261. Save Money on Medical Bills and Navigate Health Insurance Like a Pro with Dan Weissmann

22:16Dan Weissmann:And there are, you know, deductibles and other things. Medicare doesn't mean that like you've closed the you've you've you've kind of drawn the curtain on the question of like, now I never have to pay for health care again. I have to think about medical bills again. It helps a lot. It helps a lot, but it's not free. And there's like the most surprising thing that I learned is like there's deadlines when you sign up for Medicare. And there's one of them where if you miss it, if you don't sign up within a year, I think of turning 65, you pay a penalty, like a fine every year for the rest of your life.

22:50Dan Weissmann:And the longer you miss the deadline by, the bigger it is. I mean, it's like, what, really? Really? So like stay on top of it. So that's one is like Medicare doesn't mean health care is completely free. Now, here's the other really important thing is that if you or someone you love is approaching Medicare age, they'll probably see a lot of people being like, hey, come to my free seminar. We'll tell you all about how to sign up for Medicare. That person is likely to be an insurance broker and they are likely to say, look, regular Medicare, it's super expensive. You're going to have to buy this supplement policy.

23:26Dan Weissmann:You're going to pay these other things or you could sign up for Medicare Advantage. and here I can offer you this, I can offer you this plan with like almost no premium or maybe no premium. And I can offer you things that Medicare doesn't cover at all, like vision and dental and hearing, which yeah, Medicare doesn't cover those things. So that's a whole thing. And, you know, that sounds super, super good. But here's the thing in most states, once you've signed up for Medicare Advantage, you can't, it's like a no backses thing. You can't go back and be like, actually, I'd rather nutritional Medicare.

24:03Dan Weissmann:And the reason that's important is because, well, Medicare Advantage is run by private insurance companies like UnitedHealthcare, all the people that we love so much to deal with as non-retired people with all the administrative burdens and the preauthorizations and the denials and all the time you spend on the phone with them. And this is as people who like, hopefully we're not needing a ton of medical care all the time. You know, you are signing up the oldest, sickest version of you to deal with those people if and when you're really hurting. Right. And I talked to people who are like, oh, my gosh, you know, like I developed a big health condition and like United Health Group or Cigna or whoever it was, was like, no, we don't think you really need it.

24:50and like that's me i talk people like that who are young younger and who are and i've talked about that who are on medicare advantage and they were like i can't do this like i can't i can't get the health care i need so that's a huge consideration for me is like as i you know look toward hoping medicare is there and that traditional medicare is there when i'm ready for it i hope Traditional Medicare is there because I don't want the oldest, sickest, weakest, tiredest version of myself who's the most in need of good medical care to have to engage in the kind of battles that I chronicle all the time.

25:31So what is your advice for someone navigating that? Like, how do they not get totally overwhelmed? How do they make smart insurance decisions? Oh, actually, I have an answer for this. Great. Which is, yeah. I'm like, give me answers because all of this feels so pretty overwhelming. I just want to walk into the ocean.

25:50Dan Weissmann:Yeah, at least at least at least at least for now. Right. Because this is a federally funded program. So who knows what's going to happen going forward? Every state has a program called SHIP, S-H-I-P. And what it stands for is actually a little bit different. But state is usually the S and health insurance is the P, but is the I. You get the idea. there's uh but it's basically free counseling for people who are signing up for or dealing with medicare and like counseling meaning like advice like you call somebody and i had a friend a couple weeks ago who was like hey i'm coming up medicaid you have you know what's your advice i was like get in touch make an appointment with a counselor for your local shit office and she was like will do and afterwards after she texted me she was like okay that was a two and a half hour phone call and I'm still kind of like putting myself back together.

26:41But thank you so much. Can you imagine, can you imagine like, I mean, God, saying this, I'm like, well, who the heck knows what any government program is gonna look like coming up. But to put it in the other way, like the idea that you could call somebody and get somebody who does this every day to talk to you for two and a half hours about this process and what it's like for you, what your options are, right? Because again, like you're gonna sign up for a Medigap plan. Well, there's literally an alphabet soup of those. There's like a type A, B, G, F, and D.

27:21Dan Weissmann:There's letters that are missing from the sequence. I don't remember which ones they are. And then they're each offered and they cover different things and they're each offered by different carriers. So, you know, am I choosing regular Medicare, traditional Medicare or Medicare Advantage? Oh, traditional Medicare. I need a supplement. Well, which kind of supplement? All of that. So, yeah, having somebody you can call who's not the insurance broker who's I mean, they're like, I can set you with a Medicare Advantage plan and get a commission. Right. When you do, the people at SHIP are just there to help you.

