Crush Medical Debts

Today's Valuable Free Resources/Links: https://crushmedicaldebt.com/free-resources/

Summary

In this episode, I introduce you to Dr Virgie Bright Ellington.

Dr Ellington is a board-certified internal medicine physician, former health insurance executive, medical billing expert, award-winning author, speaker, and radio show host, but it wasn’t until she became a two-time cancer patient that she discovered why medical bills are the #1 cause of debt, stress, and bankruptcy, 

She is the principal of evidence-based and award-winning Crush Medical Debt Financial Wellness, which helps individuals, military veterans, and employees struggling with medical bills save their finances, families, and future.

Crush Medical Debt Financial Wellness is for you if you’ve ever felt overwhelmed, confused, or trapped by bills from having to get care in the U.S. medical system; if you have to spend hours of time you don’t have on the phone begging for help instead of focusing on your work; or if you think you have to know how the human body works or fancy medical words to understand and save money on medical bills.

Today Dr Ellington speaks about:

Medical debt and financial wellness with a cancer survivor. (0:00)

Medical billing fraud and patient rights. (3:42)

Insurance tricks and medical billing. (10:16)

Medical billing and financial literacy. (16:26)

Medical debt's impact on mental and physical health. (23:04)

Join me for this episode of Mommy Heal Thyself to learn how to crush medical debts.

Transcript
(Note, this was transcribed using a transcription software and may not reflect the exact words used in the podcast)

Intro  0:00 

Welcome to Mommy Heal Thyself.  We featured guests that provide you with the tools, resources and strategies you need to say no to a life of pain and suffering all forms of preventable disease, toxic drugs and unnecessary surgeries. We hope to inspire you to boldly reclaim your ability to heal, and to serve ones to love.

Dr Michelle  0:27 

Welcome everyone to another episode of mommy heal thyself. Today I'm able to introduce you to Dr. Virgie Bright Ellington. She is a board-certified internal medicine physician, former health insurance executive medical billing expert award winning author, speaker and radio show host but it wasn't until she became a two time cancer patient that she discovered why medical bills are the number one cause of debt and bankruptcy. Now she is in charge of crushing medical debt financial wellness, and this is a wonderful service because if you have ever felt overwhelmed, confused, trapped by bills, having to take care of that you have to take care of in the medical system of our country. No more she has the answers for us today. Because she developed like I said the crush medical debt system. So Dr. Ellington, thank you so very much for joining us today.

Dr Ellington  1:38 

Thank you so much for having me. Dr. Campbell. Much, much. Appreciate it.

Dr Michelle  1:43 

I tell you, you know we were just talking before we started our session today about how overwhelming this problem is. Tell us a little bit more about the people that come to you and what are the pains that they're experiencing?

Dr Ellington  1:58 

That's a great question because the the reason that crushed medical debt was born Dr. Gamble is because I met somebody who didn't know that she was being cheated by the system. She just thought oh gosh, you know, sucks to be me and just was trying to figure out how to get by. So the story is I was I was going about my business. And I always tell people, you know, doctors are the worst patients. My my surgeon told me not to do something after surgery that don't lift, like apps, whatever. And that three months later, was rolled into the emergency room and you know the surgeon the the incision, came open internally and saw a piece of while got caught up in the incision and was going gangrenous. So I rolled in septic really sick shot out and I thought you know what, Virgie you really? Really, really messed up this time. If you wake up they told me I had to go into surgery, emergency surgery and I thought, You know what? Early if you wake up and you don't hear the emergency, the emergency the ICU bells and whistles and all the noises if you don't, if you wake up and you're not in the ICU, then you dodged a bullet. So I woke up wow I wasn't in the ICU I didn't hear any bells and whistles like okay for GE dodged that bullet next time we'll listen to your search. So when I heard somebody's I heard somebody screams like they might hear snoring. I was hearing snoring. I thought I heard you're really really shut out because usually if I had to go to the hospital, I tried to make arrangements to have a private room. And you know, this was in COVID and all that. Yeah. And it turns out that I had a roommate and it was this young woman named Mia and Mia was a mom of two young toddlers and her husband her insurance was on her husband's insurance that he worked in a 24 hour diner. Dr. Gamble so he's very modest income family doing their best. And she was telling me that she was thinking about leaving even though she her doctor said you know, she really needed more tests. And she said because she was worried about the bill and she's telling me that because she had been there a year before for something similar basically they were concerned she was having a rare cause of a stroke. And she said before I left, the day I was being discharged, one of the hospital billing reps came to my office. I mean my office from the Office of billing office there at the hospital came to my room and said before you can leave, you have to sign this document saying that you agree to pay whatever your insurance doesn't pay. And she said I signed it and you know, I don't know how I'm gonna afford it. And now this has happened again. I don't know what I'm gonna do. I think I just didn't I should leave because I can't afford this and so she's telling me this and it clicked, you know, and I tell the story all the time. True story. The curtain dropped. I saw read. I was enraged because I knew she that deliberately tricked into signing an agreement to pay money she doesn't Oh, just to cut to the chase. She agreed to agree to be balanced build, which is she has insurance in network. And being a network means that the provider agrees to accept payment in full of whatever the insurance pays for certain services in full no not including your co pays coinsurance deductible, that kind of thing. But many providers will say well, if we can trick the patients into believing that the difference between what the insurance agrees to pay the balance between what the insurance agrees to pay and what we charge what I call them, or is it p manufacturer retail sticker price, that's balance ability. And so they tricked her into agreeing to pay that. So she's on the hook for that and I it's just outrageous and it's contract fraud. It's wrong. She doesn't owe that money. And I realized it was a thing. The same facility tried to balance bill me six months after I was discharged six months after this. I got a bill from the alleged bill. It wasn't a real bill, and we can talk about what a real bill is later, but it was the alleged try to make you believe it's a real bill saying hey, you owe it was almost $90,000 basically $90,000. And, you know, I just I thought okay, this is a thing. And this is how crush medical debt was born. I realized they really this is a thing. There are many they're not the only provider that does this. So thinking they owe money. They don't know.

