Negotiating Medical Debt with Dr. Virgie Bright Ellington

to us, I was elated. Oh, I'm so excited. We say we're excited about every interview, and that's not wrong. We're not lying, we are, but this one is over the moon for men many many reasons, and we are already anticipating this is going to be a fan faive because it's something that we many of us, have dealt with, our family members have dealt with, and unsure of what

to do. There's so much red tape and systems you have to be aware of, and just being equipped with knowledge can be so so helpful, and from an expert, I just cannot wait to get into this and share this with our community. Yeah, this is when everyone should listen to. Tell your wife, tell your kids, tell your neighbor, and yeah, start knocking on doors, you know, spread this message, spread the message. This episode is brought to us also by that old forgotten four oh one kid. She's old

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old four oh one doesn't know it. The service will be free forever, but you should take advantage of it while it is. So start your rollover today at Frugal Friends podcast dot com slash capitalize. Yeah, it's it's awesome. I had my mom do it. I did that for my mom. I did it for Travis. But it's not that hard. Because it's that hard, it's not just like she had other things to do. So yeah, uh so, if you want to queue up a few other episodes after this one and so these are old episodes, y'all.

So episode of forty five negotiating Tips for lowering bills uh and episode twelve how to save money on healthcare. So and there we talked about some like health insurance, healthcare sharing, preventative care. But we don't talk about this a lot because we don't have a lot of experience negotiating metal medical debt. I was able to negotiate my by some pregnancy medical costs, and so it is so easy to do. You just have to know what to say and how to say it, and you have to

know what to look for. But it's really so overwhelming and so dr Virgie bry Ellington. She is an internal medicine physician and billing expert. She's a patient advocate, practiced more than twenty years in primary care and psychiatric care, and she has been a health insurance executive and so now she helps patients understand complex medical procedures, how to communicate effectively with health care providers and avoid the financial

devastation that comes from crushing medical bills. She's the author of the What Your Doctor Wants You to Know series, and she's a wealth of information, what an amazing human being, And here we have her. So enough of us, let's get to Dr Virgie. Dr Virgie, Welcome to the Frugal Friends podcast. It is a honor and pleasure to have you on. Yeah what, ladies, It is my honor and pleasure. And I've been following you guys for a few years.

I've been on your list Serve and I'm trying to think of how many years has been, but I know it was like way before the pandemic. So when I saw you guys have a podcast, I'm like, Hey, the world is small, this is awesome. Life is good. So we're just fanning on each other, but mostly we are here to highlight you, Dr Virgie, your knowledge and experience and what you have to share with our listeners today. So thanks for being here and sharing what you know.

Thank you so much for having me. Yeah, so let's dive in. You are an expert on medical billing and medical debts, so I know the first thing people will usually get is a surprise charge on their bills. That's happened so often. How should people handle surprise charges on their medical bills? So a surprise charge, we call surprise

billing is actually a formal description. There's an actual The term surprise bill or surprise billing refers an actuality to cases in which you have insurance and you go to get care at a facility and maybe you had the option it was an elective thing and you had a knee surgery had planned, or unfortunately, if you had an emergency and you go to a facility and you know that they take your insurance when you don't have any choice of the physicians that are involved with your care.

Physicians that you have no choice in choosing, like the e er doc, the nithesiologist, the radiologist who reads the X ray of your broken to determine if your bonus broken. If you have the elective surgery, they take tissue, they send it off, anything that's taken from the human body, they'll send it off to pathology for a position to look at it under the microscope to make sure it's not it's always benign meaning non cancer as versus they

don't see any cancer cells. Those are all folks. Those are all physicians that you don't have any choice in picking. And if they are out of network, that means that they'll send you a bill for their whole full retail price and you're stuck with it. So this has been an issue because, um, there are business models. There are

there's private equity. There are corporations whose business model is to say, Okay, we're gonna hire all these docs who you have no choice in picking when you go to the hospital or you need care, and we're going to charge some full price, which is often tens and tens and and I can't explain how outrageous the numbers are when they don't take insurance, They take no insurances. That's their business model. And you go in thinking that you've done all of your research to make sure that you're

in network with this facility. But they hire physicians who are not That results in a surprise bill. So how do we when we do we have any power over that, either before or after. Yep. The great news is as of January one of this year of bill was passed.

It's now federal law where if you have insurance and you go to an in network provider and you are given sent a bill by other physicians that are involved with your care who do not accept your insurance, they have to negotiate directly with the insurance company to work out a payment. You know, workout is it going to be the in network rate that they usually pay, are they're gonna pay a little bit of a premium, whatever

it is. The patient is out of the middle. So until now, until January one of this year, there are a few states that had you know bills were in that state that you could not get a surprise bill. Uh, well, it was illegal in that state to charge patients who um you or if they're out of network, if you charge them out of network um prices. But now it's

a federal law. So that's how you protect yourself. You make sure that if you've gotten a bill from you go to get care and you've gotten a bill where it says, you know what, we're not in network with your provider, well, um, with your insurance rather, well, not my problem anymore. As a January one, you're going to put them in touch. Then they know this, The providers

know this. They have to deal with your insurance directly and leave the patient out instead of having the patient holding the bag, which has been the case for eons until now. So if you get that bill, if we get that bill in the mail and we realize this, we've now listened to Dr Verjee and we know a bill has passed and we're not responsible for this, would that just be us minding the provider of that law.

