding scale. And one thing that's interesting, I mean, hospitals are all over the map
about who qualifies for what kind of assistance. Some of them are extremely stingy. Some
of them make it hard for you to get the charity care policy and some of them are more
forthcoming and more generous. And in some of them, at some places, the charity care
policy includes income ranges that you might not expect, [30.0s] partly because they know
lots of us have super crummy insurance if we're insured at all, and we might have a
deductible, that's five thousand dollars or more. And that's not the kind of money a lot of
people have in their pocket. And they know that like trying to squeeze blood from a stone
is a crummy business model. So they'd rather write it off on the front end. If you can
negotiate it with them, then chase you for it, spend all their resources chasing you for
making your life miserable when you still can't pay it. Right. So that's the thing.

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[00:31:30]There are other cases where you can call them if it's a doctor's office or a
hospital and there's a human, you get to a human being and you can just say, like, "Hey,
you want five thousand dollars for me, that's really not going to be realistic for me. It's
going to be a giant hardship for me. I don't want to be in some dance with you for the next
bunch of years where you're spending resources chasing me. What if I gave you two
thousand dollars right now? Could we settle this?" [21.5s]

Beth And they'll say, yes?

Dan Weissmann I mean, sometimes. I mean, it's like, yeah, we're in the casino. We have
no idea what's going to happen. But, you know, don't ask don't get right. [00:32:02]This is
this is like, you know, when you talk about like, how do I ask for a raise? It's the same
thing. Like it's a negotiation. You lay your cards on the table, you adopt the persona that
you think is going to win for you. You have a strategy. And one of the pieces of persistence
is if you get overwhelmed, you know, because it can be overwhelming. You can say—this
is from our self defense expert—you can say, "I'll call back later." Right. You can just end
the call and start over with somebody else. [24.4s] And I heard this from people on the on
the call center and to of like, you know, "if you get one of my colleagues who's a real jerk,
hang up and call back, you might get me. I'm here to be helpful." So there might be a note
in the file that says, like you called and hung up on my colleague and I'm going to be like,
great, good for you. Yeah. So so you wanted. Yeah. You got to just take care of yourself. I
mean, the H.R. director who who fights these things all the time was like, "Look, I tell
people come to me after you've called the insurance company three times because the
first three times are kind of reconnaissance, you're trying to get a sense of like how do they
even see this?" You know, again, when you talk to—you've talked to negotiation experts
who will tell you like get a sense of what the other side's values are, what their perspective
is. And it's the same thing here. It is a I mean, sometimes things work fast and but a lot of
times they don't. And so having a strategy, part of your strategy for yourself is like being
able to know that you're going to persevere. Even if things don't go your way right away,
you're going to be able to stay calm and grounded in some ways is the most important
thing, which is, again, extremely hard. Right? Like, it's not easy. Most of us are not dripping
with time and extra patience. We've been living through a pandemic. The climate is
changing. Our politics in this country are upsetting or terrifying. I think that's the range,
depending on your disposition. You know, it's really it's not a great time. And maybe you're
sick, you know, or you're extremely worried about a sick, loved one. So this is not a small
ask, but this is what you've got. The health care world is that next door neighbor who
boards dogs and lets them bark all the time and lets them out at 11:00 p.m. and shouts,
"Go poop, go poop!" And doesn't care if they bark at you while you're in your driveway or
maybe things like, "Oh, Otto, don't bark at them like that." And you're living with them and
you bought this house and they're impossible to talk to you like the health, the world of
health care is that neighbor like we're living in hell. But so, like, what are we going to do
about it? What are our strategies? What do we really have?

Jordan One of the strategies that I've heard and you can confirm if this is actually real or
not, is that [00:34:43]there are magic words that people can say before receiving health
care that would sort of constrain some of what the hospital could potentially charge you
after you've received that medical care. So, you know, saying, like, "I consent to, you
know, receiving medical care up to twice the cost of Medicare or something..." [17.0s]

Dan Weissmann Very good. You've got it. Yes.

Jordan OK, is that a real thing?

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Dan Weissmann Well, it is a real thing and it may or may not work.