27:55Dan Weissmann:And by the way, they're also there when you're on Medicare. So I talked with a woman recently who runs one of these programs. And she's like, every year we invite seniors because one thing you never get away from working with private insurance is drug coverage. That's its own part of Medicare. There's a whole separate alphabet soup. There's Medicare A, B, C, and D is for drugs. And that's entirely run by private insurance companies. There are often multiple that offer you a plan in a given year and you got to choose among them. And every year they change. every year you got a re-up. And so, you know, she's like, people come in.

28:34I'm like, let's look at, there's a list called the formulary that says which drugs, which plans cover at what rates. And you want to pick the right one for you because otherwise life gets very hard. That brings me to - You look really tired. I'm just like, thank you first of all for doing this work. And second of all, I'm like, I am so scared to get old.

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31:18Okay. So before we move on to just general health insurance questions, we're kind of dancing around it, but like, what does happen if he is doing the thing he says he's going to do with passing the big, beautiful bill, which is that Medicare gets, is it Medicaid gets cut? Like what happens if like I, you just said this lovely public service, which is like a phone line, you can call and get questions answered. And I was like, Like, I literally had a thought where I was like, that sounds like Donald Trump's worst nightmare. Like, that sounds like the thing that he would cut first. So what happens when these things start going away?

31:57I don't know, but it's really bad. Yeah. I mean, that's all I can say. I mean, like, I have not yet heard that SHIP is being cut the way some other things have been cut. But, you know, this is year one of this presidency. So we don't know. years baby what's coming down the pike yeah call your reps that's my that's my answer to that call your reps do what you can do okay let's talk about health insurance generally because we get so many questions about it um i've done some content and some uh helping people navigate like negotiating medical bills or just like looking at their bill to see what's covered and what's not i have a video that went viral when i first started like on tiktok in like 2020 about how i went into the gynecologist and that was a routine visit, but they didn't bill it as such.

32:49And if I wouldn't have caught it, right, like it would have cost me, I think, a couple of hundred dollars. So first of all, can you walk me through what people should look for when choosing a health insurance plan during open enrollment?

33:03Dan Weissmann:Yes. You're going to look at all the plans in front of you and here's what you're not going to do. If there's any way to avoid it, you're not going to be like, what's the least amount of money I have to shell out per month for this? Note that, like, right, they all have different premiums. Set that aside for a second. Don't make that, don't just look at that and circle that one and go. Because you need to make a couple of calculations because the one that is the least out of pocket for the premium per month could cost you a lot over the course of the year. So you want to make basically two little lists, two spreadsheets, two whatever, like two columns in it.

33:38Dan Weissmann:One is, what do I need in terms of health care? What my things cost? And a normal year for me. And a normal year for you is just different from anybody else. I see this therapist every week. And, you know, if I didn't, like, that could be bad. Are they covered? Or in the case of, you know, I have type 1 diabetes. I need to make sure that my endocrinologist is covered. Or, like, I'm planning to have a kid this year. Or I need knee surgery next year. Whatever you know is your deal. What's that going to cost you? And on healthcare.gov, you can look to see like which doctors and which whatevers are a network and also at what level.

34:13Dan Weissmann:Because the other question is like, OK, there's going to be out of pocket costs. And what are they going to be for me? When is my insurance actually going to kick in? What's the deductible? Like I have to shell out this much for most things. Some like routine doctor's appointments supposedly know before the insurance kicks in at all. And that number can be like on Obamacare marketplace plans typically is in the thousands of dollars per person per year. And that's hard to get away from. But then the question is like, OK, I've paid that. Then what? Then what are my co-pays? Am I seeing someone all the time?

34:47Dan Weissmann:That's going to add up. And then there's my favorite term that I learned in making the show, co-insurance. It's like, dig me. I'm co-insuring myself. If I, God forbid, go to the hospital or whatever, this is a percentage of the total that I'm paying, like an 80-20 split, meaning I'm paying 20 percent or a 90-10 split or a 70-30 split or a 60-40 split. And again, for most of us in the kind of normal year, I'm not worried too much about that because I'm not planning to spend a lot of time in the hospital. But now you've got to look at the other side, which is what happens if I get hit by a bus this year?

35:24Right. Where does that leave me? How wrecked does that leave me?

35:27Dan Weissmann:And that's where it's like, well, that that coinsurance, 40 percent of whatever it costs to be recovered and being hit by a bus. That's a lot. So you kind of do those two calculations and then you kind of. For most of us, for most of us, we're really mainly going to look at that number for like what's a normal year look like, because that's going to be scary enough to hit by a bus year. I mean, that's going to be scary enough. Like, what do I got to shell out every month for an insurance policy that lets me, last time we did this, we did this last year. Like, we were looking at policies that were, I could pull it up, but I'm not going to because it's too awful.