Please talk to my insurance company. Yak to my insurance come, you know, and they say, talk to the hand, talk to my insurance company. I'm out, So you know, I I really like to use this as an opportunity to talk about there's a reason why. This is the reason why there's only one right way to pay a medical bill. And that's because usually, unfortunately, I would say nine times out of ten, medical care facility will send you a bill that's not a real bill. And they do that

because they know it works. We panic, and we'll figure out how to pay this off. So I'm going to take you through the one right way to pay a medical bill. There's three steps, and in this process, um Jillian, we're going to say, Okay, you know what. By doing this process of the one right way of paying medical bill, going through the three steps, we're not going to get caught by any tricks like surprise billing. So it's the one right way to pay medical bill will protect you for,

among other things, um, surprise billing. So the one thing you want to do when you get up any medical bill is to look to make sure that it's an accurate or itemized bill. And what I'm calling now a real bill. A real bill has what's called CPT codes. CPT codes are just like bar codes, and you go into a store. Every product has a bar code, right you take that product, you run it through the scanner,

and it'll tell you. It'll identify, you know, some description of the product and the price that the facility is charging for that particular product. Same thing with CPT codes. Every single medical service in the United States has a CPT code. And I won't borry with what CPT stands for. There are people who work in the insurance company I know for years, and they can't remember what CBT and you know, it has a long name, you know, common procedural terminology, which is why we don't use what it's

called CPT codes. And I was talking to a radio host a couple of months ago and he says, you know what we should call it. I can't pay this. That's a CPT anyway. So right, so you get a medical bill and you make sure it has CPT codes at the top. You'll see CPT at the top and under it. CPT codes are usually like a five digit number describing a service. So that's what you're gonna do. You're going to first step is call your provider and

get a real bill. So what I've I've been talking about this and one of those things that's been plugging me this week, I'm realizing, you know, these bills that we often get that consumers, the American patient of public gets are just not bills. They're kind of like wishful thinking. They're like, oh, maybe they'll pay it if we send them this with no CPT codes and it has a description and that's it. You know, they think that it's

a real bill. But it's not. So first step always called to make sure you get a real bill, which is UM an itemized bill basically fancy name for a bill with CPT codes, and that takes you to the second step. When you get that bill with CPT codes, you're going to take it and google the codes to make sure that each of the codes describes the service that you think you've got. Our services that you think

you received during your stay or during your visit. Great, once you get those codes will come up as a description awesome, and you're making sure that that makes sense in terms of what you've got makause you're not getting double bill that kind of thing, or bill for something you know that you didn't get. And then you're going to take those codes and you're going to continue to google, but this time you're going to google what Medicare pays for each of those codes, for each of those services.

So Medicare is federal government meant care health care, and CMS which stands for Centers for Medicaid and Medicare Services, has a standard list of things that they pay for each CPT code. Right. The thing is is that I consider Medicare the basic flat rate, So there are a lot of people who do this kind of work, meaning trying to help people with who are struggling with medical bills, educating the American public in terms of medical financial literacy.

And they say, well, okay, we look this up, but we're going to agree to pay two times the Medicare rate, and that takes us down to step three. I disagree. I think start at Medicare started the Medicare price. That's the point where you're going to negotiate. Don't go straight to negotiation without doing the first two steps because you're being overcharged. Their retail rates are often three hundreds more

than what Medica Care pays. And so when I say, you know what, I started the Medicare rate, When I say step three, that's the number you're gonna start when you call back the medical billing department or the patient accounts department of the facility and say, you know what, this is what I came for, These are the services I got, this is what I'm able to pay. I think this is fair from my research and the care

that I received. Now, some folks likes I were saying, UM, thinks, you know, I think that two times the Medicare rate is a good place to start. And that's because if you call some of these facilities, you're going to get pushed back. And the general thought is the general pushback is, well, if everybody paid Medicare rates or paid the Medicare prices, we wouldn't be able to stay in business. We wouldn't

be able to provide care to everyone. I'm not so sure about that, and even so, not my problem, not my problem. If I have a budget which takes me to step three, and you're going to call back the provider's office, building department, patient accoun office and ask for number one an interest free payment plan that fits your budget. And this is really important because people get upset when they think about how long it's going to take them

to pay off a bill. They said, oh my gosh, it's gonna take me five years, seven years, ten years, and so what right. So the reason why you make it you're gonna get probably pushed back when you call back the department billing to partner and say, hey, this is what I'm willing to pay. You know, I need an interest free payment plan. They're gonna say, you know, well, this is a dollar bill and you know you're paying us turn and fifty dollars a month. It's just going

to take us forever to pay it off. Can you do you know? We just thiss just too that's just too little and this will take us too long to get paid. Um can you do three fifty? Uh? No, I can only do to fifty. And the reason why you want to stick with that is because if you may an agreement with the um care facility, it doesn't get reported to credit agencies, right, It's it's blind. It doesn't um impact your credit report at all, which is awesome.

But if you agree to any payment plan and you can't make a payment, they will automatically really quickly, and surprise how fast they do it. They'll send it right to collections, to deck, they'll sell it to a debt collections for pennies on the dollar. So you may say, okay, well why wouldn't May, Why would they agree to take

so little over a long period of time? And I say, the reasons why you want to stick with your budget when you're calling the facility and talking about the payment plan that you need is because, as they say, a little bit of something is better than all of nothing, right, they know it's cheaper to you know to take it, you know, instead of having to chase you potentially and or have to sell it if they have to chase you long enough for pennies on the dollar, you know,

to a collections agency. So those are the three steps for the one right way to pay a medical bill. That's so hopeful. And at the end of the day, you have already gone through the first two steps where you are equipped with knowledge, You've been able to get rid of any bills or itemized line pieces that you are not actually obligated to pay, You've lowered the rate. And then if it is still too much for you to be able to pay outright that interest free portion.

