How to Manage a Mountain of Medical Bills When a Health Crisis Occurs

A health crisis can quickly become a financial crisis. On this week's Money Confidential podcast, our caller tries to conquer a mountain of medical debt while fighting for her life against cancer.

money confidential Marshall Allen

One of the biggest drivers of debt in the U.S. is healthcare—nearly a third of American workers have medical debt, and more than a quarter of those people owe more than $28,000 for medical care.

And this week's Money Confidential guest, 35-year-old Olivia (not her real name) is one of the unlucky people who owed thousands of dollars. She was diagnosed with a life-threatening cancer that required more than a million dollars of treatment—and which forced her to stop working at the same time. "It's not just paying for your health bills," she says. "I had no work and no possibility of work, and rent, and all your regular costs of living. Now I have no work, and now, I have at least 12 grand more than I'm used to paying for the year. It was a complete 'bad luck cancer' that could have completely financially wrecked me."

Olivia spent countless hours creating spreadsheets, tracking down bills, and fighting against mistakes and overbilling—such as when her doctors sent test results to an out-of-network expert to review. "All of a sudden, I'm getting these out-of-network bills because they have not asked me where they're sending this to," she says. "They just sent it, and so I started calling and say, 'No, I have specifically chosen my doctors and my care places to make sure they're in-network.' To me, it was just a dishonest move—you know what insurance I have. Why aren't you sending this to an in-network doctor to read my test results?"

Money Confidential host Stefanie O'Connell Rodriguez and financial expert Marshall Allen, author of Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win, say stories like Olivia's are far too common.

Marshall Allen, author of Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win

"People who look at these bills for a living and analyze them would tell you that they see errors in most of the healthcare bills that they look at."

— Marshall Allen, author of Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win

And that's in large part because the healthcare system is not run like any other business. "When you go to a restaurant and you order a hamburger, they pretty much have it set in terms of you ordered a hamburger and fries and drink, they bill for the hamburger, fries, and drink. And it's accurate," Allen says. "We assume that that's how things will be at hospitals or doctor's offices too, because that's become what we've come to expect. The truth is exactly the opposite. Billing errors and billing mistakes, whether intentional or unintentional, are so common."

To combat this, Allen says to ask for the cash price of any procedure, as well as getting an itemized bill, so you can look up the billing codes and make sure that you weren't upcharged for more complex treatments or charged for things you never received. Small claims court can be a powerful tool for helping you combat incorrect charges.

Patient advocates can also be helpful, especially if you're someone with a lot of medical expenses like Olivia. "If somebody has a complicated case, where it's an ongoing case, or maybe they have a child with a chronic condition that they have to deal with a lot of things over time, or maybe it's a complicated hospital stay with lots of bills where the itemized bill runs many pages, I recommend people go talk to a patient advocate," he says. "They do charge a fee. They're worth the money."

Listen to this week's Money Confidential—"I Had Cancer at 34 and Now I'm Trying to Pay Off Thousands of Dollars in Medical Bills"—for Allen and O'Connell Rodriguez's tips for dealing with medical debt. Money Confidential is available on Apple podcasts, Amazon, Spotify, Stitcher, Player FM, or wherever you listen to your favorite podcasts.



Olivia: When I got done with chemo, they said, "Please go talk to the Accounting Office. We need to talk to you about your out-of-pocket max." I was just like, "I have just been through six months of chemo. I have no hair. I have no eyebrows. I have no eyelashes, and you want to go talk to me about money right now?"

There are people that are really sick that I don't know how they're expected to be their own advocate and how they're supposed to be their accountant and follow up on health insurance.

Camila: I haven't been able to go to the dentist, even with insurance, because I know that's going to be an added out-of-pocket expense.

The unexpected bills just kind of surprise you out of nowhere and sometimes they're big ticket items, you know.

Stefanie O'Connell Rodriguez: This is Money Confidential, a podcast from Real Simple about our money stories, struggles and secrets. I'm your host, Stefanie O'Connell Rodriguez. And today our guest is a 35-year-old freelance artist and small business owner who we're calling Olivia—not her real name.

Olivia: I'm a saver, for sure. I am a freelance artist, so health insurance and retirement is not built into those plans. So I try to be very conscious of what I'm doing with my money, and I'm big into budgeting as well.

