Healthcare Hacks That Could Save You Thousands on the Journey to FIRE

Summary

BiggerPockets Money Podcast Summary Episode: Healthcare Hacks That Could Save You Thousands on the Journey to FIRE
Release Date: April 22, 2025
Host: Mindy Jensen & Guest Host: Amberly Grant

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Introduction: The Hidden Challenge of Healthcare Costs

At the outset, Mindy Jensen highlights a critical concern for those pursuing Financial Independence, Retire Early (FIRE): health insurance and medical expenses. She emphasizes that despite meticulous planning of investments and living costs, the unpredictability of healthcare expenses can derail retirement plans or cause post-retirement financial anxiety.

Mindy Jensen [00:00]: "What is one of the biggest concerns for anyone on the path to financial independence? Health insurance and medical expenses. It is the elephant in the room that can dramatically alter your FIRE journey..."

Guest Introduction: Jared Walker and His Mission

Amberly Grant introduces Jared Walker, founder of $4.org, a platform dedicated to negotiating medical bills to alleviate financial burdens caused by healthcare costs. Jared shares his personal motivation, stemming from his family's medical emergencies in 2012, which exposed him to the flaws of the U.S. healthcare system and inspired him to assist others in similar predicaments.

Jared Walker [02:29]: "In 2012, my wife and I were hit with massive medical emergencies. These experiences made me realize that during a medical crisis, a financial crisis often follows. I wanted to help people navigate this..."

Understanding the Broken Healthcare System

Mindy and Amberly express frustration with the unaddressed issues in the U.S. healthcare system, noting that despite promises from influential leaders, significant reforms have yet to materialize. They discuss how medical debt remains the leading cause of bankruptcy in America.

Mindy Jensen [03:39]: "I'm so angry that you had to do that because we can all agree that the US Medical system is broken and in need of a giant fix."

Jared Walker [04:02]: "Medical debt is a huge problem. There's definitely no lack of need, and we're still kind of stuck in that."

The Genesis of $4.org: Tackling Medical Debt

Jared recounts the evolution of his efforts from grassroots fundraising in Portland to the establishment of $4.org. Initially, he personally negotiated medical bills for families, realizing over time the existence of hospital charity care and financial assistance programs, mandated by the Affordable Care Act.

Jared Walker [07:55]: "We are busy doing this work, and unfortunately, we're still kind of stuck in that. We have millions declaring bankruptcy or on payment plans for bills they don't have to pay."

The Role of $4.org: Enforcing Charity Care Policies

$4.org aims to enforce existing hospital policies that often go unutilized. Jared explains that while nonprofit hospitals are legally required to inform patients about financial assistance, this information is typically buried in posters or websites, making it inaccessible to those in need.

Jared Walker [08:06]: "Section 501R requires hospitals to widely publicize their financial assistance policies, but most patients leave without knowing about them."

Through $4.org, Jared has created a comprehensive database of hospital financial assistance policies, assisting millions in reducing over $83 million in medical debt nationwide.

Jared Walker [09:14]: "With $4.org, we've written off over $83 million in medical debt by enforcing policies that hospitals often hide."

Strategies for Negotiating Medical Bills

For individuals who do not qualify for charity care, Jared provides actionable strategies to negotiate medical bills:

1. Ask for the Settlement Amount:

   • Begin negotiations by requesting the total settlement amount for immediate payment.
   • Jared Walker [15:47]:
     "Ask 'What is the settlement amount?' You can often get 30-50% off by paying upfront."

2. Request an Itemized Bill:

   • An itemized bill can reveal billing errors or unnecessary charges.
   • Jared Walker [17:55]:
     "Ask for an itemized bill; it can save you money by highlighting errors like duplicate charges."

3. Verify CPT Codes:

   • Cross-reference Current Procedural Terminology (CPT) codes to ensure accurate billing.
   • Mindy Jensen [37:36]:
     "CPT codes are universal, so you can verify what each code stands for and dispute any discrepancies."

4. Leverage Community Support:

   • Enlisting the help of friends or family during negotiations can provide emotional support and ensure thoroughness.
   • Amberly Grant [38:58]:
     "Having a friend on the call can help ask the right questions and manage the stress."

Personal Anecdotes and Real-Life Impact

Amberly shares her personal experience, highlighting the stark contrast between the healthcare systems of the U.S. and Canada. She illustrates the potential for significant savings by being informed and proactive when dealing with medical bills.