Of course, none of us like having those payments, but if it's interest free, that makes a big difference, especially as it concerns healthcare things that we need to stay alive. We're not just talking about some luxury item exactly. It's not consumer debt. And you know, the current UM administration is realizing, Hey, you know what, we need to treat it as such medical debt. Medical bills are not a choice. Student loans, at the end of the day, is a choice.

But you know, none of us has to get here, right, None of us has to be born, and once we get here, we're living creatures, and we get sick, things happen, we have accidents, and so it's not consumer debt. And I'm glad that the administration is trying to teach folks that, hey, we need to treat medical bills differently than consumer bills.

Medical debt different thing consumer debt well, and it carries so much anxiety because not only are you managing physical health problems, but also financial difficulties to depending on the amount of money that's owed and whether or not insurances covering it or you're able to pay. And so I think we've got a couple of layers here of just receiving a bill that might be overwhelming that we can't really pay, but then that can stack up to medical debt.

As you're describ I've been here, and I know even before we got on you were even beginning to talk about preventative measures. So talking about preventative but as well as maybe even reactive, because sometimes we find ourselves there. What are some of your tips when we are deep into some medical debt? What can be done? One of the things you know, I I like to, you know, remind folks about is that you know it's not your fault, and and you think that, oh my gosh, it's scary,

it's complicated. You know, I'm screwed. What am I gonna do? I'm going to have to declare bankruptcy. I can't pay this and many people have. So the first thing I tell folks is that it's not your fault, and yes, there are things you can do, so yes, go through. And we'll let me just say one more thing. The reason why we also panic is because an often panic in addition to all of this, is that this happens to us when we're at our most vulnerable, when we're sick,

in pain, being scared, afraid, unable to work. You know, whether we have insurance or not, most of us get to our our insurance or employers. If we miss enough work because of the illness or the accident, we'll lose our job in there for our insurance. So that there's so multiple, many reasons why um folks in this country get taken advantage of by the system. This you know, uh healthcare industry in our country, for profit health care

industry in our country. So what I tell people number one is to step back and if you're able to pull all of your bills, don't ignore the bills you know if you can be ahead of it and call them first, the billing department first, as I explain, and go back and ask for real bills, and a real bill has a CPT code. The other thing I tell folks is to make sure that you're not confusing a

real bill with because you're not. You're not confusing a real bill with if you have insurance and explanation of benefits or an e O B. And I've gotten multiple calls and examples of focus that I got this bill from my insurance company. No, you're not going to get a bill from your insurance company. What you received is a notice of what they paid and or what they're saying they're not going to pay, and what you're going to be responsible for, and you're gonna have to deal

with the provider yourself. So I make sure that I ask folks to pull out anything that says Usually it'll say it right across the front page and subsequent pages, this is not a bill. Those are e O B SR exclation of benefits. So pull that out and then pull out the actual bills that don't have that that's

at the top, that's not from your insurance company. If you have insurance and call the provider asked for the real bill with CPT codes, and then if it's less than two I tell people this all the time, if it's less than six months out from the services that you received, you can will go back and apply for financial assistance and in some cases even Medicaid depending on the state that you're in, you can go back and apply for medicator if your income is low enough sitting

for bills that are six months less than six months old. So that's one option. Often we're kind of in between that we're not at the point where we have to say, Okay, you know what, I have zero income, I need to consider applying for Medicaid. Most of us are in the position where we've gone to a health care facility that is nonprofit. Most of the majority of health care facilities, hospital medical systems in this country, we are nonprofit. And I stopped calling it nonprofit. I call it tax exempt

because they really have a lot of surplus. Let's put it that way, right, exactly right, So six of hospitals in the United States are tax exempt a k A. Nonprofit and in exchange for the by federal law for tax exempt nonprofit status, they provide sliding scale income based discounts to the the the public and the community that they serve. So what this means is many bills that you get if you just go to them and say look, call up the office and say, look, this is the research.

I got the real bill with CPT codes of research, and this is what I can afford to pay. And for how long you call them up and say, yeah, you know, this is what I can do. You'd be surprised that although by law they're supposed to make it post it publicly, nonprofit facilities that of what the process is to apply for financial aids. Not a lot of people don't like that term financial aid, you know, but you know they think of it as charity care as

different euphemisms, right, charity care, financial assistance, financial aid. It's all income based discounts. And if you have you be surprised at the high income you can have. If your bill is high enough, you may able to get it completely wipe off just based on your income. I've seen a bill as little as I think it was like dollars.

I don't mean little, but compared to their income. The person have like a hundred and fifty thousand dollars gross income that they showed on you know, they're there, you're gonna be asked to show documents and things, um and based on their income. Uh. And the bill, the bill was so large in relationship to their income. The whole thing, the whole bill was wiped away. Now if you had not right, if you had not been aware that you have rights, as if you went to a non profit facility,

tax exempt facility, yeah, you have, you have options. So just because the majority of health care facilities in our country are non profit, sixty five percent of them, this is an option. Now, someone brought something to my attention. They see that even for profit facilities have financial assistance programs. You know, if you don't ask, you don't get right. So always always ask. A few things are standing out to me and what you're describing here. First of all,

knowing what you can pay. Of course, once you've realized what you are actually responsible for, because sometimes they might

charge you for things you're not responsible for. But then once you figure out this is what I actually oh, going to them with a number, which is classic negotiation tip for any type of thing that we're trying to negotiate having that number, not just going and saying I don't know, what can you do and then going from there, but also recognizing that this is available to us, and there is no shame in pushing for lower rates because you might not actually have to pay that high rate,

And why why would you if if you're not able to if the organization, the company, the hospital has ability to give it to you at a discounted rate. I think the thing that stands out to me is just the time and energy that all of this takes, the know how of going through the paperwork, of finding the phone numbers, of sitting on hold, of doing the research.