Dr Michelle  6:59 

Let me see if I understand this. Because if this is true that I've been built also, you know, you're telling me that if you have a bill, that is after what they have agreed to with the insurance company when you because even when you go to a medical doctor, the first thing they ask you to sign is a paper that says you know I agree to pay for whatever it is that isn't covered by my insurance company. So if I'm understanding you correctly, that is not legit.

Dr Ellington  7:36 

You so let me back up. There is a document that many providers will have you sign most providers will have you sign in a non emergent situation. And yes, they can say you are financial responsible for the bills for services. So yes, that's fair. Okay. And what I tell people in those cases, when they ask you to sign something, if you don't if you know if you're not feeling well, if you're in pain, you're scared, you're hurt, you're dizzy, you don't have your glasses because you know it was urgent when you left the house because you weren't feeling well. Just glance through it and say, You know what, I'm not going to sign this if you don't feel comfortable with if it's an emergency, you don't have to sign it and they have to treat you now once they get you stabilized and they can send you out to someplace that says okay, you're not agreeing to pay our services, they'll send you out and then non emergent situation like your any outpatient medical service or not, emergent situation. They will give you this document and what I recommend you do this when you glanced through it, you can say okay, I'm looking for things words like financial responsibility, payment, acts that out and put in. I agree to pay Medicare rates. I agree to treatment as services and to pay Medicare rates if you're in a hurry. I agreed to pay Medicare rates initially and then sign at the bottom. That's another thing post COVID. A lot of times they'll ask you to sign a blank little square electronic pad right or rectangle electronic pad or have you signed the tablet? No, I tell them I don't care how many people is in line behind me how Curt or brusque or, frankly nasty they are. You're going to say you know what? I can't sign this unless you print it out. When you print it out. They'll say something like often they'll say, Well, you know, it's just our privacy notices or it's just our COVID My favorite one is a star COVID hygiene practices, letting you know how we're keeping you safe. Yeah, okay, print it out. And I'll sign it. Always No, I'm not pregnant. No, I'm not sending anything if so, I just want to make sure to remind folks to do that. Don't sign anything that's not printed out. So you print it out. If you see something that says financial or responsibility exit out and say I agree to pay Medicare rates, so we can talk about why Medicare is the lowest most fair retail price that providers will accept. Okay. So being balanced bill, Dr. Gamble is if you have insurance, and you are going to a provider who is in network with your insurance in network means that they signed a contract to accept whatever their discounted rate is for their services in exchange for having access to sometimes millions of their patient. population. So that's the agreement. So balance billing is yes, if they're in network, yes, with your provider. So that's the thing. They can say, well, we don't accept insurance. We're not in network or we're not in network with that insurance. We're not contracted to accept as payment in full with that particular insurance company. So that's the difference. All of this eight to nine times out of 10. We've gotten tricked, or what I call like pull lightly call mistakes in being billed. But sometimes, it's just frankly, just being tricked. So just being aware, a lot of this foolishness I say you can get rich by knowing hey, if I have insurance, being in network means that not including my deductible, coinsurance or co pay, whatever my insurance pays them as payment in full they do not owe. I do not owe rather the balance of what they say, Hey, your insurance only paid $10 of something that we charge $100 For a year on the hook for $90. No, that's a balanced billing. That's contract fraud. No, you don't know it.