Amberly Grant [30:03]: "The average cost of a C-section in Colorado is $35,000 to $50,000. I called the hospital to inquire about cash prices and was quoted $5,500."

Implications for Financial Independence and the Community

Mindy and Amberly discuss how managing healthcare costs is pivotal for achieving and maintaining financial independence. They stress that early retirees, in particular, benefit from having cash reserves and time to negotiate bills effectively.

Amberly Grant [34:06]: "There are so many tricks and tips to lower healthcare costs in retirement, like choosing cash payments over insurance if it saves money."

Mindy Jensen [35:47]: "You have time to negotiate before medical bills impact your credit score, making persistence and informed actions valuable."

Frequently Asked Questions and Clarifications

Jared addresses common misconceptions, such as the belief that having insurance disqualifies one from hospital financial assistance. He clarifies that many individuals are eligible for assistance even with insurance, debunking the notion that these programs are exclusive to the extremely poor.

Jared Walker [32:02]: "People think they can't apply for financial assistance if they have insurance, but many can, even with a moderate income."

Conclusion: Empowerment Through Knowledge and Advocacy

The episode concludes with affirmations of the importance of knowledge and persistence in managing healthcare costs. Jared's work with $4.org empowers individuals to take control of their medical expenses, thereby safeguarding their financial independence.

Mindy Jensen [33:54]: "Asking for the settlement amount and requesting itemized bills are crucial steps in managing unexpected medical expenses."

Amberly Grant [39:34]: "Negotiating on someone else's behalf can be less stressful and more effective, providing both emotional support and accountability."

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Key Takeaways:

• Healthcare Costs are a Major Barrier to FIRE: Unpredictable medical expenses can derail retirement plans.
• $4.org Empowers Individuals: By enforcing hospital charity care policies, $4.org helps reduce medical debt significantly.
• Negotiation Strategies are Essential: Proactively negotiating bills, requesting itemized statements, and verifying CPT codes can lead to substantial savings.
• Community and Support Enhance Success: Engaging friends or family during negotiations can provide emotional support and improve outcomes.
• Knowledge is Power: Understanding existing financial assistance programs and being informed about billing practices is crucial for financial well-being.

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For More Information:

• Visit Jared Walker’s organization: $4.org
• Explore strategies to negotiate medical bills and access charity care programs to protect your financial future on the journey to FIRE.

Transcript

[Mindy Jensen]

What is one of the biggest concerns for anyone on the path to financial independence? Health insurance and medical expenses. It is the elephant in the room that can dramatically alter your fi journey or create anxiety after you've already reached early retirement. While we crunch numbers for investment returns and living expenses, the unpredictable nature of health care costs keeps many would be retirees tethered to traditional employment longer than they'd like. But what if there were strategies to navigate this complex system more effectively? Hello, hello, hello and welcome to the BiggerPockets Money Podcast. My name is Mindy Jensen and while Scott is out on paternity leave, Amberly Grant is stepping into his seat and guest hosting with me. Amberly, it's so good to see you today.

[Amberly Grant]

Oh, it's very nice to see you as well, Mindy.

[Mindy Jensen]

Thank you for joining me.

[Amberly Grant]

Oh, I'll thank you for having me today. Share your pockets has a goal of creating 1 million millionaires. You're in the right place if you want to get your financial house in order, because we truly believe financial freedom is attainable for everyone no matter when or where you are. Starting today, we're joined by Jared Walker, who specializes in something most people don't even realize is possible, negotiating medical bills. He is the founder of $4.org and we are so excited to learn from him today. Super excited since I just had a baby last year and I need to know this stuff.

[Mindy Jensen]

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[Jared Walker]

Thank you so much for having me. I appreciate it.

[Mindy Jensen]

What led you to focusing on negotiating medical bills? I mean, you weren't laying bed at 7 years old saying, oh, when I grow up I want to negotiate medical bills for. For a living.

[Jared Walker]

That's correct. This was not the dream. I got into this in 2012. My wife and I were sitting at home, she got a phone call and her aunt had passed away from cancer. So a couple minutes later, I got a phone call. My cousin had gone into labor, seven weeks premature baby needed a heart surgery to live. And both families, same day, same hour, hit with these massive medical emergencies. And I remember the conversations were, how are we going to pay for it? And that really frustrated me. Was probably 23, 24 at the time. This was kind of like the first run in with the U. S. Healthcare system, realizing that when you have a medical crisis, a lot of times you have a financial crisis at the same time. And I wanted to help people in that situation. So I grew up in Portland, Oregon, and I started originally dollar for Portland, and it was a crowdfunding platform to help people pay medical bills. So that is kind of how it all started me, you know, very grassroots, doing these small coffee shops, breweries, music venue, like grassroots fundraising, taking the money and paying medical bills for. For local families.