36:02But like, it was too awful. But like, you know, we could save like a hundred bucks a month on this premium, but it would cost us like an extra$5 ,000 across the course of the year, just doing our normal thing. And I was like, that's not good.

36:21Dan Weissmann:We have to pay this extra money. And it's still and the total the total between the between the insurance premium and what we expect to pay out of pocket is our biggest single expense. And the premium itself, I think, is our single. It's more than our mortgage. Right. And it's going to go up again this year. So again, for most of us, thinking about the what if I get hit by a bus thing, like we just, we can't afford to get hit by a bus. But, you know, looking at the questions like, what's a normal year look like for me? That's gonna, you should do that calculation because that's what your year's gonna be and that's your budget.

36:56I think that's really, really smart is to make sure that you're not just prioritizing, okay, what am I gonna pay now? Like, what is my monthly premium versus, yeah, what are the co-pays? What are, what do I need in an average year? You keep saying hit by a bus. And like, I think that is important to think about. I'm not trying to bring the evil eye on you or anything. No, no, no. It's more that like, I think about like, yes, there's the hypothetical of hit by a bus. But there's the more real hypothetical for a lot of people listening because we have mostly women listening, which is I'm going to have a kid.

37:28And that is financially very similar to I got hit by a bus, but much more realistic. That is something that a lot of us will navigate. So that is just something I want to highlight. Absolutely. Yes. We're thinking about, oh, yeah, what happens if I get hit by a bus? But what also happens if the much more realistic version of this, which is... Spend time in a hospital. Yeah. Yeah, right, right. I'm pregnant or I have a kid. Like that's incredibly expensive. So if you know that that is something you want to do or something that might happen, plan accordingly. 100%, 100%. Yeah, and that's where it's, looking at the network is really important.

38:16It's like, I wanna give birth over at this hospital. Okay, find yourself an insurance plan that covers that hospital. It is, yeah, it is wild. I often say like, I think, you know, parents are the folks who are my kind of like target listeners in a way. By the time one, like, yeah, having a kid is most for most people who are generally healthy. It's your first encounter with like how much things really can sock you for. And they cost a lot. Oh, my God. It's insane. And I think like a non complicated pregnancy costs at least 30 to 50 thousand dollars. Oh my gosh. like that's just a normal pregnancy you haven't had to go in and get tests every week because you're having morning sickness your baby came out completely healthy and fine and didn't have to receive any non-normal aftercare like that's a lot of money and then you add just one variable in there and it starts getting more expensive it's enormous yeah and and you come out of it and now Now you've got a new human who is at risk for having, there's another body that may need care.

39:28And, you know, babies get sick. Okay. I got to keep us like, I have to keep us in actionable because that's the only way I'm going to keep us positive. Okay.

39:36Dan Weissmann:So that's my, like, you know, I, I, that, that's my whole show. I'm just like, no one would listen to my show twice, let alone once. If it, if, you know, we make the commitment to like, it's got to be entertaining and empowering and useful because otherwise like you're not coming back. Nobody wants to sign up to like want to crawl under their mattress for the rest of their lives. and listens to that again. Some people who listen to this show do, but that's okay. We try to not keep it that way because every show, every episode, I feel like we get to a point where we're just like, fucking capitalism.

40:06Okay, so if you're evaluating a job for its health insurance, what coverage or what things am I looking for? Like, I think, put yourself in 22-year-old Dan's shoes. Like, the first time he had a job, I'll put myself 22-year-old Tori. Like, what should I be looking for? What do these numbers mean? What is all of this? Well, I mean, the first, if I'm really 22, then I'm evaluating them against my parents' health insurance and what they could cover me. Yeah, valid. Very true. Okay, so late 20s. Yeah, 27, 28. It's kind of the Logan's Run scenario. You turn 26 and now it's all you. Yeah, I mean, it depends on you, right?

40:48Some people are like, I'm type one diabetic or I'm bipolar or I have other things that just require ongoing treatment, ongoing access to specialists. I can't have my life without these things. So you're looking for like, OK, what am I getting? And similarly, like I need I need there's certain medicines that I take.

41:14Dan Weissmann:I got to have them. then you are going to HR and you're saying, I need to see the policy and I need to see the drug formulary. This is a very long PDF that lists all the drugs out there and for each drug, each drug is placed on a tier. You just like tier one, two, three, four. And then there's often a tier called specialty for things that are super expensive. And it'll tell you like this drug's tier one. you pay five bucks. This drug's tier two, you pay 20 bucks. This drug's tier three, you pay 50 bucks. And again, the numbers vary depending on your policy. This drug, you pay 50 % of whatever it is.

