The first time I figuratively, not actually, met Marshall Allen was the day he did not meet Dave Chase for lunch. Dave was in Manhattan, and he was supposed to meet up with Marshall. But something happened, and Marshall was unable to make said lunch. So, I filled in for Marshall, who I had never met at that point.
I zipped uptown to have lunch with Dave instead. We simply could not have Dave Chase eating lunch alone in my home city, I guess; and I was extremely pleased to ensure that that did not happen. Anyway, of course I met Marshall after that—I mean, being his standby and all. This was, I’m gonna say, 10 years ago or more.
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So, when I saw the beautiful words that Dave Chase had written about Marshall after his death in May of this year, 2024, of course I asked Dave if he wouldn’t mind coming on Relentless Health Value and saying a few words about Marshall and his legacy.
After Dave talks, I have teed up an earlier interview with Marshall that originally came out on Relentless Health Value after his book launch. I am sure that listeners of this show have heard Marshall speak many times, but I’d encourage you to listen all the same because this is Marshall talking to the healthcare industry. By that, I mean he’s talking to us listeners of the show; and it was a little cathartic (for me at least) to actually revisit.
If anyone is interested in supporting Marshall’s legacy, please subscribe to the content available at Allen Health Academy and consider purchasing access for employees. This is likely the best way to honor his legacy and amplify his work as a catalyst for change and to empower patients.
And from all of us at Aventria Health Group, our hearts go out to Marshall’s family.
Dave Chase: I was honored to be asked by Stacey to share a few memories on our friend Marshall Allen. In my role as founder of Health Rosetta, I had the privilege of working with Marshall quite a lot on different reporting stories that he did, and I was honored to be able to join his family and friends at the celebration of his life.
It was certainly a sad day for all of us on Sunday, May 19th, when we lost Marshall. Let me just share what I think about Marshall. He was a dedicated journalist and also a former member of the clergy. He had an unwavering commitment to investigative journalism that really left an indelible mark on the healthcare industry.
He was really a relentless voice for the little guy. He shed light on price gouging, sloppy billing, fraud, conflicts of interest, insurance denials, and unnecessary treatments that preyed on Americans in our most vulnerable moments of our lives when we’re in the healthcare system.
Marshall had a passion for justice and transparency, and it wasn’t just a professional pursuit. It was really a personal mission. Marshall’s work was driven by a deep-seated desire to help individuals and employers understand and navigate the convoluted healthcare system and really about empowering them to overcome its many injustices and win in the process.
His impact went beyond just great reporting and fascinating stories. He had a huge impact on healthcare legislation. One of Marshall’s most significant contributions was his yearlong investigation into the health insurance brokerage industry, which culminated in the publication of a pivotal article in ProPublica.
That investigation caught the eye of Senator Lamar Alexander, who was leading the Senate HELP Committee at that point in time, as well as on the Democratic side, Senator Patty Murray. They were seeking areas of bipartisan agreement, and the insights from Marshall’s work played a crucial role in drafting and eventual passage of the Consolidated Appropriations Act of 2021 (really a key part of that), regarded by many as the most consequential employee healthcare legislation since 1943.
He didn’t stop there. He wrote a book. Never Pay the First Bill is a tremendous resource for patients navigating the complexities of the healthcare system. It equips families and employers with the knowledge and strategies to fight back against unjust medical bills and practices and promoting a sense of empowerment and advocacy in the process. He also edited two healthcare books by Marty Makary, MD. This further cemented his legacy as a thought leader and communications leader in the healthcare industry.
After the success of his book, Marshall founded the Allen Health Academy. This is a platform dedicated to educating and empowering individuals to take control of their healthcare experiences. This really reflects Marshall’s enduring commitment to making healthcare more accessible and fair for everyone, especially the most vulnerable.
And anybody who knew Marshall knew that he was really on a moral mission rooted in his faith. It played a significant role in shaping his character and his work. In his New York Times piece entitled “The Biblical Guide to Reporting,” he shared how his five years of Christian ministry enriched his journalistic practice, fostering a sense of compassion, integrity, and dedication to truth.