I remember my first job, I got $225 a week, and I thought I was in the money. And even then, I was budgeting those $225. But then, you start to try to do more things in life, and you're like, "Wow, $225 is nothing."

Stefanie O'Connell Rodriguez: To supplement her work as a freelance artist, Olivia started a film production business.

By January 2020, Olivia's business and her finances felt like they were finally starting to fall into place.

Olivia: I felt like I was finally getting into my stride of, "Okay. It's a freelance business, so getting some steady clients, so you're not always worrying about where the next paycheck is coming." I think as a freelancer, no matter how successful you are, you're always thinking, "Oh, the bottom could fall out at any moment." But I was finally getting to a moment where I was thinking, I had gigs lined up all the way from January through May of 2020.

I was thinking, "I really need to make an effort to travel more and to do this, and building this business is giving me the opportunity to take time off because I split my time between Florida and New York. I sometimes go a while without seeing my family. So to be able to fly home, and take some time, and call your own schedule—it's beyond money. It's a quality of life that you're looking to give yourself.

Stefanie O'Connell Rodriguez: But at the same time that Olivia was hitting her career stride, she also started to feel overwhelmed with exhaustion.

Olivia:When you're building your own business, you are just throwing everything you have into it 24/7 because in the beginning, you're the accountant. You're taking care of everything.

I was finally getting to a point. I was like, "You know what? Maybe I can start having an assistant or start having somebody take care of X, Y, and Z," because I was physically feeling really tired.

I would say for about six or seven months before January 2020 I felt tired all the time, and I took it to running your own business. I was traveling all around the country to film, and I was just like, "You know what? I'm go, go, going. I'm not taking a lot of time off." I'm carrying tons of equipment around, and I would be walking up and down the subway stairs and just be like, "Ugh, this is exhausting."

I had this cough, which I attributed to the fall in New York City when the temperature drops. So I was just like, "Oh, here's that winter cough that lingers on," but I went to the doctor. I did a telehealth thing, and they kept giving me different meds to try to get rid of it.

It would maybe go away for a little bit, and then it would come back in a different form and then I sounded like a high-pitched chihuahua. It was bizarre, and I also had this rash on my chest that would not go away. I thought I was allergic to something.

Stefanie O'Connell Rodriguez: By the end of January 2020, Olivia had been in and out of so many different doctors appointments—primary care, ENTs, dermatologists—just trying to figure out what was happening.

Olivia: I wasn't telling the dermatologist about the cough. I wasn't telling the primary care doctor about the rash because I didn't think that they were related. I just thought, "Man, I'm really going through it right now."

On January 27th of 2020, I had a shoot, and I had a bunch of equipment that I need to carry with me. I got off the elevator at the studio I was filming at, and I was basically dragging my bags on the ground, which you're not supposed to do because it's very expensive equipment. The people behind the front desk were like, "Are you okay?" I was just like, "I'm just having a hard time breathing right now." They're like, "We'll help you get your bags."

So they helped me. I do the shoot, and so I go home, and I live on a fourth floor walk-up, and I could not physically get up the stairs. I was just heaving. I ended up calling a friend who lives a couple blocks away, and I said, "I'm so sorry to ask you this, but I just don't feel well. I think I have pneumonia, and I can't get up the stairs with my equipment. Can you please come help me?"

I had an appointment with my ENT the next day. He was like, "You really need a chest x-ray. I can hear you coughing from down the hall."

Got the chest x-ray, and I was making my way back to my apartment, and the doctor called me and said, "Uh, your chest x-ray is very concerning. You need to get to the emergency room right away.

So at first being a New Yorker I'm like, "Where is the bus to get me back across town?" I was like, "Oh, here we go. The bus isn't coming. I guess I'll take an Uber and get to the ER. Okay." So to try to make a very long story short,

they said, "The pneumonia that we're finding in your chest and the fluid buildup, for someone who's testing completely healthy otherwise makes us think that something else is happening. So then, a little bit later, a doctor comes in with no game face and basically says, "You have cancer." And in my head, immediately, I'm like, "No, I don't."

