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Marshall Allen's New Book Helps Patients Navigate A Confusing Health Care System


When you head to the hospital because something isn't right, you're thinking about how to get better. But then the bills come - hundreds, maybe thousands, maybe hundreds of thousands of dollars. So many Americans are struggling to pay medical bills - unexpected debt that for some leads to financial ruin. Marshall Allen is an investigative reporter, and he's been digging through medical bills for years. He's taken all he's learned and put it in a new book, somewhat of a self-help guide to dealing with crushing and at times unfair medical charges. It's called "Never Pay The First Bill: And Other Ways To Fight The Health Care System And Win." And he joins us now. Welcome.


FADEL: So never pay the first bill - that's a controversial piece of advice. What do you mean by it?

ALLEN: Oh, it's provocative, right?

FADEL: Right.

ALLEN: And the point isn't to never pay your bills, right? I mean, that's not what I'm saying. But the principle that we have in the title is never pay the first bill until you have checked it to make sure that it's accurate and to make sure that it's fairly priced. And so those are two things that every patient should examine because most medical bills, according to people who review them for a living, contain some kind of an error. And so the way to do that is get an itemized bill. And so an itemized bill is like the receipt that you get from the grocery store. Then you can see all of those individual charges, and you can at least confirm that those individual charges actually did occur and that those are legitimate things that you should be paying for. And often what you find is that they're not.

FADEL: Now, give us the big picture here. It feels like medical bills are particularly high in this country.

ALLEN: We pay about twice as much per person in America for health care as the citizens of any other developed country around the world. And we get a lot less for our money. So we're paying way more, but think about it. We still have about 30 million Americans who don't even have any health insurance coverage. We also have probably 50 million more who are on these high-deductible health plans, where they have to pay the first 3,000, 5,000, sometimes even $10,000 before the health insurance plan even kicks in.

FADEL: You know, the last thing people want to do after a medical scare, exhausted in recovery, is to fight with their insurance companies and hospitals on the bills. But you really encourage people to take a stand and push back when they feel something is unfair.

ALLEN: I know that many people won't be able to fight back, right? This book is not saying that every single person always needs to fight back or you're doing something wrong because, frankly, many people are too sick or too vulnerable or they're working too many jobs. They won't be able to do this. But there are many of us who can fight back. And I think if they're equipped and empowered with the right tools, then they can fight back and win. And when I say win, I mean they're paying a lot less money and getting a lot better health care for their money.

FADEL: Now, you also sort of talk about this as taking a stand, as possibly changing things if more and more people make the effort to check the bill and push back.

ALLEN: Definitely. I look at this like a David and Goliath battle - right? - where we feel like we are up against giants here because we are up against giants. I mean, we're one individual person or one family or one employer, and we're supposed to take on the big hospital system in town? I mean, it sounds completely unrealistic. But when you think about it, we have about 180 million Davids who are in the same situation. And by that, I mean working-age Americans who are on employer-sponsored health plans or they're uninsured so they're self-pay patients.

Let's just say 1% of that 180 million were to fight back. And let's say they demanded an itemized medical bill, which is fair, right? And then let's say they contested inaccuracies, and let's say they identified the overcharges, the prices that are not justified. And then they contest it. And I even recommend in the book going as far as suing in small claims court to defend yourself. We would make it so inconvenient for them to keep exploiting us and to continue with their sloppy billing and their high prices that I think it would give them the incentive that they need to give us a fair deal.

FADEL: Now, the book is filled with sort of examples of people being charged too much or taken advantage of and the way they dealt with that. If you could give us an example of a person who fought back and won.

ALLEN: One case that comes to mind is a friend of mine at my church. This particular couple was being overbilled by their dentist. The woman, Jennifer (ph), had gone in for a root canal, and they overcharged their credit card by about $300 because they just didn't run it properly through their insurance plan. And they argued, and they fought. They called the dentist office. They called the biller for years and never got any traction with that.

And I told my friend Josh (ph), I said, man, if you sue them in small claims court, it costs you almost nothing to file that case. You don't need an attorney, so you don't pay anything. And if you've already identified how they're overcharging you, you already have the evidence that you need to make your case, so you don't even have to do a lot of additional research. So it also forces that dentist or that hospital that's unjustly charging you to defend themselves in front of a judge, to maybe hire an attorney at a cost of hundreds of dollars an hour to defend themselves. So my buddy filed a case in the small claims court in New Jersey. And within weeks, he was - he got a call from the attorney for the dentist. And the attorney said, we want to settle this. We don't want this to be public, and we want this to be taken care of. And so he wrote him a check, and he got the money that he deserved.

FADEL: You know, you've been reporting on the health care industry and exorbitant medical bills that people get for years during your time at ProPublica. And you find that sometimes fighting these bills can take years. What do you say to people who have a really long journey ahead?

ALLEN: You know, the subtitle of the book is "And Other Ways To Fight The Health Care System And Win." So on one hand, you can win. And then on the flip side, if you don't do anything about it, this problem is just going to continue to get worse. So I think for the people who are in that situation where they feel powerless, they feel too weak to fight, you know what? They might not be able to fight. And that's all the more reason why those of us who have the means and the ability to push back and win and overcome these things - I think we need to look at it so we're not just fighting for ourselves, but we're also fighting for all of those more underprivileged or vulnerable people who can't stand up for themselves.

FADEL: Marshall Allen is the author of "Never Pay The First Bill." Thanks for speaking with us.

ALLEN: Thank you. Transcript provided by NPR, Copyright NPR.