Dr Michelle  11:54 

Okay, so the thing to look out for is to make sure that these are in network providers, because insurance yes, if you have insurance that they are in network providers, because if they are in network providers, and they have already signed an agreement with the insurance company saying that they will accept bla bla rates dictated by the insurance company. Yes,

Dr Ellington  12:18 

exactly. That's it. So yeah, insurance. Insurance. does it protect us from risk health insurance as it protects us from risk car insurance, homeowners insurance? Yeah, that protects us from ERISA protects us and in exchange for premiums. They take the risk of replacing things that we can't afford to replace. While our health is priceless, right? But the insurance companies the health insurance, medical insurance companies, the United States don't work that way. They don't guarantee protecting you from risk from financial risk. All they do is guarantee access to discounted rates. That's it. And they don't guarantee that they're going to cover what should be covered. You know, they decide they may say you know what, there's some insurance companies whose business models is to just deny coverage because less than some studies they less than 1%, but definitely less than 10%. That's really generous. I'd say less than 5% of people who get denied services by their insurance company assurance says no, we're not covering that insurance denials get appealed. So that's part of their business. Model like it was we just automatically deny it. There's a good chance we won't have to spend that money won't have to pay it out.

Dr Michelle  13:37 

Oh, my goodness set out what are what is the common mistake that people are making in terms of how they're approaching their relationship with their insurance. Companies? Why is it that it's the number one factor for bankruptcy in our nation? Yep.