So the doctor leaves after saying, "You have thymic cancer," and he's like white as a ghost. I looked at him, and I said, "Meredith Gray on Grey's Anatomy would not have told me that I have thymic cancer without giving me a biopsy or doing any kind of invasive procedure. So like there's no way." I'm in such denial.

I did have cancer. I had something called primary mediastinal B-cell lymphoma, and basically, a massive tumor had grown in my chest and had collapsed, completely collapsed my right lung and was pushing on my heart. Basically, the doctors were like, "We have to start you on chemo right away." So pretty much immediately, I started my regimen, which was six rounds of five-day 24-hour infusion, which is a lot of chemo.

And I just kept saying, "I have never smoked. I have never done drugs in my life. I am very physically active. I take care of myself." and I just kept saying, "How?" At the time, I'm 34 years old, healthy otherwise. Three different doctors said, "We call this bad luck cancer. We haven't figured out why this happens. Just basically a cell just morphs."

Stefanie O'Connell Rodriguez: Did you have health insurance at the time?

Olivia:Thank God I did. I got a real quick crash course in the American Healthcare System, and it is a doozy. I have talked to many friends along the years, because people are often making $225 a week, and one of the first things that goes for people that are healthy, they opt out of getting health insurance because they don't think they need it. I didn't think I needed it. It was my parents saying, "You need to pay for some health insurance. You need to do it." Thank God I listened to them I get my insurance through the Affordable Care Act because, again, I am a freelancer. but I mean, the second he said, "Go to the ER," I was like, "Great. What is that going to cost me?

But then, once things became serious, I was just like, "I don't feel well. I have got to get this figured out. I just can't... We'll figure out the money end." Thank God I have insurance, but I quickly learned about out-of-pocket max, and in-network and out-of-network, and all of these really fun terms that you have to pay attention to.

Stefanie O'Connell Rodriguez: But trying to figure out the American healthcare system and medical billing isn't exactly easy—especially when you're sick.

Olivia: The chemo gave me... They call it chemo brain, and I was confused a lot. At the time, before corona hit, I had an incredible group of friends, and my family came up. I have a notebook that everyone would take notes for me when the doctors came in because I could not remember what was happening. It's also a lot of information that you've never heard of before if you don't have a medical degree.

Stefanie O'Connell Rodriguez: But a few weeks into her treatment, coronavirus lockdowns started across the US. And hospitals, overwhelmed with the influx of COVID patients, changed their policies, and Olivia had to go through her treatments alone.

Olivia: So I've had to do five of my six rounds of chemo by myself, and it's awful. It's lonely. It's scary. It's one thing just going through the treatment itself. It's another thing when they're coming up to you and saying, "Hey, you need to stop by the accounting afterwards because they want to talk to you about your bills, and they want to talk to you about what's been approved and what's not been approved."

And you're exhausted. You're nauseous. I had no control over my bowel movements. Like "I'm wearing a diaper, and you want me to go talk to somebody about my bills right now? Are you kidding me?"

There's this thing where you get to ring the bell at the end of treatment, and it's like this celebration of like you're done. And the nurses gather around, and you ring the bell. It's this joyous moment of, "I'm done with chemo." When I got done with chemo, I didn't ring a bell. They said, "Please go talk to the Accounting Office. We need to talk to you about your out-of-pocket max." And I was just like, "I have just been through six months of chemo. I have no hair. I have no eyebrows. I have no eyelashes, and you want to go talk to me about money right now? And also, how did I not hit my out-of-pocket max at this point in time? Shouldn't this be done already?"

Stefanie O'Connell Rodriguez: Have you ever calculated the total cost for your care?

Olivia: Sure did. The first year was over a million dollars. Yeah.

Stefanie O'Connell Rodriguez: Do you know how much you wound up having to pay?

Olivia:I would say around $10, $12 grand, compared to over a million. So thank God for health insurance.

Stefanie O'Connell Rodriguez: Did you have to fight them at all?

Olivia: Yes. So you get all these tests, and then they have to send it off to someone else to read your biopsy, and you don't see who they send it off to. So then, all of a sudden, I'm getting these out-of-network bills because they have not asked me where they're sending this to. They just sent it, and so I started calling and say, "No, I have specifically chosen my doctors and my care places to make sure they're in-network."

To me, it was just a dishonest move of just like, "I've gone to an in-network doctor, and you know what insurance I have. Why aren't you sending this to an in-network doctor to read my test results?"