And and it's worth it, and we've seen that it's worth it, but especially when you might be going through a time that is physically demanding or exhausting and you've got various medical concerns that I think that that's a it's a big deal and and I don't know if there's much that can be said or a magic wand that we can wave over that, but community hopefully someone to sit by your side as your going through all this paperwork. But yeah, there's there's a couple of liayers here. Yeah.

The most difficult about this is that this happened to us. This is done to us, not by accident, just because they know they can get away with it, frankly, and in addition, they know they can get away with it more likely because it's when we're at our most vulnerable. You know, we're sick, retired, we're scared or in pain, we're grieving, you know, And and why do they do it? Well?

It works, It works. I was talking actually with my husband who's um thirty five year law enforcement veteran, and you know, we talk about you know, laws, federal laws versus state laws, that kind of thing. And I said to him, I said, you know what, I've been going through a lot of medical bill mistakes and going through you know, looking at bills and saying, well, this is

a mistake. And if you can imagine of every medical bill and generating this country has mistakes, and if you can imagine, they're not going to be in the favor of the patient, right, They're going to be in the favor of the provider and or the insurance company. I was talking to them and I said, you know, um, it just hit me, why should consumers patients be given

bills that don't have CPT codes. If there is zero insurance company in this country that would ever ever even consider a bill submit it from the provider that doesn't have CPT codes. So why do they generate them and send them to the patient? Why do they sip? Why do they generate two different kinds of bills? One that's not a real bill. I call it a summary bill. Sometimes I'll call it a detailed summary bill. It doesn't matter. It doesn't have CPT codes. It's not a real bill.

Why generate something separate that you just send the patients if it's not the same thing that you send the insurance companies, and insurance companies you always send c If you want to get paid as a provider, you're gonna send the insurance companies bills with CPT codes, right, So why do we generate Why are why to providers health care facilities generate bills that have no CPT codes to patients because it works, and because by law there's no

law requiring them to do it. I thought, you know what, there needs to be a federal law too, and have the same bill that is sent to to insurance companies sent to the patient, just so there's no confusion, right, Yeah, And my husband's like, oh, good luck with that. Virgin know the political climb. He says, you may be able to do it state by state. He says, you can start somewhere. But I love these other conversations you're having. Go forward for another day, Go ahead and try it

years down the road. You know, something else to work on in my spare time, right right. But it is smart to realize these things because as consumers, we don't know. We don't see a ton of bills. Like, if you don't work in the healthcare industry, you have no idea you know that what CPT codes are. The huge book full of CPT code, It's like there's so many of them. There's three exactly, there's more than three hundred thousand CPT codes. And you don't have to memory. You don't have to

know any of them. You just have to know where to find it. You know, it's not you know how does it goes? Not what you know? It's you know who you know? Right well? You know, dr Google, You'll take up CPT code, you'll google it. You don't need to remember, you don't need to memorize any of them. So I use the analogy jin of going to a car mechanic. Right, so your car doesn't work, is not doing something is supposed to do, you take it to

the mechanic. Well, you don't have to know fancy mechanic words and how the car runs and that kind of thing to know number one, what you're able to pay for it. Right, you don't need to know fancy medical words and CPT codes. You don't have to have them memorized and know what they are to be able to understand what fits in your budget when you have to

pay for your care. I know, I can go to a car dealership and be like, I can't afford a car that's more than twenty dollars, and they will do you know, they will tell me what I need to compromise on to stay in my budget. And it's just not the same with healthcare exactly. That's you know, Jen, that's the exact that's the exact analogy I use. I say, you know what, when you go to a car dealership,

we know personal financial literacy. We know that if you're buying a new car, old car, you are expected to negotiate there's just basic things you're supposed to know, and you don't think that well. I don't know anything about how cars work. I don't know any fancy car terms. But I know that I want like a big car with a big engine. So I know I want a

V eight. We don't. You don't have to know how the v A works and all the little fancy things connected to it to know how much you can afford to pay to stay in your budget, to stay in your spending plan for you and your family. Some of us just want good cup holders, that's all I may. You know what I had. I didn't want to, but I had to buy a new car. Um My, my baby, my favorite Bella. It was diagnosed with the terminal disease.

So I had to let her go. So I had to get a replaced when I call her Bella junr. So when I was checking out Bella Junior at the dealership, the guy was like hey and showing me all the features everything he says, and it has a sunglass holder for your sunglasses. I was like, so done. I kept playing with this is a little things. I'm with you jillion uh. So say somebody has a medical debt that's been it's been longer than six months, and you know they've already sent it off to collections. What is a

person's move then, um? Should they? You know, it's on their credit report? How do they get it off their credit report? How do they deal with it? What's the next what's the move there? Okay? So UM, this I'm going to talk about the old UM number. So as of July one, as of last week, is less than a week old. The three credit reporting agencies UM have to they have to wipe off, remove and not report any medical bill or debt that's been paid off that's

already in collections, that was in collections. They can't report it anymore. Once you pay it off. It doesn't stay on for seven years like other consumer debt. It gets wiped off as soon as you pay it off. The other thing is is that the facilities have to wait now twelve months instead of six months before reporting it to collections or selling it to collections. So that's awesome news. I just wanted to remind us of. You know, this is something that's new. Uh yeah, yeah, good stuff. Right.

