You Might Also Like: Grown-Up Stuff: How to Adult

**Cynthia Fisher** (0:07)
We have to sign with a blank check that we will be financially responsible for whatever they choose to charge us. And as long as the hospitals and insurance companies hide their prices, they can charge whatever they want. And that's exactly what's happening.

**Matt Stillo** (0:24)
You know that feeling when you open a medical bill and immediately think, I don't even know what I'm looking at.

**Lea Palmieri** (0:31)
Yes, I am familiar. There are codes, charges, insurance adjustments, amounts you supposedly owe, and somehow a $50 doctor visit turns into a bill for hundreds of dollars. Make it make sense.

**Matt Stillo** (0:45)
And most of us just assume the bill must be right because, well, who's going to argue with a medical bill?

**Lea Palmieri** (0:51)
Well, actually, you can and sometimes you should. There are things on that bill you can question, negotiate, and even ask to have corrected.
Welcome back to Grown-Up Stuff, the podcast where we figure out all the things you feel like you should know by now, but maybe don't. I'm Lea Palmieri.

**Matt Stillo** (1:09)
And I'm Matt Stillo. Today, we're going to break down the medical bill mystery. What all those numbers mean, what you should look for before you pay, and what to do when something just doesn't seem right.

**Lea Palmieri** (1:20)
And we're getting help from someone who's spent years fighting for greater transparency in health care. Cynthia Fisher is the founder of patientrightsadvocate.org, and she's here to help us become a little less intimidated by that piece of paper or that terrifying PDF in our inbox.

**Matt Stillo** (1:35)
Because being a grown-up apparently means knowing how to read a medical bill.

**Lea Palmieri** (1:39)
And knowing when to push back.

**Matt Stillo** (1:41)
We should start today by framing this as a financial problem. It reported 20 million people in the United States, that's nearly one in 12 adults owe some medical debt. Collectively, people in the United States owe at least 220 billion with a B in medical debt.

**Lea Palmieri** (1:57)
It seems crazy when 90 percent of our population has some form of medical insurance.
So Cynthia, let's start with the basics of understanding the billing process. Can you tell us when someone leaves a doctor's office or a hospital, what is happening before a bill is actually landing in their mailbox?

**Cynthia Fisher** (2:22)
The true purchasers of health care is us, right? We pay not only out of pocket, but most of us have some type of insurance coverage. But that coverage is out of our paychecks. So it's our money and it should be our health. We should be able to benefit from a competitive market place so that we know what we're going to get as far as quality, and we're going to know what we're going to pay.
And so you asked what's happening in the billing, Lea. Well, what's happening if we go in and we don't have these prices upfront, which a lot of people don't know that by law right now, we have the right to these prices upfront, and the hospitals and insurance companies have been flouting or disregarding this law.
But when we don't know the prices up front, what happens in the billing behind the scenes is both the hospitals and the insurance companies try to make as much money as they possibly can on that patient encounter. So they're both sending it off to multiple coding people, oftentimes with an online through your medical record on what's happening. But other people within the hospital and the insurance company look at figuring out ways to code at a higher rate because they both make more money, the more that they can code at a higher rate to your medical encounter.

**Lea Palmieri** (3:54)
Medical bills use codes to translate healthcare services into a standardized language that doctors, hospitals, and insurance companies can understand. But people, not so much.
One set of codes describes what care you received, like an office visit, blood test, MRI, or surgery. Another describes why you received it, such as a diagnosis or symptom. Those codes are then used by the insurance company to determine how the service is covered and how much you may owe. But a code on your bill doesn't automatically tell you what you owe. It's part of the process used to turn a medical service into an insurance claim and eventually a patient bill.

**Cynthia Fisher** (4:35)
Then they even have claims adjudicators, middlemen, that work between the middleman, which is the insurance carrier. Now, the insurance carrier may have an employer where you and your employer are essentially self-insured. You take on all the risk and the big insurance carriers like United or Aetna or Blue Cross merely administrate those claims. But remember, those middlemen, those big carriers make more money the higher the charges are. So unfortunately, there's a perverse incentive for both of these entities in the shadows.