Dr Ellington  13:52 

So most folks living in the United States most Americans, doesn't matter what your citizenship status is. Most folks live the United States would have to get care through the US health care system. Most folks within the United States are just one accident or illness away from a lifetime of debt. And that includes those of us who are quote unquote, great insurance. Doesn't matter if you have great insurance or no insurance. You have the same risk of going into a lifetime of debt or bankruptcy. Because of medical bills, if you have an accident, a bike accident, you know, when we were young and healthy and beautiful, you know, we think oh, you know, I don't need health insurance. Yeah, okay. When you're on your bike, you know, being glam and doing all that good. If you they say if you're serious biker, they say that you have eight chance out of 10 I think I saw the study somewhere statistic rather, of getting in an accident. That's not your fault. So it doesn't matter if you're young and healthy. You know, life happens. And it doesn't matter if we have insurance or not because of the tricks with insurance companies. Frankly, it doesn't matter where it's a risk of going bankruptcy where they have insurance not because of those tricks. So to answer your question, the number one trick if you have insurance is getting balanced build. So that's why I talk about that all the time. The rest of it is just not knowing that we're getting overcharged whenever you get a bill, especially if you don't have insurance, you're getting overcharged. So insurance just means that the provider has a MRSP I call it a manufacturer retail sticker price. And they give you they create it's a fantasy number. It's a wishing I call it a wishing number because they're wishing and hoping and praying you'll fall for it right. They create a number so that they can give quote unquote a huge discount to insurance companies to be part of their patient panel. So if you don't have insurance, they the number one trick they'll give you if you don't have insurance, is if so we already talked about the number one trick if you have insurance where they try to trick you into thinking that you owe that balance the Alright. Then the rest of us and even insurance companies. Well, the rest of us whether you have insurance or not, but definitely don't have insurance. You think that that MRSP is a real number and we try to pay it they trick you into paying it. They'll say hey if you put it on our medical credit card or our medical care card, then you can make payments and you don't get charged insurance for a year. Some of them there's one that won't charge interest if you can pay it off in three years. But you know, what they're saying is hey, pay this number is P number which can be tend to crazy. But it's not it's not it sounds outrageous, but 100 times what the real fair retail rate is for medical services and that's what Medicare pays. So I talked about the three steps for that reason to protect ourselves a reason why we get tricked into overpaying eight to nine times out of 10 If we paid a bill in the United States, we've gotten tricked is it is what it is. So the three steps that we don't get tripped whether you have insurance or not. But definitely if you don't have insurance, this is critical to have this basic medical financial literacy the three steps is to get a real bill and that is eight to nine times out of 10 Dr. Gamble. What we get in snail mail for for a bill is not a real bill because it doesn't have CPT codes. CPT cards are to medical services. What bar codes are to services and or products rather, at a retail store. Every service has one right and it tells you what you're paying for. Are you paying for an eight ounce bottle of Poland Springs water Are you paying for a 16 ounce bottle? The barcode will tell you right Yeah, same thing with medical services, the CPT code will tell you. So step one, call the provider back the billing office back and say hey, there's no CPT codes on this. You sent me something but you say it's a bill. And you say it's due in the month it's $10,000. And it's due you know, they tell me to put it on a credit card, you know, and it's due at the end of the month. It's I don't see this is not a real bill. I don't see a CPT codes here. Call back and demand CPT codes. And by federal law by HIPAA federal law by the way, that's your right to have it. And they know that so say you know they give you pushback by HIPAA federal law. I need my CPT codes as the bill with CPT codes as per federal per HIPAA federal law or federal law. Step two, once you get those that real bill, that accurate itemized bill with CPT codes, you're going to Google or now I do an AI search chat GPT search of what Medicare pays for those services. First, you're going to put in the code and make sure the description is a two step process. Make sure the description roughly sounds like the services you received and make sure you're not getting up charge. It happens you're not getting double bill mistakes happen. And while you're there, look at put in your CPT code 913 And that is like a type of outpatient service well, what does Medicare charge or pay rather for those services for that particular CPT code? In this case? 99213. Once you get that number, you're going to take it to step three, call back the provider billing department because you've totaled all of the CPT codes, what Medicare pays for those services and Medicare rates. And so I use this example a lot if you get rolled into emergency surgery like I did, and you get a bill and I'll just keep my bills simple. My bill was like $351,000 Yeah, right. Okay. Just to keep the math simple. If they charge $100 for a service, the I'm sorry, a 10th Ellis's use $10,000 for this is actually what usually happens for surgery. And you can call me back and say, hey, look, you guys sent me a bill for $10,000 but in my research, I'm willing and able to pay $3,000 That's the most examples. When you do step two, and you total all of what Medicare pays for each of those CPT codes. That's what we'll come up with. It'll be a huge 1000s of dollars difference. So you say yeah, I know you guys sent me a bill for $10,000 but in my research in my case, I am willing and able to pay $3,000 Because that's the total that you got. It's up to you don't tell them that you don't have to tell them that but just say in my case, I'm willing and able to pay it is what it is. Who can I speak with who can help me make a payment plan? And that's it. And I always say this, no matter how little you're able to pay you know, emergencies don't happen and when when it's convenient, right? The worst time you don't have any money, any resources, if he can only squeeze out $50 Out of your budget to however you turn it whatever you can do. $50 is all you can do. On a let's say a $3,000 bill, then that's all you can do. Don't talk you into saying what can you do? 100 Can you don't have it right? You're gonna get pushback. If we were to accept $3,000 That's a big discount. If we were to accept it. It's going to take us forever to get our money. Yeah. And at least you get it. Except that because Exactly. And your point is Yes. It'll take yield. Yes. And yeah, if I do the math, I think yes, it will take me 60 months, five years for me to pay this off. Take you five years to get your money. Yes and who can I send this to? Can I? When can you? How can you make sure that I get documentation of this agreement that I'm going to pay you $50 a month for the next 60 months on this $3,000 bill? And the reason why they're going to exempt that you stand your ground because the reason why they're eventually going to accept that is because you're being proactive. They don't have to come after you. And they know that their rates are really overcharge of just fiction. There's total fiction just made up and they know that you don't know that money and it cost them money to come after you if they have to send it to collections for pennies on the dollar. So stand your ground and do not let them talk you into doing if you only do $50 A month Sophia, don't let them talk you into 100 or a penny more. Because the moment that you send in you have a bad month and you can only send in $75 they will directly send you to collections. So that's the three steps of protecting ourselves, whether we have insurance or not. Period, but definitely, definitely if we don't have insurance

Dr Michelle  23:04 

so the first thing from what I'm recalling is to make sure that we are not being over billed, you know with that whole concept of well now you owe me whatever it is that's the difference between what your insurance company paid and this made up number get I hate it. They're a network, if they're in a network where

Dr Ellington  23:27 

you go, your emergencies happen, but then a non emergency situation. You call and make sure that they're in network and an emergency. That's when you use the three steps that we had to get emergency care. That's when you use the three steps if they're not in network and then if it's an emergency, there's something called the no surprise billing act that went into effect January last year says that if you have insurance, and it's an emergency, the out in their out network with you that they have to negotiate directly with your insurance company to accept their in network price or payment. So that's a huge that was a huge plus that came about last year from the no surprise billing and for that reason.