So So this next thing to answer your question, Jen refers to prior to any bills that m came up before July one, before last week. So what you would do is you really want to call and make sure that you owe that. UM put me back up if they call you. When they call you say hey, you owe this, it's in collections. You want to make sure you really owe it. So they have to prove by law. There's a federal law that's been in effects since the

late seventies. It's called the Fair Debt Practices Fair Debt Collection Practices Act that says that if you get called by a debt collector, they have to show send you documentation that you signed for the service or product. So you're gonna have to You're gonna have to go just o g on them, just old school and say hey, look sure I don't know anything about that. You need to send that to me in writing. Show me my signature where I agreed to pay for this, that I

received the service, Show me that. So if they don't show you that, they don't send it to you in writing, you don't know it. The second thing is okay, So let's say they send it to you and you owe it.

There are credit repair agencies that say, you know what, you're better off just working with let me back up, their consumer journalists and folks that you know have experience in doing this work in consumer debt, say, you know what, instead of paying it off with the debt collector, just work with a credit repair service business company because your

credit has already been beaned. So they suggest, you know what, maybe even want to pay it off because it's already hit your report, your credit report and ending your your credit number, UM, your FICO score. So some people suggest doing that UM. Others say, you know what, work out a payment plan, you negotiate with them, and you know they bought it for pennies, so you know they're going to get a little bit of something. And again, a

little bit of something is better than nothing. If you found out you did, you went through the steps, you found out you did owe it, you really if you can, if you can, this is more difficult to do to get the real bill with your signature with CPT codes that that's ideal. But if they have a signature from you and it looks like okay, yes this documentation I signed for these medical these care services. Um, if you can, I go back to step three, applying the three steps again.

If they can't give you CPT codes. Then you know with the you know the documentation that they have that you think that you really do owe you receive those services. Take it down step two, What the services you received, what prices? Medicare pays for it or you can go up to two times Medicare rate. If you're so implying to start there with your step three negotiation, say okay, I'm able to do this interest free. He's they're already

ding my credit interest free payment plan. And it doesn't matter how long it takes you stay in your budget. Don't let them wipe out your Frankly, you know Americans want to We love our nurses and we appreciate our dots. You know, they save they can save our lives, and we're grateful. But just because the facility and or the providers saved your life doesn't mean that you should destroy

your financial life and give up your life to pay them. Right, So don't give up your don't compromise or risk your ability to get to work. The roof over your head. So make sure you can make your mortgage. You have a budget, your spending plan that includes your budget, I mean your mortgage or your rent, your car payment, your ability to get back and forth to work. Medical bills come last. Frankly, you've got to make sure that you

stay with your ability to stay healthy. And if you're financially stressed, you're gonna you're not going to stay healthy. So protect your ability to keep a roof over your head, your ability to get to and from work. Pay those bills first, and then work out something that you can cover those. Um that medical debt collections, saying that you owe, but some people say, if you've already gotten, if it's already gone to collections, it's already danged your credit score.

Consider that. I'm not an expert in this and I'm not suggesting one or another, but some folks say, once it's gone to debt collectors, consider working with a credit repair agency or business company. Just yeah, definitely, if you're going to go that route, make sure it's a not not for profit, like yeah, oh that's yeah, big, thank you for bringing that up. That's that's important. So I've heard and I've I've experienced getting like a payin full discount.

Do you recommend the interest free payment plan over possibly getting a painfull discount for either a bill or a debt. That's up to you once only only only only after you've gone through the three steps. If you've done the first two steps, sure you know whatever works for you. So yeah, okay, I've done the three steps. First step, I got the CPT codes describing the services that I received. Number two, I took those codes and found out what Medicare pays for those services. And so this is a

fair price. So you go to three. Okay, this is what I'm willing to pay. So let's say that, UM, I guess sent a bill and this is not unusual. You've got sent a bill for ten thousand dollars, and you worked out the numbers, you know, did the three steps, the first two steps, and you googled up actually Medicare pays, you know, three thousand dollars for these services. Well you call them back and you say, you know what, if I pay you in full three thousand, will you take it?

This is what Medicare pays. Will you take it? If you don't ask, you don't get And then if you believe that that's what um, you've done the research, meaning you googled the CPT codes and what Medicare pays for them. Then and you believe that the actual fair number is three thousand dollars. Say, look, this is all I'm willing to pay, take it or leave it, and you know you'll give me a semi percent discount if I pay

you in full. Now. Yeah, for someone at that step two of comparing to Medicare prices, where can they go to find that information? To go back to the car illustrations, they're like, has their blue book? Actually there is a health care blue book. You can start there, but that the health care blue book looks at the prices that are paid are charged and paid in that particular region where you live, and care does a little bit of

tweaking based on regions, but not a whole lot. So I usually tell people to go to healthcare dot gov is the big one where I tell people they can start their search for the actual prices that Medicare pays for certain services CPT codes services. Yeah, so that's where having that code comes in hand. Hey, that so that's why step one call them. You know, the first step is easy, just a phone call. Yeah, you know you're gonna be on hold. You know, Well you're in front

of the TV. Just put the TV on mute and a commercial and call, you know, just and then watch and then when they come and they pick up, you know, ten minutes later, fift twenty minutes later, however long it is. You can put your TV on mute and talk to them and say, I need a real bill of CPT codes. M H nice, Yeah, you know what else I need? Every week it's it's on the same level as this conversation the week. That's right, it's time for the best minute of your entire week. Maybe a baby was born

and his name is William. Maybe you paid off your mortgage, maybe your car died, and you're happy to not have to pay that bill anymore. Tough bills, Buffalo bills, Bill Clinton, this is the bill of the week, Dr Virgie. Every week we invite our listeners and our guests to share with us their bill of the week, and we, as a billing expert, we are very excited to hear what

