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Americans and Crushing Medical Debt with Dr. Virgie Bright Ellington

by Jen Barna MD, Courses and Coaches, Financial Independence, FIORE and FIRE, Money and Finance, Podcast

Dr. Virgie Bright Ellington and Dr. Jen Barna shed light on crushing medical debt.

“The concept came to me for a book series, or media series, called What Your Doctor Wants You to Know when I realized that I was having the same conversation with patients and there were just things that I wanted to scream from the rooftops.”

– Dr. Virgie Bright Ellington, Internal Medicine Physician and Author of What Your Doctor Wants You to Know Book Series

Approximately 8-9 medical bills out of 10 generated in the U.S. contain errors that do not benefit the patient. Today, DocWorking brings guest speaker Dr. Virgie Bright Ellington, MD and author of her book series What Your Doctor Wants You to Know to Crush Medical Debt onto the podcast. CEO of DocWorking and cohost of the podcast Dr. Jen Barna has an informational conversation with Dr. Ellington about how you can best confront medical billing to assess for errors. The passionate Dr. Ellington speaks with listeners about her book series and the steps she encourages you to take to tackle medical debt. Hear how Dr. Ellington’s background in internal medicine and balancing work and life as a doctor mom inspired her to write this book series.

What Your Doctor Wants You to Know to Crush Medical Debt: A Health System Insider’s 3 Steps to Protect Yourself from America’s #1 Cause of Bankruptcy by Dr. Virgie Bright Ellington

Virgie Bright Ellington, MD, is an internal medicine physician and medical billing expert. A dedicated patient advocate, Dr. Virgie earned her degree at the University of Michigan Medical School and trained at the Cambridge Hospital of Harvard Medical School.

 

After practicing more than 20 years in primary care and psychiatric settings and as a health insurance executive, Dr. Virgie now helps patients understand complex medical procedures, communicate effectively with their healthcare providers, and avoid financial devastation from crushing medical bills through her What Your Doctor Wants You to Know series. She also hosts a weekly radio show on VoiceAmerica by the same name. Dr. Virgie is a former NY1 News health contributor and has been featured in Dallas Fox News, several podcasts, and national magazines.

 

Dr. Virgie lives in Westchester County, New York, with her husband and three children.

 

Learn more at www.crushmedicaldebt.com.

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Podcast produced by: Mara Heppard

Please enjoy the full transcript below

 

Dr. Virgie: The concept came to me for a book series or a media series called What Your Doctor Wants You to Know, when I realized that I was having the same conversations with patients. And there were just things that I wanted to scream from the rooftops.

[DocWorking theme]

Jen: Welcome to DocWorking: The Whole Physician Podcast. I’m your cohost, Dr. Jen Barna and I’m thrilled that you’re here with us today. Thank you for listening and I’m excited to bring to you our guest today, Dr. Virgie Bright-Ellington, a physician who has also become an author and has written a book called What Your Doctor Wants You to Know To Crush Medical Debt: A Health System Insider’s Three Steps To Protect Yourself From America’s Number One Cause Of Bankruptcy. Dr. Virgie Bright-Ellington, welcome to DocWorking: The Whole Physician Podcast.

Dr. Virgie: Thank you so much for having me, Dr. Jen. Much appreciate it. I’m excited to talk to you guys. What you guys are doing is good stuff.

Jen: I’m so excited to speak with you as well and I am very curious about your story of what brought you to write this book and your experience as a physician.

Dr. Virgie: I did my residency at the Cambridge hospital of the Harvard Medical School System in Cambridge and finished in, I never said I would date myself, but I have to. ‘96 is when I finished my residency. And so, it’s a primary care residency. The residency is actually a formal internal medicine residency, but because the hospital facility had an inpatient psychiatric program for their psychiatrists in training, we had to staff, or on-call, the overnight shift for medical issues for the inpatient psychiatric floors of The Cambridge Hospital. Actually, my board certification and training is only in internal medicine, I got a good amount of psych in there. So, that was good stuff. I appreciated that.

Jen: So, tell me about how that played into your decision to become an author? How did you go from practicing for a number of years to deciding to write the book?

Dr. Virgie: Dr. Jen, it’s been a journey. It seems maybe 10 years ago, 15 years ago, but ‘96 was a good amount of time ago. Lots of changes. My intent when I went to medical school and decided to become a physician was to do geriatrics. I was a kid and wanted to work. I was 14 and I wanted to work to go out. I lived in a rural area. There wasn’t a lot of people to interact with. I wanted to get a job. I think they allowed you to have permission from your parents, you had to be like, 16. I said to my mom, I said, “Well, just lie for me and say I’m 16.” My mother was like, “No.” 

