Journalist Jeanne Pinder, founder of ClearHeathCosts reveals how medical costs can vary widely for the same products and procedures- and how we can find out- and negotiate- to get the best price.
Episode Links:
Blinkist - The app I’m loving right now. Please use our link to support the show and get a free trial.
Some of the links in this post are affiliate links. This means if you click on the link and purchase the item, I will receive an affiliate commission at no extra cost to you. All opinions remain my own.
Transcription
Bobbi Rebell: Financial Grownup Guide, how to pay less for healthcare. Like a Financial Grownup with Clear Health Costs, Jeanne Pinder. You're listening to Financial Grownup with me, Certified Financial Planner, Bobbi Rebell. Author of How to Be a Financial Grownup. And you know what? Being a grownup is really hard, especially when it comes to money. But it's okay. We're going to get there together. We've got this.
Bobbi Rebell: No secret. Our healthcare costs are ridiculous. What makes matters even worse is that it is one of the few things that we buy where we don't even know what it costs. In fact, we don't even ask ahead of time. Very often we don't negotiate. We don't know what the competition is charging and there is often zero transparency. The costs are all over the place. For example, a simple blood test could be $500 in one place, $7 nearby. An MRI routine procedure can cost $300 to $6,000 in another location just a few blocks away. Very few of us even think to compare costs and shop around the way we do almost obsessively sometimes for everyday items.
Bobbi Rebell: This is an urgent episode. I worked to bring it to you for a very long time. I am really excited about it. As you can tell as a journalist, I can tell you I really appreciate the work that goes in to getting the data that I just shared. Before my New York Times reporter, Jeanne Pinder is nailing it with the company that she founded, Clear Health Costs. Their work in bringing transparency to the healthcare marketplace by telling people simply what stuff costs is amazing. She has been called a benevolent genius for good reason.
Bobbi Rebell: Listened to the end of the episode. It's not that long. Take notes or listen again, or go to the show notes at bobbirebell.com for a transcript. And by the way all the episodes are there. Use the search bar in the top right corner to get more info about our guests, or more info about the content of any of the episodes. But first, listen to this one. Here is Clear Health Costs founder and CEO, Jeanne Pinder. Jeanne Pinder, I'm so excited you're here with us. I've been trying to get you on the show for quite a while, but you're a busy lady. You are the founder and CEO of Clear Health Costs, and you are here to basically give us the lowdown on how we can be better financial grownups when it comes to what we pay for our healthcare. Tell us first about Clear Health Costs, and how it came about and what it does.
Jeanne Pinder: Yeah. Thanks for inviting me. We're a New York City journalism company, no longer startup, bringing transparency to healthcare by telling people what stuff costs. We do this not only on our home site, but also in partnership with other news organizations in long running consumer friendly investigations. We're partnering now with CBS national news and WNYC public radio, and Gothamist here in New York, telling people what stuff costs.
Bobbi Rebell: How do we even know where to begin with controlling our healthcare costs, because obviously, we often don't have that much choice when it comes to insurance, and we all feel like we're overpaying for insurance, and then we still do pay for this stuff.
Jeanne Pinder: Right. Yeah, so we recommend that people just, whenever it's feasible, ask what stuff is going to cost you. We know that not everything is shoppable. Like we wouldn't expect you to shop your emergency up, inducted me or your cancer treatment, but if you think about it, somewhere around 80% of our healthcare system interactions are shoppable, where are you going to get that sore throat looked at, where are you going to get that MRI. Do you have choice in scheduling your surgery? So once you've ascertain that it is shoppable in some sense, you can start out by asking simple questions. Ask the insurance company if applicable and the hospital or doctor, how much will this cost me on my insurance?
Bobbi Rebell: Okay. Meaning what's the net cost to you?
Jeanne Pinder: Yes, and what's the cash price? Quite often they'll say, "Well, we don't know or we can't tell you," but our view is that if we make that behavior a normal behavior if everybody's asking. And increasingly, we hear that people are able, doctors, hospitals, labs, clinics are able to come up with a number.
Bobbi Rebell: And then how do you even know where to go to start comparing? Because sometimes to go to get a second opinion, I would think you maybe have to go get a second appointment with another doctor, which is not only money but also time. Should you be going to second appointments just for the cost of it? How does that actually work in practice?
Jeanne Pinder: Yeah, we usually suggest something simple like an MRI. You can call three separate providers, and ask them those questions. How much will that cost me on my insurance? What's your cash price? Very important, ask for the cash price.
Bobbi Rebell: Can you explain that?
Jeanne Pinder: Yeah. So we're hearing increasingly that people are finding if they put away their insurance card and pay cash. They can get a better rate. It doesn't necessarily fall against your deductible. Although, you should be able to take something like that from your HSA if you have one. But increasingly, we're hearing that people who are choosing to put away their insurance carrier didn't pay cash, do better. Not in every case.
Bobbi Rebell: What is the thinking behind that? Because my gut instinct, which is clearly wrong, is that it's better to have insurance, right?