your bill is for the week. So my bill, actually I talk about it in my book How to Crush Medical Debt, or I call it just a crush medical debt what your doctor wants you out a crush medical debt, And I talk about it because it is a subset A great example of what we talked about at the beginning of our conversation, which is surprised bills. So surprised bills, as I said, is when you go to an end network provider and our hospital facility, but they have out

of network dots taking care of you providing the service. Okay, so that's a subset of balanced billing. Balance billing is when you go to an end network provider, meaning they accept your insurance, and they send you a bill for their real call m RSP Right, as we're talking about cars full manufacturer retail sticker price, they send you a bill for the balance between what their retail their full

price by laugh, so I don't cry. Really, um, they send you a bill for the provider send you a bill for their full price, even though they're a network of their provider. So let's say that, just to keep the math simple, say that I go get Care and the insurance pays ten dollars for this particular CPT code right, this particular service, but the providers full price is a hundred dollars. So instead of saying, oh, we're a network, we've agreed to accept whatever they pay for their members

as payment. And full. We accept that ten dollars and it is what it is. Right, they send you a bill for the balance, which is ninety dollars. Right. That is balanced billing. So the reason why that's important is, and we talked about the surprise billing is a is a type of balanced billing. The reason why that's important is because we can imagine it's if it's just you know, a hundred dollars or two hundred, never say never put

just in front of money. Right. If it's just you know, a hundred, two hundred dollars, okay, you know it's gonna you're not gonna be happy about it. But if it's thousands of dollars for the services, that that'll put you in bankruptcy land debt land really quick. Right. So anyway, so my medical bill mistake of the week is I went to a hospital for emergency surgery and I got a balance bill. They tried to balance bill me. Uh, they said, my I always laugh, I really I laughed.

I don't cry. They sent me a bill, uh six months later that had one CPT code and the rest was like general you know, so it wasn't a real bill because it only had like one CPT code describing you know, inpatient day, surgery, all this stuff. Right, So it's like, okay, this is this is interesting, this is gonna be entertaining for me. So, um, they sent me a bill for three hundred that said, well, our charges for your surgery and all this and the inpatients day

uh is three d fifty one thousand dollars. But then you put a second line in that said, um, this is quote unquote insurance adjustments slash payments of like two hundred and in sixty dollars or something, and then it says patient, third line, patient responsibility and up at the top, uh, same number patient do you know within like thirty days or something, you know, low low price of like almost ninety thousand dollars. Right, Oh my gosh, So manage, we

just help you out exactly right. So I have to say, you know, I was I was laughing because they didn't realize, you know, they're putting one over on the author of what your doctor wants you to go to crush medical debt, right, not for crush mold debt. And I was cracking up, and I had to I was. I was working from home that day and I had to just let it. I had to talk to someone, so I called my

best friend and I tell other story. I said, I just got a balanced bill for thousand dollars from this facility that was in network, that is in network with my insurance. And I'm telling her the story, just cracking up, laughing, and she finally says, you know, Virgie, You're the only person I know who laughs when everybody else would be curled up in the fetal position in the corner crying. And you know, I tell this story because it is a perfect example of why we have to educate ourselves.

We have to have medical financial literacy, just basic three steps and it'll save you literally sometimes hundreds of thousands of dollars. If I had gone back and apply the three steps, I would have called the provider, asked for CP a real bill with CPT codes for everything, and not just like I think they gave me a CPT code for like the tissue they took during my surgery and send it to the lab. They sent me a

CPT T code. They broke it out with our services and stay um three hundred and fifty one, three hundred and fifty thousand and nine nine and then CPT code for lab service mythology service forty four dollars. It was just like that. Rich. So yeah, if I had applied all three steps to that, I would have gotten a

real bill. And then I would have figured out that, hey, when I've gotten the e O B for my insurance, that the number they were actually charging me, that ninety thousand dollars was the same number that they sent the insurance company to pay. The insurance company only paid ninety thousand dollars, probably less, but you know, they figured like nine times out of ten it works, and they were going to I was sent a bill for ninety thousand dollars that I didn't owe, and they sent the same claim,

the same bill to my insurance company. So you didn't actually owe any of that. No, I owed nothing. So yeah, that's a great question. And so a year later I was talking to my best friend again about something and I said, you know, well, yeah, that's why you know I you know, I called myself the lady that got out of paying the ninety thousand dollar medical bill, and you can too. Let me show you how. And uh, she says, well, Virgie, um, by the way, she says,

you didn't pay that right. I was like, of course not. I told her I wasn't gonna pay that, and she says, well, are you sure? Like it didn't get sent to collections. They did check your credit report, your credit number, your five cost score. I'm like, who are you talking to? Like what I was like, you're you know, you're talking to the author of crushed medical debt right as I said, you know, dude, I just refinanced my mortgage last month.

My credit score, my five post score was they said it went down from the month prior UM it was now one And I was like, what I mean, I missed the snapshot. I got a screenshot and sent it to her. But apparently the month prior was eight fifty. So I said, there's no. They didn't say. It's about that's what balance billing is. It is it's she's a lawyer. She won't let me use the word contract fraud. But let's say it is UM. It is not. It is not in contract. You're if. They said, when they send

you a balanced bill. When they send a balanced bill, they the provider send a balance bill to UM members of insurance companies who they contracted with to accept their insurance sending a balance bill is breach of contract. Yeah, I mean recognizing that what is happening here with medical billing is not always ethical, and sometimes we think what's illegal is the same thing as an ethical and it's not the same thing. You so much for saying that.