41:58And whatever it is can be thousands of dollars. This drug is an off formulary for us. We don't cover it. So you got to get that formulary and you got to hit Control F and find your drugs. And you got to do that for every policy that's available to you. So that's probably number one. And then, yeah, you're looking at like, what are, like, again, what's a normal year look like for me? It's all this process. Like, what does it look like for me? Like, I'm going to maybe go to the doctor once next year to get a checkup because my mom bugs me. And I'm going to go to the dermatologist to get a skin check because my mom bugs me.

42:39And that's it. You know, that's it.

42:41Dan Weissmann:That's me. I'm a 26-year-old marathon runner. I'm all good. Other people, not so much. So it's just going to completely depend on you. When you first are interviewing for a job and you get an offer, are you having those conversations with HR? Are you like, can I see the healthcare plans? Me personally? Man, that would be an awesome idea. Okay. I'm trying to think about, again, if you're getting the benefits and it's like, okay you get a 401k maybe or you get this and it's like 85 health care coverage premium which i think what we offer her first 100k like the company is going to cover 85 of that like what does that mean for somebody in like very basic layman terms basically i mean i looked this up this morning um the last time this got documented was you know coming up on a year ago employer health insurance for a single person is like$9 ,000.

43:34For family, it's like$25 ,000. So it's like 85 % of that, right?

43:40Dan Weissmann:That's already, that's money out of your pocket. But it's also like, yeah, what does it look like? I mean, I'd say you want to, yeah, get as much information as you can as soon as you can. If you know somebody, I mean, and again, it depends on you. If this, and you'll know it, right? Like, you know, if you are a person who has essentially a chronic health condition where you need access to specialists, you need access to certain medicines. You don't need me to tell you this. You know this. You have chosen your you may have chosen your career based on the idea, like I got to be in a job that's going to make it possible for me to live my life.

44:14Dan Weissmann:But like so I think, yeah, it's all it's it's it's individual. But but, you know, as I've learned, like and so I think then you may be thinking about these benefits more in the question of like hit by a bus or get pregnant or, you know, have a baby, like have a big unexpected expense. Like what's the, what's the kind of downside risk of any given plan? Cause you know, if you're rather than like, what's it going to do for me? I mean, I think I can give the advice that like you want your employer to cover as much as possible. Like that is a really, really great benefit. So if you are looking, one, do they offer health insurance at all?

44:53A lot of companies don't. I think if you're doing full-time work, that should be a requirement that you have, that your company offers you health insurance. I think the second thing is figuring out when is that health insurance going to kick in? Because a lot of places say, well, you can get health insurance, but after you've worked here for three months or six months or even a year, you can't get health insurance from us. They can make you wait a year. It's not as much anymore, but I have seen it and I've gotten questions about it. I think it's less common now because people know it's insane.

45:27But they're doing that so if the job doesn't work out, they haven't paid health insurance for you for a period of time. And then I think the last thing, again, speaking as an employer, it's how much are we going to cover versus how much we expect you to cover. A more candidate or employee-friendly job is going to have... The company is going to cover more of that premium. So again, for Her First Under K, I think we're at 85%. We cover 85%. That's a pretty liberal, generous policy. That's hopefully what you're looking for. And if you're not at 85 or above, just be aware of that. It's not like I've taken jobs that we're not covering that much, but it's just something to know.

46:14I mean, I think of this a little differently, although I totally agree with what you're saying. I think of it as like, well, this is all money. This is all cash. And like, what's the like what's the premium on that health benefit? I mean, one of the thing that I think about with this is like even if you have the most generous benefit in the world and your employer is paying that twenty five thousand dollars to cover your family. That's money your employer could be paying you.

46:37Dan Weissmann:I mean, that's just cash on their budget line for you. And in a world where we didn't have this kind of horrible inflation in health care costs, because the cost of everything goes up, the price of everything goes up every year. And insurance premiums go up to reflect that. And if we weren't living in this world that was so enragingly, so outrageously expensive and continue to get more expensive, we wouldn't have to think about this. again, there was a story just last week about like, this is, this is, we surveyed employers and, you know, we think they're expecting this to be the rate of increase in their premiums.