[Mindy Jensen]

First of all, that's lovely. But second of all, I'm so angry that you had to do that because we can, I think we can all agree that the US Medical system is broken and in need of a giant fix. And I thought Warren Buffett and Jamie Dimon and was it Jeff Bezos? I thought they were all getting together and they were going to fix it. And it turns out that they all got together and then they didn't fix anything. And that story kind of went away.

[Jared Walker]

I feel like there's been a lot of people that have said, oh, we're going to fix a, you know, health care system. And yeah, unfortunately that has not happened. It's the number one cause of bankruptcy in America. It is, you know, medical debt is a huge problem. There's definitely no lack of need. Like, we are busy doing this work, right? So, yeah, unfortunately, we're still kind of stuck in that. You can kind of lose everything if, if you get sick at the wrong time.

[Mindy Jensen]

I feel incredibly fortunate that one of my jobs in my late teens was working in the HMO office for a large medical complex as a temp. And I learned a lot about the then HMO system. I don't. Do we even have an HMO system anymore where you had to, like, call ahead and get permission from your primary care doctor to go to a different doctor? Um, I feel like I have saved myself tens of thousands or hundreds of thousands of dollars in medical bills just by knowing that you had to do that. And you don't know what you don't know. So for people who are in these. These situations, it feels shameful. Oh, I should have known this, or I should have asked. And. And I want everybody listening to know that this isn't a shameful thing, because you don't know what you don't know. So you didn't know, or your cousin and your aunt's family didn't know how they were going to pay for these bills. I didn't know that you could really negotiate bill. I had my second baby. She was born the beginning of November, and all the hospital bills came due in December, right when we were spending a lot of money for Christmas. And I called them up and I said, is there any way I could, like, split these payments? The bill was eleven hundred dollars. And they said, we can spread that out over eleven months. If you need more than that, then you'll have to speak to a different department. I was like, I was just looking for 500 now and 500 later. Like, this is awesome. So I'm like, yes, I'd be up for that. I'm good with $100 a month for my b. But at the time, I had really great insurance. That was just my out of pocket. It's shocking to me that you can negotiate these bills. Like, I don't negotiate. I don't go to the grocery store and rig it up and be like, oh, can I just give you 50? How did you discover that you could negotiate these bills? Because I think most people just pay them when they come due.

[Jared Walker]

You definitely touched on a few things there. One, the shame, I mean, and then I think just the panic, right? You get a bill, and it's like, a lot of times you have sticker shock. A lot of times you. You can freak out when you see the bills start coming in. And then the other thing is, like, you get the hospital bill, then you get the anesthesiologist and the surgeon and the, you know, all the different providers within the hospital. So it can be quite overwhelming. So, you know, I. I started because I would raise, you know, a couple thousand bucks each month. And then I was just trying to stretch the dollar as much as I possibly could. So we'd find a family that then needed some help. And, you know, I would call the hospital and just kind of be that annoying pest, right, and ask. Ask questions about the bill. And I started, you know, realizing that, okay, this does seem to be something that there is A little bit of wiggle room here. I did that for years. In about 2019, I met an attorney and he asked me if I had ever heard of something called hospital charity care or hospital financial assistance. And I had never heard of it. So I kind of dive into these policies and realize when the Affordable Care act passed, it required nonprofit hospitals, which is most in America, to have these programs. And if you are within a certain income range, the hospitals are actually legally required to either write off or reduce your hospital bills. And I had no idea that those programs existed. So I had spent years paying medical bills for low and middle income families that all would have been eligible for these programs. That was kind of the next step realizing, okay, yeah, you can negotiate these medical bills, but also there are programs in place that can actually reduce the bills or waive them entirely. So that's kind of, you know, the next, the next step.

[Mindy Jensen]

So quick question. You said nonprofit hospitals are legally required to write off or reduce. Are they legally required to inform you that they have to do this on paper?