Jordan That seems be the theme with most of these...With most of our strategies for
dealing with our health care system. It's like it's worth trying because closed mouths don't
get fed. And if it works out, then great. But if it doesn't, then at least you took the shot.

Dan Weissmann I think that's part of it. And I think it's also it's I think of it as the
self-defense strategy of like, my job is to survive and take care of myself. I got to learn how
to do what I'm going to do and I'm going to adjust my strategy, not just my strategy, you
know, one way or the other, I'm going to survive this. And I want to be I want to train myself
to have good approaches and accept that I live in a world where I don't always win. So,
yeah, Marshall, you memorized the thing that Marshall tells us to memorize, which is
[00:35:49]"I agree to pay reasonable charges up to twice the Medicare rate." Medicare
pays rates that's set by the government. They tend to be lower than what BlueCross
BlueShield takes, but it's a standard that the hospital accepts all the time. So you're saying
I'll pay twice Medicare? That's a reasonable standard. That's the good news. [16.1s]

Beth So where do you say that? Like, do you say this out loud when the doctor walks into
the room?

Dan Weissmann Now, here's where. Right. Yes. Where do I say that? Yes. [00:36:16]If if
you show at a place and they hand you a paper form that has a paragraph, it's like, "I
agree to pay whatever the hell my insurance doesn't happen to pay that you're charging
me," then cross that out and write the magic words and sign and initial it. And if they don't
hand it back to me, like, sorry, we won't accept it. You have to sign it as is. Right. They
may be like, screw you. We're not going to accept this unless you done it is OK. You tried.
You took your shot, you wrote on it. I mean, you can also in Marshall advises, I think it's
smart, like take a photo for your records, like even before you hand it back to them. Right.
Like I, I made this offer. That's good. That that's that's a step you can take. [40.5s] If
they're handing you a tablet with the gobbledygook on it, what are you going to cross out?
What are you gonna do. You don't you don't get your shot there. So and maybe you write it
and they take it and they're like, yeah, no, no, that doesn't count. So like it can work. It's
again, as you said, like quiet mouths don't get fed. You miss all the shots you don't take,
take the shot. It's probably better than, you know, throwing salt over your shoulder.

Beth So are there things you can do even before you get to that point? Because one thing
that also drives me nuts about our health care system is like, you can know that you need
to get a surgery and you can have, you know, potentially options for where to go. But like,
how do you even know what it's going to cost? Like, especially when you're deciding, like,
do I even want the surgery now? Can I afford it this year? Should I put it off till later? Which
hospital should I go to? I know that there have been some recent laws that are supposed
to increase price transparency. I also know that they're not working very well. What can
you tell us? Like, can you shop around for care? Can you even know ahead of time what
you're getting into?

Dan Weissmann Sometimes. Sometimes, yeah. The federal requirements around price
transparency. Yeah. As you said, are not working. Well, people who care about this stuff
have been scouring the Internet. They're supposed to post everything and most of them
don't. So far, one reporter in California actually tried shopping between two providers for
like certain things that are supposed to be spelled out explicitly in all these places. And
these places had technically complied with the policy. And he just I mean, he was just in