47:16Dan Weissmann:And like 50 % or 51 % are saying like, you know, we're going to, our employees are going to have to take on some of that, but it's all just dollars. It's all just dollars. And it's all going to, even, you know, even those of us who are in jobs where it feels like our employer takes care of us, like we don't like we don't have to worry about this big system it's money out of our pockets if our employer is paying$25 ,000 for that like what would you do with$25 ,000 because that number was below$20 ,000 not that long ago and it was below$15 ,000 not that long ago what would you do with that extra$10 ,000 it's an interesting frame of reference because for me I'm like both as a now employer, but also as an employee, I'm like, I am okay getting a benefit as part of my total compensation package where I don't have to worry about researching that benefit and the coverage and wondering if like, I think one of the biggest reasons it took me so long to be my own boss and to be an entrepreneur full-time is because I had both my parents in one ear and the system and the other going like, you need health insurance, you need health.

48:25Like, that was a huge barrier to me making the right financial decision, which was quit my job, make as much money as possible, do impact driven work. But the health insurance thing was the reason one of like, only like two other reasons that I was like, I can't, I don't think I can do this. Like, it was just... What were the other reasons?

48:47Dan Weissmann:What were the other reasons? Oh, God. I mean, what if I fail? Right? It's like, it's like more of the psychological shit. But I think that that's a larger conversation about how we largely have tied in this country health insurance to employment, right? It's like those two are pretty inextricably linked. Obamacare has helped a ton with that, right? But again, we have people in office now who want to get rid of that so badly and who are trying, it seems like, every day to get rid of it. Most other countries do not operate this way. It is not you make money, you have a you have employment, you get health insurance.

49:28So I think that that is one of many problems we're talking about here where it's like it's not a basic human right. It must be earned. It must be.

49:38Dan Weissmann:And it's got to come with your job and it creates problems for employers. I mean, you're on the employer side now, right? Oh, it's very complicated. It's very complicated. And my COO is largely in charge of it. Like I don't even touch it as much. And it's so complicated and it's very expensive for us to offer. But we offer it because it's the right thing to do. Yeah. And and you're investing, right? Like a lot of your staff time, a lot of your COO's time. I imagine she's not. I hope she's not badly paid, right? You're you're investing a lot of time and labor that you're paying for in learning.

50:13Dan Weissmann:And I'm like your parents and the world were telling you, like, well, you need health insurance. I'm going to say like they maybe weren't wrong because you needed to have a kind of head of steam under you before you were ready to do what you're doing now, which is like you're now responsible for essentially sitting down at that table at the World Series of Poker and like negotiating with United Health Group and Cigna and Aetna and trying to figure out which of them is the least worst deal for you and the people you care and work with. Oh, I know. So I have so many more practical questions for you and maybe we can do kind of a rapid fire.

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52:39so little rapid fire are there red flags or common billing errors patients should double check for oh double check everything get from any medical encounter double check everything

52:50Dan Weissmann:i mean anything that looks high to you like double check it even if it doesn't look that high you're like no i guess like double check it like ask them you can always ask for what's an itemized bill sometimes you can call it the super bill that has codes on it and the first thing you do is just reality check it like, hey, I didn't get an MRI. What are you talking about? I was there. That didn't happen. That happens a lot. Some the estimates, there's no real number, but people who do this estimate, you know, like half or more of medical bills have errors on them this year. And similarly, like, do they run it through my insurance?

53:24Like my colleague,

53:26Dan Weissmann:Claire, was like working with her roommate who broke her arm and got settled with$14 ,000 in medical bills and the biggest one, 10 ,000 bucks. She like just did the due diligence and turned out like, oh yeah, I don't have an insurance statement for that one. And she called the building department. They're like, oh yeah, we never billed your insurance. We'll do that now. Great. I do feel like that one's super common of, yeah, we didn't bill your insurance or, you know, something happened. And then the other one, which I was talking about at the top was like, it was a routine procedure or a routine like annual checkup and they didn't cover it.

53:59I've also heard that if you ask questions, like let's say I'm going to my GP for a general checkup and I start asking very specialized questions, they can charge you differently. So just be aware of that. True story. Don't let it stop you from asking the questions you need to ask. But yeah, true story. So many listeners are feeling powerless when they get that massive medical bill. What steps can someone take to challenge that bill or think about paying it in a way that's more sustainable for them? Absolutely. So two things. We just talked about one of them. Reality check it. Did this happen?

54:35Dan Weissmann:Did they charge your insurance? That happens all the time. Second, if the biller is a hospital, see if you might be eligible for charity care, also called financial assistance. But it's important to look for it as charity care. nonprofit hospitals in the United States are legally required to offer charity care, which is to say, to say, like, we'll cut your bill or forgive it entirely if you hit a certain income threshold, if your income is below a certain threshold. A very common threshold is like 300 % of the federal poverty line, which is like, it turns out something like 60 % of Americans have incomes below that amount, which say most of us.