I can't tell you how many times I had to call because they always say, "We'll call you back," and then they don't.

Yeah, and I'm writing down every call, every person's name I'm talking to at the time because you have to. With anyone that you call with the actual doctors or hospitals, or with the health insurance company. You just have to do that. The health insurance company, they're in this business. So they're explaining everything to you with their health insurance jargon instead of just breaking it down into layman's terms. I had to keep being like, "So what you mean is? Is it this?" It is exhausting.

I have multiple spreadsheets of trying to figure out what I was actually billed, what I've actually paid, what's the discrepancy. Last year, I definitely hit my out-of-pocket max and beyond. So it didn't matter as much to me about running down the in-network stuff because obviously, I had bigger fish to fry of feeling better and living. But this year is a little different because I am in remission, but I'm not back to full living yet, if that makes any sense.

And I knew, "Okay. I am going to have to have at least two PET scans this year. I am going to have to go to X amount of doctors. What new insurance plan do I need to get that's going to make the most sense?"

That's the other thing that's crazy to me is you can't just call anyone and say, "Hey, how much does a PET scan cost?" Every person I called, they were like, "Well, we can't give you an exact quote because it depends on what contract the insurance company has with this specific provider, and then what discount they give you, and blabby, blah, blah, blah." I just kept saying, "Can you give me a ballpark?"

The ballparks I got were anywhere from $8,000 a PET scan to $1,500 a PET scan Then, you learn about co-insurance, and percentages.

It's not just paying for your health bills. I had no work and no possibility of work, and rent, and all your regular costs of living. Now, I have no work, and now, I have at least $12 grand more than I'm used to paying for the year.

I don't say this to terrify people, but I legitimately had no idea I was sick. It was a complete "bad luck cancer" that could have completely financially wrecked me. When this first happened, a couple of my friends, unbeknownst to me, started a GoFundMe for me. I said, "Ah, I just... I don't know how to feel about that. I don't ask people for money."

They're like, "You don't have to. We'll take care of everything, but you have to let people know that you're sick." I waited a couple weeks before I posted anything or not said anything for a couple reasons.

You don't know what's happening, first of all, in the beginning. It's just a whirlwind of, "Okay." I mean, you literally get told one day you have cancer, and then you're on the rollercoaster of biopsies, tests, chemo. I mean, it's crazy. But also, for me, just admitting the vulnerability of, "Yeah, I'm sick," and people know that part of my job is carrying camera equipment around and filming people. I don't want people to think that they can't hire me anymore because I'm sick. There are all these thoughts that go through your head.

So that GoFundMe. I am very, very conscious of how or if I spend any money currently because I don't know when I'm going to be cleared to go back out into the real world, and there are so many factors that go into that. My healing, my immune system, what coronavirus looks like. I don't have control over any of that. So I budget the hell out of that GoFundMe because I don't know how long it's going to need to last.

Stefanie O'Connell Rodriguez: How has your life changed?

Olivia:My life is truly unrecognizable from what it was and granted a global pandemic happened.

Stefanie O'Connell Rodriguez:Right. In the midst of all of this.

Olivia: And honestly, even if the pandemic hadn't happen, I was in no shape to be working. So yeah, my life has completely been flipped and turned upside-down, and I have truly been stuck in a bedroom in South Florida for almost over a year because I haven't been allowed to leave because of the pandemic and because I'm immunocompromised. But I have this true appreciation and gratitude for life because I have been given a second chance.

So that's where I'm struggling at, trying to live in each moment, and find the gratitude in each day because this was not guaranteed, but also wanting to live a "normal" life.

Stefanie O'Connell Rodriguez: Do you feel like you can have goals?

Olivia: Honestly, right now, I don't, and I don't mean it in a negative like, "I can't look to the future," but I can't look to the future right now. Of course, I have hopes, and dreams, and things, but I have realized for myself, even if the world had not come to a screeching halt, there was no way I was going to be back working in July. There's no way, and so I have realized…that was pretty devastating for me.

I do feel like things will come back. I just don't know how long that will take. So I'm just trying to stay positive, and stay in the moment, and figure it out as I go along.