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miles of spreadsheets. It was impossible to figure out. So that's probably not going to work.
However, [00:38:33]here are a couple of things you can do. One is for certain things you
know, you're going to need. There are alternatives like, say, an MRI. [6.5s] I talked to a
woman who has been living with brain cancer for ten years and it's been in remission for a
long time. Every six months, she gets an MRI. She changed insurance and she asked,
like, where do I go? You go to this hospital, they're the best at this. And she went there and
she got the bill and it was sixteen hundred dollars. And she was like, "well, that's before
insurance, right?" And the answer was like, "No. That's your share after insurance," the
theoretical price was like ten thousand dollars for an MRI. And she was like, that's
unacceptable. She went and, you know, asked around, looked around and she found there
are places that she calls MRIs R Us. And she found one of them. And she went there for
she called her doctors like, could I go to this place? The doc was like, yes, you could. She
went there. She walked in. She had her scan. She walked out there like, that'll be ninety
dollars to you. And here's to freshly baked chocolate chip cookies. So that's the thing. I
mean, you can shop around, I mean, now you're though in this kind of shopping world and
it's like buying in a mask on Amazon. It's like weight or anything. And it's like, what are the
reviews like on this? This is our place. I got to compare all of them and see who's had a
crummy experience. I mean, which is true elsewhere, too, right? You don't know that the
hospital that your friend went to is going to give you a good experience. But it's you know,
I'm not really Mr. Sunshine here, but that can work. You know, she'd say fifteen hundred
bucks every six months. That was a big deal. And you can call if you know, like you need
surgery, you can call the hospital. Some of them have desks there just for this where they
like you, give them your insurance information. You tell them what you're going to need
and they like, look it up. Like, we'll get back to you day and they're like, this is what it's
going to run here. Now, that's not a promise necessarily, but it's again, like I feel like I'm
just like Mr. Doom and Gloom. Like I talked to a woman who did this and then got a bill that
was like way, way more. And she was like, "wait, you said it would be X?" They're like,
"Yeah sorry."

Beth Because they can do that!

Dan Weissmann And. Well, they can. But here's the thing. Because she had shopped and
she'd call other places and she was skeptical, she asked them twice and was all all
recorded. And, you know, I was working another reporter kind of did a print version of the
story. And then I picked up and reported interview this one for the radio. And in the original
version of the story, they talked to people who are like professional patient advocates were
like, yeah, sorry, non-enforceable. We post this to the Web and on Twitter, a lawyer wrote
back and said like, "Oh, yeah, she has a legal right here. [00:41:17]There's a principle
called promissory estoppel and detrimental reliance." And the detrimental reliance part
means, like I relied on your word that this would cost X to my detriment because you're
now charging me five X so the judge should promissory estoppel. The judge should stop
me from being responsible for any promise I made to you because I relied on your crummy
word. [23.9s] Now, that's fancy lawyer talk. And you may or may not. And you might have
to really look find a lawyer who will, like, take your case to fight it. But it's a thing one trick
that Marshall Allen and I both like, not for the faint of heart, is if your bill is under a certain
amount, it depends on what your state is. You could fight someone off in small claims
court. And that's a whole thing now, and the amount varies from state to state, maybe it's a
thousand dollars, maybe it's 10,000 dollars at a certain point, you hear your case outgrows
small claims court. But I love this. [00:42:17]If you're the kind of person who really is going
to go for it and there's a whole process where you look up what this thing costs elsewhere.
For instance, if they're overcharging you and you're like, this isn't fair and you tell them,
I've looked it up, you're charging me four times what I would pay elsewhere, that's not

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reasonable in good faith. Determine what the going rate for something is. And you said, "I'll
give you this. I'll give you this plus 20 percent," which is, you know, maybe a third of what
you're charging you. And you tell them, if I don't hear back from you with a yes on this, I'm
going to take you to court, take get a small claims court. [34.6s] Now, I've talked to people
who do this and they say, like, when I do that and I mean they do their homework, they do
it correctly, they're like nine times out of ten I hear back right away. And they're very happy
to take what I'm offering them because they're used to sending out letters saying, like, give
us ten thousand dollars and you're getting ten thousand dollars or chasing people of ten
thousand dollars. Right. That's profitable for something that maybe should cost like a
thousand dollars. That's very profitable. If I could be sitting on my desk doing that, sending
out emails and hoping to get ten thousand dollars, why am I going to spend a day traveling
to your jurisdiction to show up in small claims court on a case that I probably am going to
lose? So a lot of the time they'll fold. But like, you know, bills for cancer treatment. You're
out of luck on this one, which really, really, really sucks. But this is a thing you can do. And
the guy who from whom I essentially learned this name, Jeffrey Fox, I mean, he makes he
makes one small claims court, kind of his, like, avocation. He has a small business and
he's taken like Microsoft to court and won. He just, like, believes in sticking up for yourself.
Like if this were like a Boy Scout manual, you know, this is like the advanced wilderness
stuff. Not everybody's going to want to climb Mt. Everest, but like you could people do.