[Jared Walker]

Yes, they should. So section 501R, if you really want to nerd out on it, it basically says that hospitals, I think that the language is these policies need to be widely publicized and widely available. So what does that mean for most hospitals? That means that they have a poster in the ER somewhere and the application is, you know, hidden somewhere on the website. So most patients leave the hospital without having any knowledge of these programs. So we have millions and millions of people that are declaring bankruptcy or on payment plans for bills that they actually don't have to pay. Um, so that's kind of what $4 stepped into was how do we enforce these policies and how do we get patients access to these really complicated, you know, applications? And even seeing if you qualify can be difficult.

[Amberly Grant]

It's pretty incredible that you took money and paid people's medical bills. I'm sure that made them feel like supported, heard and out of a financial bind. And you mentioned that they didn't even need to pay these bills because a hospital would have written them off or give them a reduced rate. Do you have a sense of how much money now you've saved people with all this knowled or maybe how much you've saved yourself personally?

[Jared Walker]

You know, it's funny, I just had a medical bill, it was $1300 and I was able to negotiate it down to like 3, 350. So I like, I've probably saved myself, I don't know, maybe $5,000 over, over the years. But with $4, the the non profit. We've actually, we have been able to write off over $83 million of medical debt for people all throughout the country. So. Wow, that's a shocking number to you all.

[Mindy Jensen]

That's a shock. Million is. I don't know if you know this. That's kind of a big number.

[Jared Walker]

It is, it is a big number. I mean, so this kind of all unfolded in. At the beginning of 2021, I had found out about charity care and hospital financial assistance and I just felt like an idiot because again, I'd been paying bills for people that would have been eligible for these programs. So I ended up getting on TikTok and I posted a video that just said, hey, if you have a hospital bill, you should check this out. You know, this is how you can find your policy. And I just told people what charity care was. The video ended up getting like 30 million views and it just exploded and I had all these people reaching out, asking for help. So since then, we've created a database of every hospital in the country. So We've got about 8,000 hospitals in here that has all of their financial assistance and charity care policy data and eligibility criteria, because it's not, it is not standardized, unfortunately. So every hospital is different, every application is different. So now a patient can very quickly put in their household size, their income, what hospital, and it tells them immediately if they're eligible at that hospital, and then we help them with the paperwork, submit it to the hospital and advocate on their behalf.

[Amberly Grant]

Oh my God, Jared, I saw that video. I'm like, that's how I know your face.

[Jared Walker]

That's hilarious.

[Amberly Grant]

I don't remember when I saw it because I'm sure it's probably gone around a couple times, but it was actually one of the inspirations for me for checking out the hospital that I was going to for my child and seeing if they had, you know, some better self pay options versus insurance options, et cetera. So you gave me some inspiration. I unfortunately didn't follow through with a lot of it, or I tried to, but was blocked by the insurance company when I was submitting some of the self pay bills and things. And I ended up giving up on the process and they took my thousand bucks and I just couldn't do it. But I just remember your video and feeling so empowered to stand up against kind of the practices of these companies. So thanks for that.

[Jared Walker]

Thank you. I appreciate it. And you know, at the time, at the beginning of 2021, we're like right in the middle of COVID I think that a medical crisis and health care was kind of the top of a lot of people's minds. So I think it was a timing thing. You know, people see that video and go, oh my gosh, you know, I have a, I have an unpaid hospital bill. I can, you know. Yeah, it was a very, very interesting time for, for me and the organization.

[Mindy Jensen]

My dear listeners, we want to hit 100,000 subscribers on YouTube and we need your help. Hop on over to YouTube.com biggerpocketsmoney and make sure you're subscribed to this channel while we take a quick break.

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[Amberly Grant]

Thanks for sticking with us.

[Mindy Jensen]

Do you have a quick link to your on your website that we can send people to to get that hospital charity care information?

[Jared Walker]

Yeah, so it' just $4 org. It goes directly to the eligibility screener where you can see if you're eligible.

[Mindy Jensen]

Oh, that's awesome.

[Jared Walker]

We've actually mapped all of the applications as well, so you can fill it out on your phone or whatever and it's, it takes your info and fills out the hospital info. That's how we've been able to, you know, eliminate 80, 80 plus million dollars in medical debt is just enforcing these policies that a lot of times hospitals hide, unfortunately. So, and you know, it's 80, 80 million. Like we're very proud of that. That's very exciting. Unfortunately, every year hospitals fail to distribute about $14 billion of charity care that should be going out to, to these patients. So we have a lot of work to do.