Stefanie O'Connell Rodriguez: Yeah. The "in the moment" thing makes total sense to me, but it's interesting to hold in tandem from a financial perspective as someone who identifies as a saver, which is such a future-focused outlook, right?

Olivia: Yeah, and I think that's why I am budgeting this GoFundMe money because it's like, "Okay. What do you really need to spend stuff on?" because if you can save any of this because I don't know what the future holds, and there were all these other things that I didn't think I was going to need.

I needed physical therapy and occupational therapy. I just did not realize the fallout of what this would be. I just thought it was, "Okay. You get chemo. You don't feel well for a little bit, and then you're back to normal," and that is... I do feel like down the road, when I look back, this will feel like it went by in a flash.

When you're living it day to day, it does not feel like it's going by in a flash, especially when you have a global pandemic it has just been so grueling and so hard. You have to be your own everything, you know, and not for lack of people not wanting to help you.

Stefanie O'Connell Rodriguez: The burden of medical bills not covered by insurance can be a lot to manage, especially in the midst of a health crisis, as Olivia experienced first hand. But even without a health crisis, surprise medical bills can create major financial and life disruptions.

According to a 2020 survey, nearly a third of American workers have medical debt, and about 28% of them owe $10,000 or more.

This already pervasive medical debt spiked during the pandemic, as many people grappled with the health impacts of the coronavirus and the financial impacts of pandemic layoffs that for many, also resulted in the loss of their employer-sponsored health insurance coverage.

So after the break, we'll speak to the author of the recently released book, Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win for a practical peek into his guide to navigating the American healthcare system, and all the bills that so often aren't covered by insurance.

I'll never forget the $800 bill that showed up in my mailbox a few weeks after my annual physical. After working as a freelancer with constantly changing insurance coverage for years, I'd finally gotten on a great health plan and was relieved to schedule all of the preventative checkups I'd spent too many years skipping out on. But it turned out that while the primary care physician I'd gone to see was considered in-network and covered by insurance, the lab where my bloodwork was sent to be tested, unbeknownst to me, was not.

It's a story I share, not to trivialize the enormous challenges and costs of a life-changing medical diagnosis like Olivia's, but because of how often I hear stories like it. Even the most basic, standard care can create a major financial disruption in our lives, and the resulting bills can leave people scrambling.

Marshall Allen:I think you have to understand some of the basics about the way the healthcare system works so that you can understand how to fight back.

Stefanie O'Connell Rodriguez: That's Marshall Allen, an investigative journalist at ProPublica and author of the new book, Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win.

Marshall Allen:When you go to a restaurant and you order a hamburger, or when you go to the grocery store and check out at the end of the checkout line, they pretty much have it set in terms of you ordered a hamburger and fries and drink, the bill for the hamburger, fries, and drink. And it's accurate.

We assume that that's how things will be at hospitals or doctor's offices too, because that's become what we've come to expect. The truth is exactly the opposite. Billing errors and billing mistakes, whether intentional or unintentional, are so common that people who look at these bills for a living and analyze them would tell you that they see errors in most of the healthcare bills that they look at.

So always ask for the cash price. Always try and find out how much it's going to cost before you get the service or treatment. Then when you get the bill, make sure it's an itemized bill.

What the healthcare, or hospitals especially, tend to do is they give you one price for everything. Get an itemized bill with the billing codes. And then you can see what they charge for each service they provided. You can look up the billing codes. And it's actually really easy to Google the billing codes.

You can see if those billing codes accurately described the services you received. Often, they do what's called upcoding, which is where they'll use an exaggerated billing code, a higher complexity billing code so they can bill you more for a very simple service.

And sometimes you see codes in there for things that didn't even happen. So you can say, "Look, that service didn't even occur. So you shouldn't have it on the bill." We're not talking nickels and dimes here. We're talking hundreds or even thousands of dollars that these bills can be reduced when you identify these errors.

You mentioned your $800 lab bill. I think one of the most untapped resources we have as consumers is small claims court. You could get your itemized bill and you could see the billing codes that they used for the labs. You could compare that to a cash price or what you would pay at some other lab. So you could identify that they probably overcharged you by certainly hundreds of dollars on those labs.