Dr Michelle  24:10 

Well, I think the reality is that the people who are still being surprised are the consumers like you and I because they're I know if I remember correctly, you can correct me if I'm wrong, that that billing also said that they have to make you aware of exactly how much all of these different procedures are. But a lot

Dr Ellington  24:29 

of times not an emergency. That's called the good faith estimate. Yeah, yes.

Dr Michelle  24:33 

Yeah. So if it's not an emergency, but when I looked at certain reports, they said that very few hospitals are actually complying with the bill. Exactly. So but most people don't realize that this is what they're supposed to do. So nobody's calling them to the carpet for it, you know exactly. You got it. You got it. It's crazy that this is where we are especially given the fact that you said that this isn't the number one creator of bankruptcy and for me, it's even more powerful. An issue to be dealt with because it disrupts people's lives. It breaks up marriages. This is the bankruptcies the number one thing that breaks up marriages and then we look at you look at what happens to people in terms of stress and anxiety and, and gastrointestinal disease all coming from the knot. That is created in their lives by this cloud, this dark cloud that is just so pervasive. Ah

Dr Ellington  25:42 

that's the point. That's why we're here. That's why we get up and do every every day and do what we do every day. Because medical bills are the number one cause of debt, stress and bankruptcy in the United States. What is the notice of that? Medical bills are the number one cause of debt stress and all the things that are that come with that in bankruptcy in the United States could hold that one hand. It's the number one cause of divorce, financial problems, money problems, money differences. So your there is a direct relationship a direct correlation between medical bills debt and destroyed families. And I hit it right on the head. That's it. I'm

Dr Michelle  26:31 

gonna take it a step further Dr. Ellington and say that debt is one of the number one triggers of death because when we look at the number one cause of death in our nation, cardiovascular disease, heart attacks, strokes, all of those things, yes, they're their dietary factors. I'm not negating all of that, and to accelerate it. It's all of that anxiety and I and I, the reason why this is coming to mind is because I know of a particular client of mine, who is doing phenomenal things in terms of her health, you know, taking care of her health, she changed her diet. She started exercising everything, but she was so overwhelmed with debt from being in the hospital, you know, prior to and having this huge amount of debt. She was in a position where she was just working, working, working, taking on two jobs, three jobs. You know, she was also a counselor she was constantly taking on new clients trying to get more money to pay off the debt and she was consumed with worry about debt. Which

Dr Ellington  27:36 

89 is added to the I'd say even nine times out of 10 There's a 90% chance she didn't I'm sure she didn't know all that money. I'm sure a lot of that was MRSP manufacturer retail sticker price, but she hit it on the head. There's a direct you're absolutely right. direct relationship, direct correlation between debt and death. Why is that? Because stress causes increased cortisol. So that's a stress hormone. And it increases our hold it increases basically the insolence response to holding on to and creating fat so we gain more weight. And around our abdomen is where that weight usually centers collects with time, eventually that increases your risk of developing type two diabetes, type two diabetes, or diabetes period. Diabetes, where there's type one or type two diabetes shortens your life that's just what it is. Yes. So it will shorten your life by causing takes you out from basically at the end of the day at some point from cardiovascular related problems, a heart attack or stroke, the ball end of story just to cut to the chase. So you even if it if it kills your kidneys, you die because of basically cardiovascular related related causes from kidney failure. You know, whether you're on dialysis or not. So the point is, yes, you've hit it right on the head, direct relationship between debt and death. And the way the only way in the United States that medical bills get paid is by a call the three Ds debt going into debt, bankruptcy or losing to get your wages garnished or your how your house you lose your house. People think they have to pay rate their retirement. Crazy so debt donation, so now GoFundMe kind of stuff for cancer and I think I saw a statistic last year it's now I think, if you compare it to all the insurance companies United States is like the number five or number seven payment for medical bills if you compare it to insurance companies in the United States. Yes, ma'am. So debt, donation, and death. People just don't get the care that they need because they don't want to add the debt or they're like, I can't pay that. I can't pay this. I can't pay it already. I'm just going to put off either the prescription or the care that they need. So yes, ma'am. Good. Got it. That's exactly correct. direct relationship between debt and death in the United States period.

Closing: Thank you for tuning in for this episode of Mommy Heal Thyself, if you liked what we're doing here, please share subscribe, like us and leave a comment. Your feedback is very much appreciated.

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