He wrote his years in ministry made him a better journalist because he was a Christian, not in spite of it, is how he put it. It soured him to see people “getting beaten down by the system.” Marshall Allen’s legacy is one of courage, integrity, and relentless pursuit of justice. His work has not only illuminated the dark corners of the healthcare industry but has also inspired countless individuals to stand up for their rights and demand better, not to mention many journalists following in his footsteps.
As we mourn his loss, let’s celebrate the remarkable impact he had on the world and take solace in the lasting changes he brought about. Marshall will be deeply missed, but his contributions will continue to resonate for many years.
One of the people that Marshall was closest to as a friend and as an editor was Dr. Makary, and I’d like to wrap up with what Marty shared in a post announcing Marshall’s passing. “In his final hours, this is what I told him: Marshall, we watched you fight tirelessly for the voiceless and become a fierce advocate for the defenseless—a fight many will continue. At every step along the way, you reminded many of us what’s really important. … Thank you, my friend, for being a role model to so many. … We will miss you dearly.”
I’d encourage you to bring some part of Marshall into your day every day, and it’ll be a much better day and you’ll have a huge impact on our nation. And once again, thank you for the opportunity to share a few thoughts on Marshall. Thank you.
Stacey: Today, I’m interviewing the incomparable Marshall Allen. His book, Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win, a book with that title being on the New York Times best seller list, has implications to healthcare leaders. Marshall’s book is an instruction manual for patients on how to fight back against unfair and/or egregiously inaccurate bills.
This interview with Marshall Allen is different from others that you may be hearing. Because listeners of this show are healthcare executives, I wanted this interview to be relevant to you. What does this book mean for you? Doug Aldeen told me one time, unless something has a direct impact on the CEO or leadership team at a health system or insurance company, they’re just bored. Let me sum up this interview in one sentence: This is not boring.
If you want to skip to the exact examples of not boring, you can skip ahead to about the 28-minute mark. We go through the ways that health systems can and probably will be hurt by the financial toxicity that they create. Here’s the three-ish ways that Marshall and I talk about:
1. Doctors who no longer trust their employers (ie, the health systems they work for) leave, and then you have to recruit new doctors—#problematicandexpensiveonanumberoflevels, but I don’t need to tell you that.
3. Employers and taxpayers reading best-selling books like this one and Marty Makary’s (which also is or was just recently on the best seller list)
Additional links mentioned in this episode: Healthcare Dive, Kaiser’s Bill of the Month
You can learn more at Allen Health Academy and on Marshall’s site.
Marshall Allen spent more than 17 years investigating the healthcare system as a journalist. He is the founder of Allen Health Academy and the author of Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win. His book and his health literacy videos, The Never Pay Pathway, are helping working Americans save hundreds and thousands of dollars—per healthcare encounter. Marshall is a two-time finalist for the Pulitzer Prize and winner of the Harvard Kennedy School’s Goldsmith Prize for Investigative Reporting and dozens of other journalism awards. For more information, visit allenhealthacademy.com.
“How does this affect the people who are paying for it and the people who are undergoing the care?”
What are the first-order and second-order consequences of what’s happening in health care right now, and which of these consequences will actually drive change?
“When you tell the truth about what’s going on … they become so ashamed … that they change their behavior.”
You know why I’m interested in the Particle v Epic EHR (electronic health record) systems lawsuit? It’s because … data. Say I’m thinking about this like, say, a plan sponsor and I want data so I can do better population health or do care navigation to help my members avoid downstream bad things or …
The American healthcare system is broken. With rising costs and decreasing coverage, many Americans feel powerless against insurance companies and healthcare providers. But there is hope – you can fight back against predatory billing practices and get the care you deserve.
In his book “Never Pay The First Bill” investigative journalist Marshall Allen provides practical strategies for pushing back against the healthcare industrial complex. After 15 years of investigating the health industry Allen reveals how individuals and employers have succeeded in forcing providers to play fair. This article summarizes his key insights from the book and provides tips for protecting yourself from billing errors, price gouging, and insurance denials.
Know Your Rights as a Healthcare Consumer
The first step is understanding your rights under the law Federal and state regulations protect patients from certain unethical billing practices For example
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You have the right to an itemized bill, so you can verify charges line-by-line.
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Providers must provide prices for procedures upfront upon request, allowing you to shop around.
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You cannot be charged more than your in-network co-pay/deductible for emergency care, even at out-of-network hospitals.