Jeanne Pinder: Well, you have to ask every time. All bets are off. There are no rules. Everything we thought we knew about healthcare, we don't really know that anymore. So for example, we all grew up thinking that our insurance premiums gave us access to the lowest price. That is no longer true necessarily in every case.
Bobbi Rebell: How do you even know?
Jeanne Pinder: In most cases, making three phone calls to ask the price, it might take you half an hour. It might take you an hour in advance of a procedure that you'd be surprised what you find out. Yes, in fact, we've heard that a simple blood test could be $500 one place in $7 another place. And if you haven't met your deductible, it really makes a difference. A simple MRI could be $300 one place and 6,000 in another, a few blocks away in the same city.
Bobbi Rebell: So explain why there's such a cost differential? Does one person pay higher rent? Is one place subsidized by the government, one isn't? Why such a big differential?
Jeanne Pinder: Well, the biggest reason why is that there is no transparency in healthcare. So people aren't used to publishing prices, and people aren't used to asking for prices. A few rules of thumb. We generally think that any procedure in a hospital is going to be much more expensive. So let's say that lab test, if you get it at LabCorp on cash can be dramatically cheaper than if you get it in a hospital lab.
Bobbi Rebell: With that, can you negotiate? Let's say for some reason you want to have it at the hospital, can you tell the hospital, "Well, if I go to a lab it's going to be less." Can you match that price? Is that something that people do yet?
Jeanne Pinder: Yes. People are doing that increasingly. I did it myself actually. I needed an MRI for a member of my family. The orthopedist in question gave us a list of three radiology providers that he uses. And because I know how to do this, so I called the first one and said, "I'm a cash customer. I'm not using my insurance. What's your price for the MRI, the particular code number?" And she said, "$900." I called the second one and had the same conversation. She said, "$600." And then the first one called me back and said, "If you can be here at seven o'clock tonight, it'll be 450." Right. So it's like surge pricing on Uber. Right?
Bobbi Rebell: Jeannie's reacting to seeing my face. I have a look of surprise for our listeners that obviously can't see me. I was like, "You got to be kidding." Oh my gosh. It's like, are they going to have Black Friday sales one day? I don't know.
Jeanne Pinder: It is. You never.
Bobbi Rebell: So you can definitely negotiate. And is it the thing where you can say, "I'm willing to come in last minute and fill an empty slot." Because they're trying to manage their business. That's crazy.
Jeanne Pinder: And you can say anything that you feel comfortable with. Not everybody is. Well, like for example, my friend Cindy, she was going to a doctor, and she had to get slightly gross. She had to get wax removed from her ear. So she went in and the first thing they said at the billing office was, "Give us your credit card." And she said, "How much is it going to cost?" And they said, "We don't know." And she said, "Well then, why should I give you my credit card?" And she left.
Bobbi Rebell: I love that.
Jeanne Pinder: Well, not everybody wants to do that. And again, we don't expect you to behave like that when you're on the gurney waiting to have your appendix removed. But increasingly, people are asking because people are getting these terrifying bills, making decisions not to go to the doctor because they get a terrifying bill.
Bobbi Rebell: So what is some of the language that people could use when you want to negotiate beyond saying, "Well, your competitor offers this price." Can you make a hardship argument, especially if you have insurance but then the insurance isn't going to cover it that well? What are the kinds of techniques that are most successful in negotiating a healthcare bill both before and after you get the bill?
Jeanne Pinder: Right. Generally, we say just those simple questions, how much is this going to cost me on my insurance? What's the cash price? Yes, I'm shopping around. We don't hear a lot of people who are having a lot of success they're saying, "Well, your competitor up the streets charging 6,000 and we'd rather have it for 4,000." But we do hear a lot of people who are asking that question very specifically, and asking it of several providers because quite often the providers do know what their competitors are charging and they do want your business.
Bobbi Rebell: We'll talk a little bit about that because I think people don't always understand that there's the other side to this, that they also in some cases are not necessarily getting rich off of us. They have their own business issues going on.
Jeanne Pinder: Right. And one of the issues that they do have going on is that there are people who are not paying their co-insurance and their deductibles. There's a huge conversation in healthcare finance these days about people who are just not paying. So as a reaction to that, we think these cash prices are coming to the fore. Not every time, not every place, but quite often.
Bobbi Rebell: Let's talk about prescriptions. What can people do to lower their prescription costs? Because we were joking before we started taping that I have a prescription that would be very, very expensive, but my doctor gave me this kind of coupon that goes directly to the manufacturer, and that made it only $25, and it's a monthly thing, which is great, but what if you didn't get that coupon? How would you even know what you don't know what to ask for?
Jeanne Pinder: Yeah. So we say ask that same question at the pharmacy. How much is this going to cost me on my insurance and what's your cash price? You can also go online to goodrx.com and get an idea of what the prices are going to be there. They have coupons that the issue. In general, we hear a lot of people who are saying that they are finding that their copay, like they might have a $35 copay for a common medication, but they can buy it on cash for $4. It's crazy.
Bobbi Rebell: That makes no sense though.
Jeanne Pinder: It makes no sense. Right. Again, you think that your insurance policy gives you access to a lower price. That's no longer true.