You could go sue them in small claims court, and you could say, "That this is an unfair, unjust medical bill. You've overcharged me." And now think about what you're doing when you do that, you were creating a hassle and an expense for them. Do they want to hire an attorney for hundreds of dollars an hour to fight your medical bill? You're taking them onto a level playing field of our American justice system, and you're saying, "Hey, as a consumer, you don't have a right to exploit my sickness for your profit. And I'm going to stand up for myself and I must say that you can't do that."

Filing a case in small claims court is a very low expense for you, and it creates a very high cost and hassle for them. And my argument is, they should come to the table and they should give you a fair price for the lab services that you received.

I'm not saying you shouldn't pay your bill, of course, but they don't have a right to charge us whatever they want for the services that they provide to us. And that as consumers is what we need to do, is be informed, be empowered, and then fight back, and demand a better deal.

Stefanie O'Connell Rodriguez:I know when I reached out to you about this listener's story, you expressed some hesitancy.

Marshall Allen: First of all, there's no simple, easy answers to any of this, right? Even the things we're talking about—the $800 lab bill, that's a pain. But imagine if you're dealing with cancer at the same time you're having to fight these bills.

So what I recommend is if somebody has a complicated case, where it's an ongoing case, or maybe they have a child with a chronic condition that they have to deal with a lot of things over time, or maybe it's a complicated hospital stay with lots of bills where the itemized bill runs many pages, I recommend people go talk to a patient advocate. And there are professional patient advocates. They do charge a fee. They're worth the money. But again, you have to have the money to afford them, right?

But a professional patient advocate has probably handled cases like that that are more complicated. There are ways to fight the healthcare system and win, but what I want to be really careful of is to be very sensitive and careful not to make it sound like you can always win. Often, you don't win.

Again, one in six Americans has medical debt in collections. Imagine having a medical debt collector chasing you down just because you went to the emergency room and couldn't pay the bill, or just because you got cancer and couldn't cover your co-insurance. I mean, that is just an absolute tragedy. And it's a shame that people are in that position. So that's why I had hesitancy there, because I just want to make sure that I don't imply that there's some simple solution for somebody who is in such a dire position.

The one thing came to mind as you were talking about this, and it may or may not relate to this particular person, but it might relate to a lot of your other listeners, financial assistance policies. A lot of people don't realize that the hospitals, especially non-profit hospitals, are required to have financial assistance policies. And they're actually a lot of times quite generous, surprisingly generous.

So I don't know what her income is, but she should look and see what her hospital's financial assistance policy is. Because if you're a low-income person, you can usually get your bills completely wiped free. And that's because, especially a non-profit hospital, is required to give kind of a community benefit and to really help justify them not having to pay taxes. But even people who make up to six figures can get some discount on their medical bills. So it's not just low-income people who qualify financial assistance.

Stefanie O'Connell Rodriguez: Before there's a major medical catastrophe when you're young and seemingly invincible, what do you think of people thinking, "Oh, well, I don't make a lot of money, so I'm just going to forego insurance?"

I would never recommend people go without insurance. If you can afford insurance, I think you definitely want to have it. But at the same time, I understand the financial burden is so huge and people have so many other bills to pay. I mean, this is again why we have so many people who have medical debt.

Marshall Allen: There's a big myth of having great insurance as if that's going to help you. Or having what some people call rich benefits like, "Oh, well, I don't need to worry about it. My health insurance plan covers it." But even people who have great benefits, maybe they don't realize, that money that's used to pay for their great benefits is coming out of their employee compensation.

So when we get hired, we get wages, we might get a 401(k) or like a retirement contribution. Maybe we get some paid time off and sick time that's paid. But also we get health benefits. That expense for those health benefits comes 100% out of our compensation package. So even if you have rich benefits that covers a lot of things, your employer is using your compensation to pay those benefits.

So as healthcare costs go up, as they have gone up every year for 30 years, all that money is getting put on to the people in those employer-sponsored plans. So working Americans are burdened by these high healthcare costs. And economists have studied this. And they've shown that this is one of the main reasons for wage stagnation in the United States in the last 20 years. Our wages are not going up because our compensation is getting consumed by these outrageous and unfair healthcare costs.

That's the best case scenario where you have great benefits at work. Even in that case, you are getting ripped off and taken advantage of, it's just happening in a way that you don't necessarily see or feel because these costs are just coming out of your compensation. But then you have the cases of the extreme terrible bills people get, the surprise bills people get, the out-of-network care that they don't realize is out of network.