I looked around at that. Well, I can be a candy striper. I was a candy striper volunteer in this nursing home and I saw this guy in a lab coat walking around and going from room to room. I realized that that is the doc, that’s the physician for all of these people and he gets paid. He gets to walk around and talk to old people all day. I thought, “Dang, that’s it. That’s what I want to do.” Now, I was a kid. And I tell people it doesn’t matter what my name is. I’m not the brightest bulb in the building. I was not a bright kid. I didn’t know that there was more to it than just talking to people being a physician. But that’s why I went into and I thought I was going to be a geriatrician. 

But in my training and residency, I realized that no one wants to take care of seniors, so I didn’t have to take the extra time to do a fellowship and doing a living at fellowship training salary, like, a start at a junior tenure attending salary couple of years sooner so I just said, “Okay, I’ll do internal medicine.” The psychiatry was because when I moved away from—finishing residency and my husband at the time was finishing his training, we moved to his hometown in Youngstown, Ohio, didn’t have a lot of resources in terms of physicians. There was a family friend of his that needed someone to cover medications for his psychology therapy practice. I thought, “Okay, I can do meds.” That’s what I do. I can do some psychopharmacology. And so, that’s how I ended up doing a lot of psychiatry work. There’s really just prescribing meds for taking over for a psychiatrist who was leaving and they needed someone to continue and monitor the psychopharmacology. So, that was my background. 

Fast forward, I have to tell you, Dr. Jen, I knew that when I had kids that I wasn’t going to probably do clinical medicine, it seemed weird at the time. But I really felt that what I would like, to be able to have income without having to charge for my clinical services, and  had this idea back when I was at the Cambridge Hospital, and the attending physicians patted me on my head and said, “Oh, cute kid, that’s not the way the world works. One of the things you can do is, you can be an employed physician at a public hospital like the Cambridge Hospital.” And so, I said, “Oh, okay. That’s a good point.” I thought I would always be an employed physician. What I did was make sure that I participated in all of the – from the very beginning maxed – out my 401(k) opportunities for a government facility which the Cambridge hospital was is a 403(b). 

I always tell folks, “Max it out because it gives you while you’re busy working, you’re going to look up one day, it’s 10 years past and this is grown or at least you have a stash that you can actually have options, you can do things. So, put that as an aside.” Fast forward, my kids’ dad and I moved to New York City to Manhattan. There was a position he got there. And our kids were born. I realized, you know what, I felt trapped working a nine to five or ten to six, whatever, in an office every day. I thought, “Wouldn’t it be nice if I could figure out how to be a physician and use my physician brain and help people working from home?”

The concept came to me for a book series or a media series called What Your Doctor Wants You to Know, when I realized that I was having the same conversations with patients. And there were just things that I wanted to scream from the rooftops. At the time, now, this was in the naughts, so, like, between 2000 and 2005 or 2006. I wanted to tell folks things like, “Look, ladies, cervical cancer is an STD. Make sure you get your Pap smears. It’s an STD.” What your gynecologist wants you to know, things like that. That was actually the first book, The first book was released in early 2009 and it was called What Your Doctor Wants You to Know But Doesn’t Have Time to Tell You.

And unfortunately, my father passed away suddenly at that time and all of my plans to do like, book tours and all that stuff just went out the window. And I realized my marriage was in trouble. And I realized I was going to have to be head of household. So, I had to go out and get a real job with benefits and that kind of thing for my kids. We were very young at the time and that’s what I did. And so, I worked for an insurance company doing case reviews for what’s called appeals. When I told people that I was going to work for an insurance company to do case reviews, they automatically think you’re going to the dark side.

I have to say this particular insurance company I went to it, was probably the only insurance company that I would work for. I thought they were very honest, upfront, and I just didn’t think they were part of the dark side. So, anyway, I join this insurance company and I always tell people, “I’m Dr. Maybe. I’m not Dr. No, I’m Dr. Maybe.” Meaning, I joined their appeals department. I wouldn’t do UMUR, I just couldn’t do that. UMUR is Utilization Review and Utilization Management. So, those are the horror stories you hear about with where they say,I can’t be Dr. No, where they say, “No, you don’t meet the criteria. No, you can’t stay longer.” “No, no, no, no, no.” I just couldn’t do it.”

The department that I joined was the appeals department. That’s why I said, “I’m Dr. Maybe.” The appeals department has when you have a claim that’s been denied by the company, the insurance company, they say doesn’t meet criteria for whatever reason and you appeal the decision. My job is to say, “You know what, oh my gosh, I reviewed the records. You’re absolutely right, this should have been covered. Let’s get this covered for you.” Or, “You know what, dude, this is never going to be covered. Just let it go. This is not going to happen or next time if you send us this or if we’re requesting this, maybe we can get it covered for you. Maybe we can support the criteria that’s needed to have it covered.” So, that’s what I mean by Dr. Maybe and I work for the appeals department. 