[Amberly Grant]

I'll say, I'll say. But you're doing a really great job right now. Okay, so for people who have a higher income, someone like me, and do not qualify for charity care or any of these programs within a hospital and they receive a medical bill, which I did, you know, all of 2022 from my pregnancy then, and then 2024 with my second baby. Can you explain what medical bill negotiation actually involves and how common is it for us to actually do this?

[Jared Walker]

I would say first take a deep breath. You know, I mentioned a lot of times people panic. People, you know, stress out about that and that's, that's natural. But you have time. A lot of people think that, you know, these hospitals are going to send you to collections and ruin your credit right away. They actually are. You're really not able to be impacted in any way until a year has passed. So they cannot impact your credit score until it is one year without payment. So you do have time and you are going to continue to get those, you know, bills that say, you know, final notice and all of that. You can take A deep breath. You have time until it will impact you. The second thing is, what can you offer? If you have cash, usually you can get anywhere from 30 to 50% off. I mentioned earlier, I got a $1,200 bill down to, you know, 300 with the simple magic words of what is the settlement amount? That is where I start all the time. So I call the provider and I say, hey, I've got a bill, I've got some money. What is the settlement amount? If I can close this out right now, what will you take? Because you have to keep in mind they want to close this out just as much as you do. Right. And these bills, we know that these bills are inflated. We know that there are. I think the last. There was a report that came out that says that 80% of medical bills have billing errors in them. So, like, these bills are usually not correct. So I start there. What is the settlement amount? And usually they will take less. Now you're always going to have providers that might say, you know, oh, we don't do that. We don't do that. I usually try three or four times before I'll actually accept that. Because if they say that. And again, this is an annoying process. Like, you know, you're going to wait on hold, you are going to, you know, talk to people on the phone that, that aren't going to be happy about it or whatever, but you can usually negotiate these. So that, that's kind of where I start. I guess I'll pause there. Any, any questions on, like if you have cash negotiate kind of kind of thing?

[Mindy Jensen]

No, I love that. What is the, the settlement amount? Like, I wouldn't know to ask that.

[Jared Walker]

You know, a payment plan can be great for a lot of people, but if you have cash, then you can usually just close it out right then and there. You're not usually going to be able to negotiate a lower bill and then ask to be on a payment plan for the lower bill. Right. You're going to have to either pay it upfront or get on the payment plan. So that is kind of, you know, step one. So, okay, let's, let's say you don't have extra cash and you're not able to do that. So then I think you would go to step three, which is find the errors or at least see if there are errors in the, in the bill. Number one, ask for an itemized bill. Just asking for an itemized bill alone can, can save you money because they are going to look through that. And this is where you see Those very common stories of, you know, the $75 aspirin or the $50 band aid or, you know, what, whatever it is, where the hospital or the provider will usually look at those and adjust those. So just by asking for an itemized bill, a lot of times it can come back lower. And then this kind of stuff is more time consuming and a little bit like investigating, you know, what. What is the cost? So you can get on a website like Healthcare Blue Book, and you can look up the CPT codes and you can see, like, are they overcharging you? Because when you get that itemized bill, it's going to have a lot more detail in the bill. And you can kind of see, like, was I charged for something that didn't happen? Or was I charged twice for something that did happen? Or whatever it may be. And a lot of times you can kind of call the billing office and call out some of these errors. Again, it's a little in the weeds. It can be a little intimidating. But, you know, I have done this. It works. And even just hopping on YouTube and, and, you know, Googling what, what the codes are and, you know, seeing what to say, like, it. It can help. So if you don't have the cash and you're just trying to lower the bill, that's another option. Obviously, I'm always gonna say, like, number one, always see if you're eligible for charity care. I know, like, that this whole thing is like, well, hey, if you don't qualify. But a lot of times people disqualify themselves for this program because they just think, oh, it's not for me. You know, I'm not. I'm not super poor. Just as an example, I'm in the Pacific Northwest. Every single hospital here will waive 100% of your hospital bill if you are at or below 300% of the federal poverty guidelines. And then they will give a discount up to 400%. So if you're a family of four, you can make about $120,000 gross annual income and still receive some type of discount. A lot of times these policies can be a little more generous than people think. And then I would say the final thing, like, get on a payment plan. Usually, you know, you can. You can talk those down pretty low to something that's affordable if, you know, if all else fails.