55:18Dan Weissmann:And and depending on where you live, like, you know, I talked to a listener in New York City where the hospital she went to, the threshold was 600 percent of the federal population, which makes sense. New York's a crazily expensive city. So those policies are generally public. You can look it up. There's but you can also go to a website called Dollar Four. And they're a fantastic. They've educated me about charity care. and they have built into their website, they've collected the charity care policies of like every hospital in the country. And by the way, for-profit hospitals are not required to offer charity care, but most of them do.

55:54Dan Weissmann:Maybe even all of them do. And you can plug in to their website. This is where I live. This is the institution where I was seen. This is my income. This is how many people live in my household. And hit a button and it'll be like, we think you qualify for charity care at this institution. Here's a link to how you apply. We can help you. They didn't estimate a year or two ago, just trying to add up like how much charity care hospitals could give away that they don't, but that their policies say like, you know, people are eligible for. And this is essentially using their own calculations, using their own because they're required to report to the federal government like, hey, how much how much how many bills we write off last year and how much of that money could have been forgiven through charity care?

56:42I'm scared. And the answer, conservatively, based on hospital's own estimates, was$14 billion a year. Fuck.

56:50Dan Weissmann:So see if you apply for charity care. See if you qualify for charity care. Because so many of us do. So many of us do. And it is. And as I've learned from Jared Walker and the folks at Dollar Four, like, if you're like on the edge or like you missed a deadline or something else, like, don't write yourself off. Like make a call, find out, write a letter, make your case, tell your story. People don't. And similarly, if your insurance is denying something that you need, appeal. Because most people do not. And a surprising number, although, right, I mean, appealing an insurance now can be like the worst and their reflexes say no and you don't work your weapon.

57:36It's a giant job. a good number of people win those appeals. So like basically don't take no for an answer. Don't take like, this is it for you for an answer. I talked with a guy, we were looking at how to pay less for prescription drugs. And I had one guy who was like, yeah, you want to take, when your insurance company says we're not covering this or we need you to do what's called step therapy to test out these other drugs you've already tried that don't work for you or whatever, like think of all those as suggestions. rather than a straight to now. Like we think of it as like, that's a, that's our opening offer.

58:13And I really like that way of looking at it. Yeah. Yeah. I'll echo that call about everything. And even if you don't qualify for, remind me the name of it. The charity care. Thank you. Even if you don't qualify for that, even just saying, I'm going through a financially difficult time. Is there anything you can do for me? They have so many things they can do for you. The other tip I have is that if you do have financial flexibility to pay a bill, like I remember getting my wisdom teeth out and I did not do my research and did not realize that the dentist I chose was out of pocket or out of network.

58:51And so it was$1 ,400 and I was like 24 and that was so much fucking money. so what you can do is you can say hey i can uh pay this entire bill in full right now but you're going to discount it for me because they don't know if you might default on that or might only make four out of eight payments right so they would rather take you know burden hands so if you can say yep i can pay a thousand dollars right now a hundred percent they will often take that. Okay. So you mentioned saving money on prescriptions, especially if insurance doesn't cover them well, what are some ways we can save? Oh boy.

59:35Dan Weissmann:Uh, we just, so we, we asked our listeners this year, like what, like we've talked to experts, we know some things, tell us what you know. And what I came away with was a kind of like a, like a playbook almost at like what you can do. Like you show up at the pharmacy and like, that's going to be 500 bucks. And I'm like, all right, what are some moves that I got here? And there's the easy ones, the quick ones anyway, and the longer term dig in for a struggle. The easy ones go like this. Like you're at the farm's going to be like, that's me five from your bucks. Like, oh, what if we what if what if I paid cash or is there a coupon from the manufacturer?

1:00:10Dan Weissmann:And then you're like, can you hang on a second? And you pull up your phone and you pull up good Rx and there's a couple of competitor sites. and you're like, can I just get this for less someplace else paying cash outside of my insurance? And if the answer to those is yes, then, you know, okay, cool, great. If that's gonna solve your problem that day. And like, there's no guarantees with any of this, but like a lot of the times, one of those things is gonna work, right? So you can do it right there at the pharmacy counter. If not, well, now you're gonna have some questions, right? One of them is like, oh, this inhaler is 500 bucks.