And over time, I developed a niche. I was hired to do case reviews which is a productivity job. Let’s be very clear. At the time when I joined, there was a quota that was on the books that you had to get through, certain number of cases per week and then they quietly removed it. Because they realize to do quality work, you have to take time to look at the medical records. Okay, so great. But during that time, over the 10 years I was there, I started to take on a completely different set of responsibilities, which was to teach the enterprise particularly the nurses, the clinicians, who were doing the frontline case reviews, coding. I was a coding SME, Subject Matter Expert. And then I got into DRGs, which is inpatient hospital claims and really loved it. It was awesome. It was great until I hit the wall.

Dr. Jen, you and I were talking a little bit right before we went on. I would say, the generation, the millennial generation of docs, they figured it out that it’s not appropriate for us to work in the days when I was talking to about a colleague of mine who was older. She’s an infectious disease doc who came of age during HIV and she’s still working. I have a radio show on Voice America and I had her on as my guest talking about updating us on monkeypox and COVID. She was talking about the difficulty she’s having because she and her colleague that started their practice are trying to retire. They’re very much ready to retire and they are having a hard time recruiting young docs to take their place because of the work hours that physicians have been told that that’s okay to do.

And so, I wanted to give major kudos to you guys for this work that you’re doing with the podcast with DocWorking, because it’s being very clear that there needs to be a balance, there needs to be a life. And without a life, you’re just going to burnout. When you burnout, that is taking away from folks that you could help. There’re so many things you could have done to help people. You’ll never know how many folks that would be touched and cared for, and how many lives you would frankly save by just being there. So, you can’t allow yourself to burnout. So, we talk about this a lot but it really has to apply to us. You can’t take care of anyone else if you don’t take care of yourself and we have to have that balance.

Jen: You’ve touched on a number of things that are really important. You mentioned that it is really critical to think about how you structure the balance in your life, and I think you’re absolutely right that making options for yourself by setting yourself up for financial security from as early as possible. One thing I often talk about is the FIRE movement, which is something that I’ve been interested in for years and financial independence and retire early movement, and for physicians I like to call it financial independence with the option to retire early with a big O, then you really can choose what to do and it’s more intentional. As a mother and then becoming a single mother, you really had a lot on your plate to balance and how you manage to walk that tightrope and find solutions that worked for you. I’m always really interested in hearing about that because I think there are a lot of people listening who are saying like, “How are other people making this work?” It sounds like you found a way to make it work and that was through working for an insurance company.

We may have to have you come back and to have a whole conversation about the specifics of how to do that because I think there are a lot of people who are interested in utilization review whether it’s a side gig or whether it’s a full-time gig, just the logistics of how to become a physician author. Because you recognize that as a potential opportunity to have a work from home type of a setup, which I think again, a lot of our listeners are just wondering like, “But how do you actually do that? How do you take that idea and make it a reality?” So, those are things that I think we’ll have to revisit because I also want to hear about the book here, which I think is another really important topic, especially in the context of our healthcare system.

The number one cause for bankruptcy in this country is paying medical bills. I think a staggering problem that we should at least pause and recognize. Other countries have found a way not to have that problem. And so, this is something that we have basically created for ourselves. I do think it’s really, really important the work that you’re doing to let people at least have some steps and a path to help them try to work their way out of a terrible situation. 

Dr. Virgie: Folks in this country are hit with medical bills, outrageous medical bills that unfortunately, there’s too much of it that they don’t owe, because 80% to 90% of all medical bills in this country have errors. If you can imagine, they’re not going to be in the interest of the patient, they’re going to be in the interest of the provider and/or the insurance company.

Jen: Oh.

Dr. Virgie: Yes.

Jen: 80% to 90%? [laughs] 

Dr. Virgie: Yeah.

Jen: Make sure I heard that correctly.

Dr. Virgie: Yes, you heard it right. 80% to 90% say eight to nine out of every 10 bills as generated in the United States have errors that are not in the favor of a patient. Yeah, that’s really important and it’s how I got to what I’m doing now with What Your Doctor Wants You To Know To Crush Medical Debt. Yeah, I thought I’d seen the whole perspective of the US Healthcare System from 360-degree angles, Dr. Jen. I thought I’d seen, well, I’ve been a board-certified internal medicine physician for years and decades at that point, healthcare insurance executive for 10 years, I thought, “You know what, I’ve seen it all. I know how the system works in terms of billing and that kind of thing.” But it wasn’t until I became a patient that I figured out that, “Oh my gosh”. I had a roommate who had been taken advantage of by the hospital billing department. She told me that prior young mom, she wasn’t working outside the home, because her kids were just toddler age, and her husband worked at a 24-hour diner. So, there’re extremely modest means and didn’t have the resources to pay for daycare kind of thing, so she didn’t work outside the home and she’s telling me that when she was in the hospital prior the day of discharge, the hospital billing department rep came and said, “Before you can go, you have to sign this agreement that you will pay this amount, whatever the bill is and whatever your insurance doesn’t pay.”