[Mindy Jensen]

I think this is really, really important for everybody on, well, on American health care to know about, but I also think this is really important, especially for people who are early retirees, because you now don't have any more income or probably don't have any more income, and you get hit with a medical bill. I remember I had my Appendix out in 1997, and it cost $27,000. Which saying that just seems so stupid. Like, how is it only $27,000 for surgery and three days of hospital care? But it was. That's what I remembered. I don't know if that was my dad's portion because I was still under his insurance. Maybe I'm just misremembering it. Maybe there was a one in front of there that just seems so cheap to me. But either way, I was not going to be able to pay a $27,000 invoice for this random thing that may or may not happen. Amberly, did you sell your appendix?

[Amberly Grant]

I do.

[Mindy Jensen]

Okay. Jared, you got your appendix? I do, yeah. You know what's gone up since 1997? Appendectomies. So having the ability to ask these questions that now, you know, do I qualify for hospital charity care? Go to $4.org and that's $f o r.org and throw it in there. See if you do qualify. And if you don't qualify, ask them what the settlement amount is. See if you can get on a payment plan. I love this information so much. I'm so happy that you were on this show with us today. But we're not done. We've got a lot more to talk about. Are there specific types of medical expenses that are more negotiable than others?

[Jared Walker]

I would say you have a really good chance with hospitals if you're going to, you know, physical therapy or you're going to the dentist or you're going to, you know, it might be a little bit more hit or miss. I mean, most of the time we're dealing with hospital bills and bills within hospitals. So imaging or labs or the bill that I mentioned earlier, the thirteen hundred dollar bill, that was down to three hundred, that was labs. Just, you know, labs at the hospital. So I think that once you start getting into smaller clinics and stuff like that, you're probably going to have a harder time negotiating. But, you know, typically, those bills aren't tens of thousands of dollars, right? They're. They're usually more affordable. So I would say hospitals are kind of where we see the most success.

[Amberly Grant]

So I have a very important question before we go on to the next one. When you call, do you end up crying on the phone every single time, or is that just me?

[Mindy Jensen]

That's just you.

[Jared Walker]

I've gotten pretty frustrated with People on the line. But I, I, you know, I have a couple videos on this where it's like, okay, how kind can I be to this person? And also, like, I do want to tell them my situation. Like, you are. You are talking with another human. The odds are the person on the other line has been in your situation. Like, medical debt is something that is. Is a big fear and for. For a lot of people. And again, number one, cause of bankruptcy. And a lot of people deal with it. So I think that you can appeal to their emotions as well.

[Amberly Grant]

So it sounds like for you, he said, be nice, appeal to them, and then hopefully they'll be able to help.

[Jared Walker]

Yeah, absolutely. And I think, you know, there are times I'm. Even when I. When I talk to people, I will crack jokes. I will, you know, I'll be like, hey, like, I know that I'm being that person. I know that I'm being annoying right now, but, like, I'm gonna need to talk to your supervisor, like, it. Or whatever it is. So, like, most of the time, I feel like they are able to do this, but obviously they've been trained to not, you know, negotiate too much or whatever. But, you know, typically, if. If you are persistent enough, you can get it. And it. There have been many times when I start, I say, okay, what's the settlement amount? And they'll give me an amount, and I will say, okay, well, that's not good enough. I'll call back later, and I'll call back the next week. And if I've done that, I don't know, three, four, or five times, and until I get a number that I. Because that's the thing is, I've gotten in trouble for saying this, but I stand by it. Like, these are fake numbers for the most part. Like, they can be negotiated down almost always. If they're gonna, you know, give you 10% off right away, you could probably get 30 or 40% off if you. If you wait and you have time and again, you have the cash. It can be annoying and it can take a while, but you can save a lot of money doing it.

[Amberly Grant]

We have to take this one final ad break, but more amazing tips for negotiating medical bills after this.

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[Mindy Jensen]

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[Amberly Grant]

I'm just going to show how crazy those numbers are, which is I'm Canadian. I had to go back to Canada for a visa. Reason for my husband and we had our baby in the US But I wanted to get Canadian numbers for having my baby just in case I had to pay out of pocket because something happened and I ended up in a hospital there. So I call them, I say hello, I'm Amberly, I'm going to I what is the most I'm going to pay for a C section if I come to your hospital, they say one second, put me on hold, come back clearly looked at numbers and said $5,500.

[Mindy Jensen]

What?

[Amberly Grant]

Yes, $5,000.

[Mindy Jensen]

Mindy I had two C sections. They were not $5,000. Those bills were shocking.