1:00:45Dan Weissmann:is there another inhaler I could use for my condition that I could get for less? And then you're going to want to think about whether and like you ask the pharmacist, but if you can get somebody at your doctor, at your provider's office on hold on the phone, you do like, OK, is this one going to work for me? Can I do this? So then you kind of investigate, right? Because your insurance company may well be like, we don't like that one. We make less money when you get it. We prefer you take this one. If this one is fine for you, great. If not, now you're in this other territory where you're gonna be calling your provider and saying, okay, help me appeal this.

1:01:27Like you and me, we think it's medically necessary for me to get this one. We're gonna be fighting with the insurance company.

1:01:34Dan Weissmann:Like let's gear it up and you can have some resources for them. And this is one of the things I learned from a listener who's a pharma sales rep. He was like, while you're doing that, ask your doctor, hey, any chance you have any samples of this medication that I can use while we're having this fight? I was like, that is wild. And, you know, there are, I mean, drug reps and free samples have like not great reputations in many ways. Like, you know, the opioid crisis is like a reason was largely driven by those kind of samples and by aggressive sales tactics. but this made sense to me. Like a lot of, a lot of doctor's offices and hospital systems don't even allow you to, don't even allow their physicians to talk to drug reps, but they could go online and be like, can somebody drop off some doses of this, some samples of this drug from my office for this patient?

1:02:28So that, I was like, that's really smart.

1:02:31Dan Weissmann:One listener, you know, went kind of, took the, the also important to know about, built a spreadsheet, you know, clocked like this is good or the price from good or X at various pharmacies near me. Like there was a couple other competitors. This is the price from them. Mark Cuban's cost plus drugs is a site that will sell most generic medications for super cheap. You pay like a$5 processing fee. But like for some, sometimes a drug that your insurance says is going to cost you 50 bucks you could get for like$5 worth checking. He put that on his spreadsheet. So some there are Canadian pharmacies that will ship to the U.S.

1:03:18Dan Weissmann:and will take orders online. There are also a lot of people operating websites that say I'm a Canadian pharmacy and will ship to the U.S. You don't want to go to any of those. So there's a website called Pharmacy Checker that actually presents you like only actual pharmacies in Canada and what prices they charge for your meds. so those are those are all kind of routes to take we we took that listener spreadsheet and adapted it and kind of like amped it up a little bit and you can download it from our site and adapt it to your needs to check about like mark cuban and canada and good rx and several of their competitors um it's a real i mean you know it's a real homework assignment and not everybody is like oh sure a spreadsheet i use those every day like up until a certain point in my life i was one of of people who's like that sounds scary um but like ours is not so bad and it's probably a good if you're if you're if you're trying to build wealth in your life it's not a bad skill to have yeah we'll link it in the description that's great thank you we've partnered with gardarx before and they're yeah it's kind of incredible how uh much you can save on just the things you need just checking to see if you can get yeah a different pharmacy or a different uh you know the not name brand medication, but the exact same thing.

1:04:37Okay. My last question for you. How can people advocate for themselves in the doctor's office, both for the right care, but also for clarity on costs? And what sort of questions should we be asking before we agree to anything? This test, this procedure, this prescription, like how do we advocate for ourselves there. Yeah, this is big. And it goes, it's, it's a little bit beyond my pay rate, I can tell you, but I do know a couple things I can say, right? One is, one is, you know, come prepared, like have your list. This is either my, these are my questions, write them out in advance, talk to them, talk about them with a friend or a loved one.

1:05:20So you really have your list and bring them in writing. And when the, when you see the doctor, you know, the first thing you say is like, hey, doc, you and me are a team. I want to make sure we do the best job we can. I got all these questions for you. So kind of just like let the, which is, which, you know, hopefully your provider will appreciate, right? I mean, you're coming in, I mean, there's all kinds of people in this world and some of them are doctors. And so you just don't know what you're going to get, but like, you know, you want someone who's going to answer your questions and, you know, make sure you get your questions answered and, you know, about things that they recommend.

1:05:52Like, I think that's really complicated, right? Like a doctor recommends a procedure. Like, I think a reasonable thing to say is depending on how, how serious the procedure is, how big a deal is like, Hey, thanks. You know, tell me about information. Tell me about what's the latest literature on this. And like, give me a minute. I may go seek out another opinion. I, this sounds like a significant decision, questions about anything they want to do for you. I mean, you can ask them, um, if they were like, I'm going to do this procedure. There's all kinds of questions. Like, how many times have you done it?

1:06:26Right. If you're concerned about like, are they the right person to do this for you? That could also lead to a question about what they do this all the time. Is it like, you know, a business model to kind of churn people through that procedure? Ask good questions. Don't commit to any like like anything else. You know, don't get sold anything in the first conversation. And yeah, you can always get a second opinion, especially if it's something big, something more serious, you should get a second and maybe even a third opinion. Okay, I lied. Last question for you. If someone is uninsured or underinsured, what options do they realistically have for accessing care without going broke?