Hospitals can charge whatever they want. And then if you don't pay it, they'll send you to collections. They might even sue you. And a lot of times we think there's nothing we can do about it, but there actually are a lot of things we can do to defend ourselves and be savvier healthcare consumers.

The simplest way to look at it is: Just look at your deductible.

When did you ever use the term deductible in your life? Never. But the deductible is the amount of money that you're required to pay before your health plan pays anything. So there's been a big movement over the years for employers to lower the premium. So you don't pay as much per month for your health insurance, but they'll raise the deductible. And that means you pay the first $1,000, or you pay the first $3,000 or $5,000.

So that's the second thing I'd look at. Look at the premiums, look at the deductibles and see how your deductibles have changed. And then the third way to look at it is see if any coverage has changed. See if there's any things that your health plan used to cover, that it doesn't cover anymore. And this is one of the sneaky ways they pass costs onto the employee, is they stopped covering things that you need. And so it might be a drug that you need. It might be a specialist that you need. Maybe you go to physical therapy or a chiropractor. Maybe they'll take those things out of the plan. And so your plan just doesn't cover as much.

The fourth would be the co-payment. They'll raise the copayment. So if you need to go to a primary care doctor, or maybe your copay is $25. If you need to go to a specialist, maybe it's $50. If you need to go to the urgent care, maybe it's a hundred dollars. Emergency room, maybe $250. They'll creep those costs up so you don't necessarily notice it, but you end up paying a lot more out of pocket for each of those types of copayments.

Stefanie O'Connell Rodriguez:

Now, we're talking about a lot of words here that I would call—

Marshall Allen: Yeah. You need a glossary to keep track of it.

Stefanie O'Connell Rodriguez: Exactly. I would call it jargon. I don't know if it's intentional.

Marshall Allen:The only positive is it is standardized. If you have an idea of that terminology, at least you can understand your health plan, you can compare one health plan to another, you can compare your current health plan to your past health plan So even though the terminology is confusing and complicated, if you can just learn the basic terms and understand... It does take some engagement, right?

But If we can engage with our healthcare costs the way we engage with, say, looking at our cell phone bill, looking at our bank account, looking at our credit card bill, the healthcare costs are probably actually a lot higher. I mean, people don't really think about it. But our healthcare costs are thousands of dollars a month in many cases.

And so we need to begin engaging, and then also pushing back. Asking smarter questions, analyzing our medical bills, being careful about where we go for the services we receive, demanding prices up front. There's a lot that we can do to become empowered consumers. And so I'm trying to equip and empower people to be savvy healthcare consumers, in the same way they would be savvy cell phone consumers, or restaurant consumers.

There is no justifiable reason for these high costs. So in other countries that are developed countries, they spend about five to $6,000 per person per year. Here we spend $11,000 and our outcomes are actually a lot worse. When you look at quality of life, life expectancy, disease burden, Americans are way less healthy and we spend twice as much money. And that's probably the most frustrating thing when think of your dear 35-year-old woman who's dealing with cancer. If she was in a country with universal coverage, she would not have these financial burdens.

Stefanie O'Connell Rodriguez: To Marshall's point, the American healthcare system is complicated, frustrating, and too often, we're not getting our money's worth. But as he explained, the more we can engage with our healthcare the way we engage with other parts of our financial lives—like our cell phone bills or credit card companies—the more we can start to push back.

By asking questions about cash pricing up front, and interrogating what even generous employer-sponsored health coverage is truly costing us, for example. Or by analyzing our medical bills and asking for itemized versions so we can look out for upcoding and errors, and make sure we're not being charged for services we didn't even receive.

We might even consider taking our fights to small claims court, or in a case like Olivia's that involves an extensive interaction with the healthcare system, working with a professional patient advocate to fight on our behalf or negotiate a financial assistance policy directly with the hospital, because no one should have to fight for their financial future alone, much less when they're already in a literal fight for their lives.

This has been Money Confidential from Real Simple. If, like Olivia, you have a money story or question to share, you can send me an email at money dot confidential at real simple dot com. You can also leave us a voicemail at (929) 352-4106.

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