Bobbi Rebell: What tips do you have for getting the right amount of money back from your insurance provider? Because I find, how do you know if your doctor even coded it correctly? Are there certain ways you can research that yourself, and make sure when they submitted it's submitted in the best possible way for you? Because I find, a lot of times they're not necessarily paying attention.
Jeanne Pinder: I think you're right about that. We generally suggest, and again, I'm not saying that this is right because they feel like when people are not healthy, they're not at their best. They would rather not be arguing over nickels and dimes, but we do recommend that people ask on the front end, how much is this going to cost me, and then scrutinize the bill on the backend, like is this what they said they were going to do, and does everything look kosher here? We have a little handbook on how to argue bills on our website.
Bobbi Rebell: I love that. We'll leave a link in the show notes. Make sure to send that to us.
Jeanne Pinder: Okay.
Bobbi Rebell: But in short, go ahead. How do you argue the bills?
Jeanne Pinder: Yeah, so I have argued many a bill over the years.
Bobbi Rebell: I'm not surprised. And probably very successfully.
Jeanne Pinder: Well, sometimes yes and sometimes no, but you should document everything. Do it in writing. Don't do it on the phone because doing it on the phone, you're not going to have any record of stuff. I have sent stacks and stacks of copies to CEOs of hospitals and of insurance companies complaining about my treatment. I can get a little bit enthusiastic about arguing bills, but it's worked out for me in many cases. And I think if everybody was reading their bills and challenging them, I think we would be able to reduce the amount of shenanigans that goes on in hospital and doctor billing.
Bobbi Rebell: Do you think there's a lot of... we just calling it shenanigans? I would call it fraud over-billing.
Jeanne Pinder: Well, In some places I think it is fraud. In some places that shenanigans. In some places it's just so complicated. The doctor submits one code and the insurance company says, "Well, we don't code it that way. We code it another way." The sum total is that the patient gets stuck in the middle.
Bobbi Rebell: What are the things we can control it? So for example, I noticed that one doctor, they have multiple labs. They can send a test out to, not all the labs, maybe on your insurance. Can you tell the doctor, "Please send it to this lab, not the other lab."
Jeanne Pinder: Yes. And try to in every case. Again, it's really hard to place that burden on you as the patient. They should be doing it automatically, but you can remind them. And also when you're doing this prep work, I always recommend that people take notes, take names and take numbers. You can ask for something in writing, for example, a hospital estimate in writing, which will then make it easier for you to argue on the back end should you want to. For many of us, we're a little bit squeamish about talking about body parts and money because it feels like, "Ooh, well, maybe my doctor's going to think that I'm like a cheapskate or something." But I really think it's time for this to come out into the open, and for all of us to get comfortable with the fact that asking that question is going to make us, and our doctors frankly feel a lot better.
Bobbi Rebell: Well, you are a tremendous resource. One more question. We're talking in general about medical procedures that are not necessarily elective. Do you have any negotiability when it comes to things that are elective?
Jeanne Pinder: The elective procedures that we price on in our database are pretty much already negotiable. They're basically a cash marketplace. So we do pricing on Botox, LASIK and teeth whitening, and they really are pretty much an open marketplace.
Bobbi Rebell: Fascinating. So they're probably more negotiable because they're really running purely as a business where you can truly take your business somewhere else?
Jeanne Pinder: Yeah, they'll have specials, special on the LASIK, special on teeth whitening.
Bobbi Rebell: All good to note. Jeanne, where can people find out more about you and Clear Health Costs?
Jeanne Pinder: Yeah, clearhealthcosts.com. You can also find us on cbsnews.com/healthcosts, wnyc.org/healthcosts, and gothamist.com/healthcosts.
Bobbi Rebell: Tremendous resources. We are so grateful to you. Thank you so much and happy holidays.
Jeanne Pinder: Thank you Bobbi. Thank you. Happy holidays to you too.
Bobbi Rebell: That was awesome. Big things to Jeanne Pinder. Be sure to check out Clear Health Costs as Jeanne said in all the places, including their partnership with WNYC public radio and Gothamist. That's wnyc.org/health costs. You can also check out their partnership with CBS national news at cbsnews.com/health costs. This is one of those episodes you definitely want to go to the show notes. You could do that at bobbirebell.com/podcast/jeannepinder.
Bobbi Rebell: You can also just search for her name, J-E-A-N-N-E P-I-N-D-E-R in the search box. That also goes for all the episodes of Financial Grownup. You can get show notes and resources for all of them. And if you like this podcast, please be sure to subscribe and leave a review. And if you have other ways to save on healthcare DM, so that I can share it with the whole community. On Instagram, I am @bobbirebell1, and on Twitter @bobbirebell. And of course, check out Money With Friends. My other podcast with my friend Joe Saul-Sehy. You may know him from Stacking Benjamins. Be sure to follow Money With Friends also. On all the socials, it's at moneyfriendspod. Thank you everyone. Infinite things to Clear Health Costs, Jeanne Pinder for helping us all get our healthcare costs under control. Like the financial grownups, we are. By everyone. Financial Grownup with Bobbi Rebell is edited and produced by Steve Stewart and is a BRK Media Production.