I tell folks us all the time, Jillian. It's like, you know what, the these insurance companies and the providers know it's immoral and unethical, but they also know it's not illegal, and they spend a lot of money every year making sure it never becomes illegal. And it's your money they're spending lobbyists, you know, hundreds and hundreds of millions of fowlers. Yes, ma'am, January hit it right ahead.

Thanks to Dr Ergie, we are one step closer to being educated and armed with knowledge and we don't have to pay that ninety medical bill. If you all listening have a similar story to getting out of a ninety thousand dollar bill, I mean, definitely call us for both Friends podcast dot com slash bill. But if it's anything, if it's a wrong bill, if it's a double bill, it's a double bill that you like. Whatever it is, right, leave us your bill from from this podcast dot com

slash bill. Now it's time for round, the Lightning round, so we are playing. This is a little bit of wait, wait, don't tell me style. We're talking about negotiating medical bills and debt. For the Lightning round, we want to know what's your best negotiation experience in general. It can be medically related, but it doesn't have to be. Uh So, Dr Virgie, we will let you go first. What was

your best negotiation? My best negotiation is um probably and this this has so nothing to do with medical bills because I just described my best negotiations saying no, I'm not paying any of it. Yeah, this is very funny. This will this, Oh, this will be a great story for my book. But no, you're not getting a dime because you don't owe it. Nice tribe, but no cigars.

My brother used to say, probably my best negotiation is being at a tax sale a yard sale and um getting they were giving away or you know, selling a plant or something, and um, I was just talking with them and gave them, you know, a beautiful smile and they just said, hey, just take it. I was willing to pay twenty five. I would have paid whatever was a gorgeous little plant. To kind of you know, like a small tree kind of thing. And I'm like, oh,

you know what, you've been here before. They had a sale prior, couple of months prior, and I bought something. They were like, you know what, just take it. Dr I don't know that's negotiating. I think that just might be the beautiful, just the being beautiful discount that you got that I would if I could a discount, I would that would be my favorite. If I would have my old you know, the twelve year old virgie smile that wasn't so beautiful. Um, then yeah, I'd have to

come up with another negotiation. I think just being kind so you can, um, just no negotiation necessary and often with them and you know, creating relationships, so that negotiation tip is be kind and friend like friend. Sometimes it doesn't even mean to get to the combative stage. You just slash a smile and walk home with a free plan. So my my husband says that, he says, you know, um, when you're at tag sales and yard sales and that

kind of thing, you know, bundle it. You know, well I bought something already, can you throw in this or okay, well, as how much is this and you already have a couple of things in your hand and we just did this past weekend, and he says, well, will you do? I think it was like she wanted three dollars or five dollars, but then something the third item and he already had two items in his hand that he didn't hadn't asked her about the prices for and he says, well,

will you take ten dollars for all three? Just like yeah, So that's my negotiationship be kind relationships and um, yeah, bundle. What about for you, Jim? You love negotiating? Yes, I will say my biggest one has a little bit to do with relationships. Also slightly stalking. You be the judge. It was our first house and I wanted that thing so bad, and our realtor at the time very much

helped us um negotiate. But when we got under contract, they still had an open house, and I went to the open house and I like stalked it and and just made sure that nobody else wanted it. And I had talked with the flippers who were also the sellers um and just found things we had in common. One of them had went to school with my old boss, good old Greg and they and so I just made sure that once the negotiation was like done, that I really had it on lock. That was that was my

favorite negotiation experience. And it ended up being, well, we had no money at the time. We were being kind of forced out of our rentals. We had saved nothing, so we had to figure out how to get the house with little to no money. I mean, that's great when your best negotiation is on your biggest asset, your biggest expect Yeah, and we thought we paid more, but we actually made out really good, being like two kids

in their twenties getting this like fully flipped house. So that was that was my favorite, My favorite negotiation experience of Travises. And this is really the best story is that Travis sat on the phone with Sprint for six hours time to end up with two free iPhones. M hmm, that's amazing. That was money. I was time well spent for the money that was saying, But who wants to sit on a phone for six hours? Yeah? But hourly

rate how much for those two phones worth? And divide into what is he so think about his job when he gets paid, you know, break it down, divide it up his annual salary, divide it monthly, then you can divide it into his ally rate, right, and then you know, take that number, compare it to what two iPhones together at least seven hundred dollars just doesn't to make the math easy, six hundred dollars. So six hundred dollars he saved, right or got products? Services were six hundred dollars over

six hours. That was a hundred dollars. He made a hundred dollars an hour. Yep, yep. So it's crazy, and he wouldn't want to do it again, but it's it's a story. Probably I tell all the most about negotiating bills and stuff because he just I got home, he was on the phone. I left for a girls night and came back. He was still on the phone. It was an early girls knife. Yeah it was. I wasn't with you on that girl's night. No, no, so yeah it was. That was That's the best negotiation experience. It

just wasn't my experience. You learned from it. Learn at the knee of the master. That's awesome. I do learn from the master. This was something for both Eric and I. We were living in one hundred seventies square feet a tiny little trailer camper and working from home like working remotely, so you can imagine what that looked like for both of us to be working in one hundred seventy square feet.