Jordan Yeah, the fact that you could stick up for yourself is just leaning towards optimism.
I like that we're getting we've gotten there. We've gotten to the point of optimism. I'm going
to give you another opportunity, actually, as we wrap up here to be Mr. Sunshine, because
the last thing that I want to ask you is what can people get for free that they might not
realize if they can get for free? Like, you can get your Covid shot for free.

Dan Weissmann Covid shot for free. For sure.

Jordan I've heard that there are, you know, that preventative care and things like that is
free. What can people get for free from from hospitals and, you know, related to their
health care?

Dan Weissmann Such a good question. Totally depends where you go. Yeah. Covid vax
is free. Covid tests, as far as I understand, are still supposed to be free for everybody. And
if you get a bill from it, like maybe fight back a little bit, I mean, places and preventative
care under Obamacare is free. Be advised that providers and hospitals love to find ways to
tack something else on. And in some cases, like you're going for your wellness visit, like
your primary care doc is getting paid butkus, like, very, very little for that wellness visit. And
anything that falls outside of the wellness visit, they may actually bill you for like. Oh, and
also my back is still bothering me. Oh, now we're now we're having a consultation about
your back. That's extra. So, like, you gave me the chance to be Mr. Sunshine. I'm not
totally, but but but here so here's here's here's the thing. I mean, I, I think I mean, I take
great hope, like we're living in hell, but we're not completely without means. Right. I mean,
this is my this is my number one thing is like like we're not all going to take some small
claims court, but like we're really not completely helpless. Like it's not always going to go
our way, but we're not completely helpless. So that's that's why there are things to do. And
I think girding yourself, you know, for just understanding that we're in hell, it's dangerous
and the things that we want, which is to be able to, like, call somebody and say this isn't
right, this is stupid, and have them be like, oh, yeah, you're right. And have it go away. It's
very, very unlikely to happen. But there are things we can do and the stakes are really
high. Right? I mean, they're coming after us for gazillions of dollars. I mean,
[00:46:13]medical debt is one of the major causes of bankruptcy. Medical debt is the

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number one reason people are in collections. It's you know, it's our credit rating. It's our
everything like this is not small potatoes. We're learning everything you can and dedicating
real time and energy to learning this and to practicing it. Like, if you can do this, you can
do anything. You can ask your boss for a raise without a problem, right? You can negotiate
with your crazy neighbor, with the dogs without a problem. Like if you can do this, this is
life hacking right here. I mean, that's that's that's how I choose to take it. Like, this is this is
these are necessary survival skills that have lots of application. [37.9s] But one more thing
about what you can get for free is millions of people. Have been able to up through
mid-August, which I think probably by the time this airs, we won't be in mid-August, but
millions of people are eligible. But but it will continue again in the fall. [00:47:07]Lots of
people are eligible for free health insurance through Obamacare because of the American
rescue plan, the big stimulus bill that passed in the spring. The American rescue plan
includes a bunch of souped up subsidies for Obamacare. And although they're kind of
open to extended enrollment period for Obamacare ended in mid-August, open enrollment
is coming back around for 2022. And these souped up subsidies mean that one. Even if
you make a decent amount of money, you could look there and find that health insurance
is a lot cheaper than you thought it would be because of these subsidies. Subsidies have
gotten a lot better, but the other is the ceiling for where you could actually get free.
Insurance has risen significantly. So if you're a person of limited means, you could get a
plan that is zero dollars out of pocket for premiums and has very, very heavy subsidies for
what you would pay as these things like deductibles and coinsurance and co-pays, what
they call cost-sharing. That's big. And for millions of people can be eligible for free health
insurance. That's a very good thing. [73.0s]

Jordan That is. Yeah, that is definitely a lot better than nothing. Dan, again, thank you so
much for being on this show. So happy to have you. And thanks for the advice that you
gave to us and our listeners.

Dan Weissmann Thank you so much for having me. It's been great talking with you.

Jordan And now it's time for our upgrade of the week where we talk about that one thing
that's making a big difference in our lives. Beth, what's your upgrade this week?

