Learn why Dr. Mike thinks that “all of my listeners need to get connected with you [Exhale Healthcare] because something in the future is going to happen and they should be prepared

Navigating Your Medical Bills with Dr. Mike in RadioMD

Navigating Your Medical Bills on Health Talk with Dr. Mike in RadioMD

Dr. Mike: So if you have some hefty medical bills or even some not so hefty medical bills, it doesn’t really matter. I have a guest that’s going to help you navigate those bills and maybe even save you some money. Definitely help you destress over the whole process. she is Sarah O’Leary. She’s the founder of Exhale Healthcare Advocates, a consumer advocacy company that makes healthcare a fair fight. I really like that.

Exhale Health is the first company of its kind to define personal health care management. Sarah welcome to Health Talk.

Sarah: Thanks so much for having me Dr. Mike.

Dr. Mike: Tell me about Exhale Heatlh Advocates. The how it got started in the why got started.

Sarah: It actually came to me in a dream about 2 years ago and I like to think of it as divine intervention. One of my friends thinks it was the fish taco I had for dinner.

Dr. Mike: We’ll go with the divine part. It sounds better.

Sarah: I know. What it came down to was that people didn’t have a voice in their health care. And their fiscal financial care was impeding their ability to get well. It was stressing people out and they were losing the fight that were losing the fight they should win.

In response to that, we got a bunch of experts together to be the advocates and to fight on their behalf with healthcare providers in there insurers. It’s really that simple.

Dr. Mike: So when people go on to your website and it’s exhalehealth.com, correct

Sarah: Yes

Dr. Mike: When they go on to that website there’s a group of consultants [heathcare advocates] that they can get connected with that, I guess, will look at their whole situation, right look at all of it together. The hospital bills, what’s going on, and you kind of just help them to navigate through that. Is that correct?

Sarah: Yes. As long as people use any facet healthcare, were there for them’. So whether it’s trying to get insurance for the first time or the hundredth time, if they are going to get an MRI or a new set of glasses or new hearing aids, whatever it is, before an event happens, we negotiate down the price of that.

Then when they start to get mystery bills for any test or procedure where they get denied a claim or they get denied service, we intervene on their behalf and represent them so that they can be successful.

Dr. Mike: Wow, what an awesome idea. You know I don’t care if it was fish tacos or not, that’s a great idea. I think this sounds really good.

Let’s backup though. What are some of the common mistakes then that people make when it comes to their medical bills. I mean, are we just not negotiating we need to realize we can? What are some of the things that were doing that’s hurting us in this process?

Sarah: That’s a great question. First and foremost, people make the mistake of thinking that if my health care provider sent me a bill I must owe it. They don’t account for the fact that there are so many millions, arguably billions of dollars lost just by medical bill errors that there aren’t even fraudulent. They’re just mistakes.

When we give away that power by saying oh gosh, we don’t question if we owe it, we just say how do I pay it? We lose money. So first we have to be smart consumers and not be afraid. We get afraid and the fear hurts us. It doesn’t help us.

Dr. Mike: So there is probably a lot of people listing right now that agree. I think all of my listeners need to get connected with you because something in the future is going to happen and they should be prepared and they needed to know that exhalehealth.com is right there for them.

However, there are probably a lot of people out there listening [or reading], that already have a big bill, so what can they do right now? You know, they open a bill up and loook at it and it’s $20,000. Is it too late to do something at that point?

Sarah: No. That’s such a great point to make. It’s never too late. It’s never too late. We have even stepped in after clients have paid and gotten some resolution. So it’s never, ever too late and keep your power in front of you. Stay on it.

What we like to see around here is that “friends don’t let friends navigate health care bills alone.”

Dr. Mike: That’s good!

Sarah: So if you are in that position where you are the patient or a loved one, and you have all these bills, get a trusted advocate. If it’s not us, then get your best friend who you trust and have them step in our your behalf.

Because when it is about us, we lose leverage and objectivity. The person that is dealing with us from the billing department know that. So you, yourself might get turned down a million times, but when a trusted friend or advocate calls on your behalf, they have a better success rate. Our success rate is off the charts because our experts speak the language of the people that we are calling and that makes it significantly faster and in the end, more successful.

Dr. Mike: So, I guess, probably the most common mistake then is, and the one that is probably the most detrimental is the fact that we think that we don’t have negotiating power. So basically, we get that bill and we stress over it and we figure out OK, I just got to start making my payments or whatever. So really, we need to get on the phone either through an advocate or just calling that hospital or doctor ourselves.

And I can tell you Sarah, as someone that has practiced medicine, I was out in Texas. Most of my buddies that were practicing medicine, whether it was surgery, ER doctors, radiology, what I did, we are willing to negotiate. We do. If you call up and say that you can’t afford that, in most cases they will figure out something that you can afford. So sometimes, I think people just need to be aware of that.

Sarah: Yes, and that is what we find. Obviously we have access to very specific software programs that will allow us to look across the county by zip code and say wait a minute, that colonoscopy with those ingredients in that colonoscopy should have cost X and your insurance company paid Y but the doctor and the hospital are trying to bill you for over and above what is really the going rate. We use that kind of information as leverage which also helps. Go in as an informed person. Do your research and say wait a minute, when I had that MRI, the insurance company paid you $1500 for it and you think that I should pay you another $800 for it. I fail to see why. And would you explain that to me as the going rate is $1500.

When you have a smart discussion point, usually they will say, yeah, you know what? You are right. You need to push back. If you don’t ask them, you will never get the best price for the care that you are receiving. So you do want to negotiate.

Dr. Mike: So let me give the website again. I think this is so important, so please write this down. If you don’t already have an issue, something is probably going to happen, right? It is what it is. ExhaleHealth.com.

Now I went on your website by the way and it’s really easy to navigate which is a very big plus for me. And I found something on there that you are going to have to explain this to me. There is something on their about balance billing and how that effects us. What exactly is balance billing.

Sarah: There are two thing that we always want to be on the lookout for when dealing with medical bills as consumers. One is balance billing. So let’s say that you have an insurance company, ACME Insurance and you have a procedure done that the doctor believes is worth $1500. Your insurance company says no. We have a contract with you doctor that says it’s really worth $1000. Well the doctor might just say to themselves that I would really rather get paid more.

So the balance is $500. They send you that bill to see if you will pay it.

Dr. Mike: So basically, that is just extra money in their pocket is what it is.

Sarah: Yes. So the industry terms is balance billing.

Dr. Mike: Gotcha. That’s why you should call. So whenever you get a bill you should call and make sure that is not what they are doing.

Listeners, this is the kind of thing that you can learn on Sarah’s website, ExhaleHealth.com. It’s full of this kind of information. And you can talk to, I don’t know what you would call them, consultants or counselors  [healthcare advocates] Sarah.

Sarah: They’re experts. We call them Exhale experts in whatever it is that you need, their job is to help you so that you don’t have to fear it.

Dr. Mike: Sarah, thanks so much for doing this. This is awesome. I hope that you have more dreams and eat fish tacos to come up more ideas like this. This is really good. ExhaleHealth.com. Go to check it out.

This is Health Talk on RadioMD and I am Dr. Mike. Stay well!