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Medical debts cannot be reported to credit agencies without notification.
Knowing these rules prevents providers from exploiting patient ignorance. Don’t be afraid to invoke your rights and appeal charges you view as unfair.
Scrutinize Medical Bills Closely
Always inspect medical bills closely before paying. Errors are common – one study found 80% of medical bills contain mistakes. Watch for:
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Duplicate charges: You get billed twice for the same procedure.
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Upcoding: Billing for more expensive services than provided.
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Phantom billing: Charging for services never performed.
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Incorrect coding: Using the wrong billing code for your diagnosis.
If you spot any suspicious charges, call the provider to dispute. Being an engaged patient minimizes overpayment.
Get Itemized Codes Before Services
To prevent billing surprises, always obtain procedure and diagnosis codes beforehand when possible. Diagnosis codes justify medical necessity to insurance while billing codes determine what you’re charged.
Armed with the codes, call your insurer to check coverage and estimate out-of-pocket costs. Verify the provider is in-network. Doing this homework protects against unexpected bills and enables smart decisions about your care.
Negotiate With Providers
Most patients simply pay the billed amount. But providers expect patients to negotiate – they inflate initial bills knowing insurance will haggle them down.
You should negotiate too. Explain your financial situation and inability to pay. Many facilities offer generous charity care and prompt pay discounts – you just need to ask. Negotiating shows you’re an empowered consumer unwilling to be exploited.
Utilize In-Network Labs and Facilities
When hospitalized, request your doctor utilize in-network facilities for procedures like imaging and bloodwork. Even if the hospital is in-network, out-of-network labs and clinics within the same building can lead to extra charges.
Check that each provider entering your room is in your insurance network. Kindly request in-network providers if not. Avoiding out-of-network bills prevents thousands in surprise costs.
Fight Insurance Claim Denials
Insurance frequently denies claims for dubious reasons or inadequate documentation. But you can fight back and win coverage.
First, get the denial code from your insurer along with their guidelines for approving that service. Then, ask your provider for help contesting the denial – they know how to word appeals to insurers. With persistence, many initial denials are eventually overturned.
Request Case Management
For complex medical situations requiring extended treatment, ask your insurer for case management. A case manager becomes your personal advocate, coordinating between providers to streamline care and reduce costs.
Case managers can guide you towards in-network facilities, set up provider payment plans, and assist with appeals. Their involvement can mean the difference between financial ruin and managed expenses.
Negotiate Payment Plans
If saddled with a burdensome medical debt, negotiate an affordable payment plan. Many hospitals and clinics offer zero-interest plans allowing you to spread costs over months or even years.
Clearly explain your budget constraints and ask for a plan matching your ability to repay. Being transparent about finances often leads to an arrangement that works for both sides.
Seek Legal and Financial Assistance
Nonprofit organizations assist patients struggling with medical debts. For example, legal aid societies provide free legal services for those meeting income requirements. A pro-bono lawyer can give guidance on contesting problematic bills and liens.
Religious institutions and crowdfunding campaigns also offer financial assistance for those dealt devastating medical debts. Do not hesitate to seek aid from your community when blindsided by costs.
File Complaints About Bad Actors
If facing truly unethical billing behavior, file formal complaints with oversight bodies like state insurance commissioners and Attorneys General. These agencies investigate and punish wrongdoing – your report helps protect others from being exploited.
You can also report hospitals to the IRS for aggressive collection tactics against low-income patients. Nonprofit hospitals risk losing tax-exempt status if proven indifferent to community needs.
Partner With Your Employer
Employers have leverage to demand fairer prices and billing practices from providers. Approach your company’s HR department about renegotiating contracted rates to reduce out-of-pocket worker expenses. Suggest they implement steps like requiring binding cost estimates before major procedures.
Band together with co-workers affected by unreasonable charges to lobby leadership for change. Employers aiming to attract talent are increasingly willing to amplify employee voices.
The Bottom Line
The healthcare system wants patients to feel powerless, overwhelmed, and unaware of their rights. By becoming informed advocates for ourselves and partnering with allies, we can fight back against predatory billing practices. While the process takes persistence and courage, we can negotiate a more affordable and equitable system when equipped with knowledge and community support. The information in this article will hopefully provide a starting point for claiming your voice as a healthcare consumer.