So we needed an office space. We were looking at rentals and ended up finding this amazing renovated barn at a very reasonable rate for us to be able to

work there. Well, it was also on lots of acreage, and it looked like a perfect place to also park our r V, So we negotiated for them to allow us to park our r V on the property, use the bar, the renovated bar, and for our coworking space for the same price that they were hoping to get out of renting out the space, just like, well, you let us also live there at no cost, and they did, And you know what, Dr Virgie, it might have been some extra smiles that got us that, because we're renting

your office space, so why don't you throw in a place for us to live too. There you go. It was bundling, and really they needed someone really specific to be able to rent because they had young kids who were playing in the driveway, so they didn't want a company renting who was in and out of the driveway a lot. We were really quiet. We kept to ourselves. It's what allowed us to be able to afford the office space and still live in the trailer. So that

was probably our best negotiation. Yeah, we'll rent this space from you. Can we also live here in our army right next door. Cause they were awesome became friends, which was great. So oh I love it. I love these stories. Dr Virgie, thank you so much for joining us. Where can people get more from you and get your fantastic book. I can go to Crush Medical Debt dot com and on Thursdays on Voice America dot com at five pm

Eastern two pm Pacific. Um you can find me at the Aska Doctor What your Doctor Wants you to Know with Dr Virgie show awesome. Yes, and definitely check out your book, Crush Medical Debt. It's available Amazon and it's gonna help so many people really escape this uh, this crushing medical debt. So thank you again, Dr Virgie. Thank you so much for having me. It's been so much fun talking with the ladies. I really appreciate all of you guys do. Likewise, Dr Virgie, thanks for being here.

Oh that was I think we were both taking notes during that episode. And sometimes I take notes for the show notes and sometimes I take notes just for myself, and that was taking notes just for myself kind of episode. I have a handful of takeaways from this. I mean her just her three steps, and I think that is the biggest takeaway. Just to remember the CPT codes, the looking up the medicare rate, the calling and negotiating and and then getting on an interest rate payment plan if

I can't pay it all in full. I mean that in and of itself, that's just gold that I know. I am going to need that information. So episode exactly. Send it to your friends, send it to your family. This is going to be a really important episode because if you don't need it now, you'll need it in the future. Yeah, and I love what she You know, she didn't highlight this a ton in the episode. I know we talked about it before we press her cord.

But being proactive about it too. If we're listening in our twenties, thirties, even forties and in good health, sometimes we don't think about this and we may not have insurance, or we have insurance with a very very high deductible, and so just considering taking a look at that now, even if this is the topic of medical debt, isn't relevant to you now, making sure that you've got the insurance and good insurance and putting money aside for some

of those medical concerns so that you can be proactive rather than react. Of certainly glad to help when we are in those situations of medical debt, but if we're not, then let's take the time now to put things in place so that that won't become a crushing circumstance for us in the future. Yeah, so, thank you so much for listening. Many of you know we have a private community where we do monthly money challenges and have accountability groups, and we want to congratulate one of our members for

a big win. Um. This one's from Corey K and this was in reference to our mindset makeover challenge we did in July, and she says, I've gotten through eight of the journaling props as of right now, and I noticed how much of a fixed mindset I had about money and the opportunity to earn it. These prompts so far have opened my mind to more things about how I got to a fixed mindset about money, and they've helped turn it around to a new perspective, and I

reflect on my gratitude for different situations. I have loved reflecting on the things I have learned and quote unquote failed. Moving forward, I will be more intentional and more upfront with my gratitude for myself and others. Congratulations, Corey, you are just ripping through those questions and that challenge. That was so fun to see. Yeah, so thank you for listening. If you want to check out our monthly challenge community, head to Frugal Friends podcast dot com slash club to

see what challenge we have coming up next. See you next week or whenever. The next time is that you listen to this because we coming out two times a week now Tuesday and Friday. See You Tuesday and Friday by Frugal Friends is produced by Eric Syrian Jen. This has nothing to do with medical debt, but I am proud of myself because it just happened and it's relevant.

Eric and I are going to a wedding this weekend, and he needed a new suit because the one that he had for the last ten years no longer fits him. You know, it shrunk. He didn't get sugar. It shrunk, he said, it shrunk, I believe him. Yeah, And meanwhile, I don't have a lot of fancy clothes. I wear a lot of dresses, but they are just your classic summer dress. Usually they work for an outdoor, back, backyard wedding,

which I do find myself at a decent amount. Yeah, you know, too many dating people, and yet I did not get a new dress. He was even saying, you might want to consider cans. I'm like, no, there is something in my closet. There's there is just something in my closet. I'm gonna make something in my closet work. No one. No one's gonna care. Really, no one's going

to notice that much. Even if I wear I'd probably will end up wearing a dress or a skirt shirt combo that I wore to another wedding that this same bride and groom were at. So but you know what, it's their wedding day. They're not going to notice that I'm wearing the same thing I wore to another mutual friend's wedding. And you know, it's not the fanciest thing

and it's a wee rewear. But I have completely flipped the script from I have nothing to wear and and I need to buy something new or I want to buy something new to I do have something to wear because I've been to five other weddings this year and I found something in my closet, So I'll find something in my closet again, and I am so there you go. There's the tie end of the mindset, the mindset challenge. And we haven't he been telling me I should go get a new dress. I was like, now I've got

something in my closet. I got Have you ever remembered when anyone wore to a wedding? Ever? Even the bride? Sometimes I don't remember what the dress looks like. I have I have remembered. I'm not gonna lie. It's usually, though, when someone looks stunning and it stands out to me, and it just never look stunning and no one will. Well, attraction is a spectrum, and when I notice someone wearing something that is particularly lovely, it stands out to me. But I'm not going to be mad if I see

them wearing it again, You're gonna be delighted. Exactly. So it's happening. I'm taking something in my closet and I'm I'm stuck with it. Whether I like it or not. You get to wear it. I get to wear it. You get But that's the thing, like I don't have time to even now go go to the store, so I have to find something in my closet and I will because I have before and believe in you. Thank you, okay, Bye,