1:07:06Yeah. I mean, one thing about charity care programs at hospitals, and I'll do this again, is that you can apply to be part of that program before you go get seen. That's great. In many cases, right? So then you become a kind of certified patient there who's all, then you're not getting bills for kajillions of dollars and calling somebody to ask, how do we knock this down? You know what you're getting into upfront and they know who you are. So that I think is the best situation. There are places, there are community clinics, like some called federally qualified health centers, some of which are terrific.

1:07:45and they offer care on a sliding scale basis. They see everybody with and without insurance and their commitment is that care is affordable to people. So if there's one near you, there are search engines where you can find that out, like see what's available. So I think those would be my top two, like the fastest things. Is there a hospital system where you qualify for their charity care program? Because they probably also run a lot of doctor's offices. You can probably do most of your care in that system. Yeah. Dan, thank you for all of this. Plug away. Where can people listen to the show? Give us your resources.

1:08:28Dan Weissmann:Thank you so much. Thank you so much. The show is An Arm and a Leg. You can listen to wherever you get podcasts. You can find our website. Our website is armandalegshow.com. And there you can also find installments of our newsletter, which is called First Aid Kit, which is our best tips for, you know, surviving the health system financially. Basically, after a few years, people were like, hey, that's really good advice. I don't have a pencil with me while I'm driving to work or doing the dishes. Could you write that down someplace? So this is our attempt to do that. All those archives are on our website.

1:09:01And we've recently, because we were able to remake our website, started creating what

1:09:06Dan Weissmann:we call starter packs that answer specific questions like help. I got a giant medical bill. What now? or help, insurance denied my claim. And these are, we've curated collections of our reporting that are our best answers to those questions. So that's our stuff. We're armandalegshow.com. Our handle is armandalegshow on most social media platforms. So you can find us there. But yeah, the podcast and the newsletter are our main thing. Everything's free. We don't charge anybody for anything because this is information everybody needs. We do, and we are powered by listener donations. So, you know, we, our, our goal is to do the most good for the most people.

1:09:47And what we found is like a certain percentage of people will be like, I'm really glad you're doing this. Yes, I will support it. Our business model and our mission are exactly the same, right? We reach more people. We help more people. More people are there to say like, yeah, I want to help out with that. So, yeah. And I know people are going to have more questions because again, this is such a personalized experience. I know that there's going to be people out here and we're like, why didn't you talk about this? Or how did you get here? And it's like, there's a literally entire show and platform for this because it is so complicated.

1:10:16We can't cover it all in an episode. So I think those starter packs are going to be really helpful for people. Thank you so much for being here. Thank you so much for having me. Thank you so much to Dan for joining us. You can check out his podcast, an arm and a leg wherever you get your podcasts, especially if you need more information. It's hard to take the entire American healthcare system and just digest it into one episode, especially when there's so many different healthcare costs and different healthcare needs. So his podcast is a great resource for you, especially as we navigate all of the upcoming changes.

1:10:48We've also linked some of the resources that Dan mentioned below, and you can go to herfirst100k.com slash sfpod to get even more of our resources. We have free guides. We have free workshops. We have debt payoff challenges. We also have our show notes that have even more resources and guides. So again, herfirst100k.com slash FFpod. Thank you so much for joining us, Financial Feminists. We appreciate you being here. We appreciate your support of Feminist Media and we'll see you back here soon. Bye.

1:11:17Thank you for listening to Financial Feminist, a Her First 100K podcast. For more information about Financial Feminist, Her First 100K, our guests, and episode show notes, visit financialfeministpodcast.com. If you're confused about your personal finances and you're wondering where to start, go to herfirst100k.com slash quiz for a free personalized money plan. Financial Feminist is hosted by me, Tori Dunlap. Produced by Kristen Fields and Tamisha Grant. Research by Sarah Shortino. Audio and video engineering by Alyssa Midcalf. Marketing and operations by Karina Patel and Amanda LeFew. Special thanks to our team at Her First 100K.

1:11:54Caitlin Sprinkle, Masha Bak-Mikyeva, Sasha Bonar, Ray Wong, Elizabeth McCumber, Daryl Ann Ingman, Shelby Duclos, Megan Walker, and Jess Hawks. Promotional graphics by Mary Stratton, photography by Sarah Wolfe, and theme music by Jonah Cohen Sound. A huge thanks to the entire Her First 100K community for supporting our show.

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