[Amberly Grant]

The average cost of a C section in Colorado is 35 to $50,000. I decided I was going to do an experiment and called the hospital in Colorado and say, hey, what would it cost if I were to show up and do a C section without insurance? We can't tell you that. We can't tell you. You'll have to find out at the end of it. Right. And so just that, you know, when you, you said at the very beginning, and I felt it was so it resonated with me and others is that when you go into an emergency, you also go into that financial emergency. So health and finances are intertwined in the United States and that's such a difficult place to be. Where in Canada. Knowing that, that bill, I would. I know what the number is. I know what would happen. Made me feel at ease, more at ease than going into the United States and having my baby down there. So thank you for, for mentioning that. Though you might get in trouble for saying that. They are made up numbers. I think that's a really good representation of, you know, that's cash prices. Right. There are totally different.

[Jared Walker]

Yeah, the cash price. I mean, there have been times where like, I have health insurance and I will go and ask. So this is always like, freaks people out. But I will tell them, like, I don't want to apply my insurance here because I would rather pay the cash price because the cash price is cheaper than if you were to apply my insurance. So that's another. You know, obviously that's kind of. A lot of people are usually dealing with this after the fact. It's an emergency. They're not like shopping around or whatever. But there, there are ways to keep the cost down on the front end as well. And then. Yeah, you mentioned health and, and money. Yeah, they are intertwined. And you have so many people that I think it's one in three Americans that just neglect care that they need because of fear of the cost, which that shouldn't be happening. And then getting the bills is. A lot of times it impacts people's mental health and stress and anxiety and all that.

[Mindy Jensen]

So, yeah, Jared, I know that we've asked you a ton of questions today. What are some of the most frequently asked questions you get that maybe we didn't think to ask?

[Jared Walker]

Yeah. So a lot of times people think that you're not able to apply for hospital financial assistance if you have insurance. So most of the time that's not the case. You can apply. And if you have, let's say you have a $5,000 deductible in a year eligible for charity care, the hospital would actually Waive that amount. So don't disqualify yourself again. I, you know, I said that earlier. You know, sometimes hospitals will deny for certain reasons. The most common is that you're out of the income range. But there are other things like you're not a resident of the state or, or something like that. So if you are, let's say you're traveling and you have an emergency, that is something that we, we fight for patients and we usually get those overturned. When you're filling out these applications, there's a lot of things that it seems like the hospitals are trying to like, get you on certain things. That is why, you know, it's good to work with an advocate. And $4 is a free service. We are a nonprofit. All the stuff that we do is completely free, no strings attached. So we do not charge to help with, with medical bills.

[Mindy Jensen]

I love that. How do you generate income?

[Jared Walker]

So we are 100% funded through philanthropy. It is all donations. So you know, we've been able to turn every dollar donated into a little over 20 DOL medical debt relief for people. So I would say like we're a really efficient non profit. We have kind of two big expenses. We have our staff and we have the tech that, that kind of runs it and, and you know, makes it so that we can efficiently do this work and that that costs money. So we, we raise money from donors and foundations and all that.

[Mindy Jensen]

That's awesome. I really, really appreciate your time today, Jared. This was incredibly informative and people can find you@$4.org all right. Thank you so much for your time today, Jared. I had such a great time talking to you and we'll talk to you soon.

[Jared Walker]

Thank you so much for having me. I appreciate it.

[Mindy Jensen]

Amberly. That was such an amazing episode. I absolutely loved everything that Jared had to say. I loved his tips. What implications do you think this has for financial independence and the community in general?

[Amberly Grant]

One thing I want to talk about before we even go into that is we need hospitals. And as much as we are maybe saying that they have these bad practices, I do want to acknowledge the fact that this is something that's important, important to all of us in our everyday life, especially in emergency situations. And we wish it were different, but it is a necessary part of our life when it comes to financial independence. There are so many tricks and tips that he told us that we can do to lower our healthcare costs in retirement. When someone is leaving a W2, they normally have really good health insurance and then they go to maybe a lesson Great health insurance. Depending on a marketplace, there's a really great option he mentioned of paying cash. So first of all, asking what is the cash price versus the insurance price? Because if you don't think you're going to max out your deductible, it might not make sense to put money towards it and instead pay cash. So just that alone as an early retiree, and I might be pulling from my HSA at that point or something else, I think that's a really good tip. Reduce those expenses in the the moment by choosing a cash buy.