Beth So my upgrade is something that I actually bought way before the pandemic and
haven't gotten to use it for its intended purpose until just recently. So I just, you know, went
on an airplane flight and I got to use my noise canceling headphones. And let me tell you,
they're great. Like, I've been enjoying them when I want to listen to music and my kids are
screaming in the background or whatever. But it really is a really cool thing to have on an
airplane when there's just sort of all that, like, background noise that you might not even
realize is there. And you put on your headphones and you're in your own little oasis

Jordan And then it's just peaceful. Yeah.

Beth Exactly.

Jordan Oh, that's. Yeah, that's awesome. That is awesome. I do have a nice pair of
noise-canceling headphones. I don't think I've ever brought them on a flight though,
because I'm normally really paranoid about taking expensive things out of my home.

Beth I am too. I have a second pair of headphones that's like my like sport headphones.
They're like—.

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Jordan Right, right.

Beth So I didn't bring both of them. I was like, I'm only going to bring one pair of expensive
headphones.

Jordan Yeah. Yeah. I basically treat expensive headphones like the president and vice
president. Like you don't keep them at the same place. You got to keep those could
separate.

Beth So, Jordan, what's your upgrade this week?

Jordan Mine, coincidentally, has to do with travel as well, and it's more related to traveling
with minors. Listeners probably know that I've had my nephews with me over the summer
and I've just recently sent them back home. They live in Texas and I'm in New York and we
bought our tickets on JetBlue dot com. And JetBlue has a policy of unaccompanied minors
being 14 or older. Have you...your kids aren't old enough to fly unaccompanied. You've
probably...

Beth No, I haven't done this yet.

Jordan Flown with your kids. OK, so so so this upgrade of the week is going to be related
to those people who are who have kids who are going to be a little bit older, sort of on the
cusp of whether they can fly alone or not, because the rules for airlines vary based on
what company you're flying with. There's not like a federal rule of, you know, 14 and older
can fly alone or 15 and older can fly alone or whatever. So we bought our tickets for
14-year-olds because they could fly on JetBlue. But when we got to the flight, JetBlue was
up, was partnering with American Airlines and the flight was through American. So we
were checking in with American. They would have flown on American and four American
Airlines that age 15 and older, which means that they couldn't board their flight. It was fine
under Jet Blue's rules. But since it was the flight was running through American Airlines, it
was not fine with American Airlines rules. So I could not send my nephews back home.
Long story short, I had to go from LaGuardia to JFK to get them on an actual JetBlue flight
so that they can fly back home as 14-year-olds on their own. So the hack here, the thing
that you'll want to think about if ever you are flying with people who are like between the
ages of 12 and 16 is you need to make sure, you know, whether they can fly if they're
flying on their own, at least if your flight if they're flying to, you know, see their grandma or
whatever, make sure that you know, what the specific airline rules are, whether they can fly
alone or not. And it doesn't count where you bought the tickets. It matters what airline
they're flying on.

Beth Jeez, that's a good hack. A good thing to know. I would never have thought of that. I
would have just checked them in online.

Jordan It was such a headache, let me tell you. And that's our show, the upgrade is
produced by Micaela Heck and mixed by Brad Fisher,

Beth Please rate us on Apple Podcasts and leave a review so others can find the show.
You can also reach us by calling three four seven six eight seven eight one zero nine and
leaving a voicemail or write to us at upgrade at Lifehacker dot com.

Jordan You can also find us on Twitter, at Lifehacker, on Instagram, at Lifehacker dot com.
That's all one word. And on Facebook, at Facebook, dot com slash Lifehacker. You can

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also find me on Twitter at Jordan M Calhoun. And Beth, what's your Twitter? It's like Beth
Skwarecki, but not the full last name spelled out. You had to abbreviate it.

Beth Yeah, it's Beth SKW.

Jordan That's right. And if you want to see Beth on Twitter, I mean, it's majority like
meathead lifting content that everyone should love. You just get to see Beth being swoll on
Twitter. It's my favorite thing. You can also sign up for Lifehacker's daily newsletter full of
tips and tricks and hacks at Lifehacker dot com slash newsletter. And you can find show
notes for this and every episode of the upgrade by going to Lifehacker dot com and
searching for podcasts. See you next week.

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