[Mindy Jensen]

Yeah, I love that. I think that's a great tip. I had never heard of hospital charity care and I have been in the hospital, I think three times in my life and that never came up, not once. And I wasn't in this financial position at either one of those three times. So I think that that is unfortunate that they don't share this more willingly, but it's fortunate that $4.org does. So I'm glad that he was able to share that with us. Asking what the settlement amount is. Once you have the bill in hand, if you haven't already asked for the cash price, if you can get a big discount, jump on it and pay it.

[Amberly Grant]

And especially with early retirees, we have cash on hand, so more than likely we can actually pay that bill right up front. Like, you know, he was saying that some people don't have that cash. We do. And so we have that. A benefit of us retiring early and having the cash available is to pay that bill. When they say, hey, it's 40% lower. Pay it today. We got it.

[Mindy Jensen]

You know what else we have on our hands as early retirees? Time. So we can ask for an itemized bill and then take the time to go through it. I didn't have a prostate removal here, you know, I didn't have in my appendix out. That was in 1997. So just going through the bill, everybody makes mistakes. People entering the bills are human. I would not characterize it as the hospital is just trying to sneak one past you, but it's your right to have an itemized bill in hand and it's going to be like this thick. The bill is just going to keep coming and coming. But going through that bill. I don't remember this. I didn't have this. I didn't have this. At least you get those incorrect items off the bill and then you can start negotiating. You don't want to negotiate on the whole thing and then discover issues.

[Amberly Grant]

Yeah, I thought the bill that they sent Was itemized because I had listened to his TikTok and was having my first baby and thought, okay, I can apply this. And turns out I wasn't even looking at the right places. So it's really cool to know that you can reach back out, ask for an itemized bill. And then as we know, CPT codes, which are current procedural terminology codes, you know, all reference one specific experience in the hospital. So it can be your ultrasound, it can be whatever else you might be getting. And so you can see exactly what they said they did and did they actually do that thing? So that's what you would look is look at those CPT codes and compare them and you can even Google CPT codes. I've done that recently to see what it is that that code actually refers to.

[Mindy Jensen]

Yeah, and those are universal. Like CPT code 915 is the same thing in every hospital, in every doctor's office. If that's, I don't know what 915 is, but they are universal. So you can look that up and be like, no, I didn't have this done, or yes, I did have this done, then move on to the next one. Another tip he gave us was that were you charged multiple times for the one thing? Let's say you had an epidural when you had your baby. Did you have one epidural or did you have 14 epidurals? Did you have a private room? No, I was in a semi private room. Or, you know, are they charging you with the C section when you actually had a vaginal birth? There's all sorts of mistakes. I'm sure those codes. It's just a fat finger. I meant to hit 915 and I hit 925 or I hit 917. It's so easy to make a mistake that could cost you tens or hundreds of thousands of dollars. Double check it. Ask for an itemized bill. That should be the first thing that you do when you get a bill like that.

[Amberly Grant]

The last thing I can think of for us early retirees is that we have a very close knit community. I know of three people who will hop on a phone call with me while I call the hospital and give me some support. So if you are in a position where you do end up crying all the time when you're calling them or you feel overwhelmed or you don't know what to ask, find a friend and have them on the phone with you. My friend Kim will do this and she'll literally hop on the phone, help to ask the right questions, making sure. The conversation's going in the way that it should and so take that time. Phone a friend.

[Mindy Jensen]

Yeah, I love that tip. I know that you are going to cry about this, so I'm going to come over, I'm going to be there, and when you're breaking down, you can say, you know what, I'm going to give the phone to my friend Mindy. She's going to ask on my behalf. You have my permission to speak with with my friend. And then I'm not invested in it, other than I want to make sure that you're okay so I can ask these questions. What is the settlement amount? Can you give me an itemized bill? Can you explain this to me why we're being charged for these things? When I don't have a skin in the game on this, then it's a lot easier for me to ask those questions. I'm not getting as frustrated as you might be because ultimately it's not my money.

[Amberly Grant]

It's so much easier to negotiate on someone else's behalf than your own. So I think that that's a really great suggestion. Telling them they can speak for me and giving that permission. Yep.

[Mindy Jensen]

Amberly, I thought this was an awesome episode, but I think it's time to get out of here.

[Amberly Grant]

See ya.

[Mindy Jensen]

All right, that wraps up this episode of the Bigger Pockets Money podcast. She is Amberly Grant. I am Mindy Jensen. Saying after a while, crocodile, want to.

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