I have to tell you, Dr. Jen, when she told me this, the curtain dropped, I saw red and I was enraged because I knew that she had just signed and she had been tricked into paying, essentially a lifetime of debt, agreeing to a lifetime of debt for her and her family’s future forever, and/or bankruptcy. And I thought, “You know what, Virgie, don’t get angry. Get to gettin’. Do something.” And that’s how Crush Medical Debt was born. So, that’s how the second book in this series, What Your Doctor Wants You to Know series came out. What Your Doctor Wants You to Know to Crush Medical Debt was born.

Jen: Can you tell us a little bit of an overview in terms of, I know the book itself in the title says there are three steps. Can you give us a little bit of information that would help us to walk away with something that we could put into action from–? [crosstalk]

Dr. Virgie: Absolutely, absolutely. I tell folks, and this is true, that there’s really only one right way to pay a medical bill, and that involves three steps. The first step is just a phone call and it’s a lot more simple than you think. Step one, pick up the phone and call the billing department or patient accounts department of the provider from whom you got the bill, from whom you received services, and make sure that you ask for a real bill, a real bill with CPT codes. I tell people, “You know what, you’re going to get all kinds of bills that say something like, ‘detailed summary bill’, or ‘summary bill’, or just ‘general bill’.” It doesn’t matter what they call it. Over time, I realized I just need to tell folks that if it’s not a bill, an itemized bill, if it doesn’t have CPT codes it’s not a real bill. First thing, call and ask for a real bill and have to use the term ‘with CPT codes’.

Now, you may get some pushback, you may hear things like, “Well, you’re going to have to ask your insurance for that. We don’t have that kind of bill here.” “You’re going to have to ask your insurance for that kind of information.” “Well, I don’t know what kind of bill, if we can give that to you. But you know what? I know that’s a lot that bill we sent you is for a lot of money, how about we transfer you to our team member who can work out a payment plan for you?” No. So, you may have to say, “I need an itemized bill or I need a bill with CPT codes as per HIPAA Federal Law.” Then everything drops. You’ll get your bill, your real bill with CPT codes. You’re going to take that and do step two. You’re going to take those CPT codes and google them to find out the description of the services that you’ve received. So, just sounds like something that you receive you’re not getting double billed or you went in for a hysterectomy and they said, “Oh, we’re billing you for hysterectomy and myomectomy” kind of thing. 

And you’re going to also google what Medicare pays for those CPT codes for those services. Because I call it that’s basically anything above Medicare rates you’re paying what I call MRSP. When you’re buying a car, full retail manufacturer retail sticker price, you’re paying 300% to 500% on average. Sometimes, a 1,000% more than what Medicare pays. And so, the argument, the providers medical systems will say, “Well, if everybody paid Medicare rates, we wouldn’t be able to stay in business.” I really don’t think that’s true. That’s another story for another day. You’ve got your list of services that you received and what Medicare pays for those services and that will take you to step three, when you’re going to call back the billing department and say, “Hey, this is what I’m able to pay. This is instead of $10,000, I think $3,000 is more accurate according to my research on my case, and I want an interest free payment plan that I can afford.” So, those are the three steps that we have to apply to each and every medical bill we receive to make sure that we’re not getting overcharged.

Jen: That is hugely helpful. Thank you so much for going through those three steps. And that really makes me wonder, too. When you see in the news recently where people have been charged these obscene amounts. And then in reading the articles, it surprises me that they don’t say that was incorrectly billed and so, what I’m wondering is if you could give us an expert’s opinion on what’s actually happening in those cases.

Dr. Virgie: Dr. Jen, I have to tell you, I talk about this in my radio show a lot. I have a segment, a regular segment that I call ‘medical bill mistakes of the week’. And I said, you know what, I’ve been doing this and I realize I’m calling it your mistake and if you think I’m going to pay this bill of the week. Because frankly, I’m realizing it’s not a mistake from their perspective. They know what they’re doing. It’s a high-level brief example. Why is it that there is such a thing as a bill that’s generated for the public that doesn’t have any CPT codes? There are zero payers, third party payers, zero insurance companies, private, public, commercial, government that will accept a bill, a claim, fancy name for bill, with no CPT codes.

I tell people, “CPT codes are just like barcodes when you go into a retailer or a store.” Every product has a barcode. You take it, you scan it through, and it gives you a general brief description of the product, and the price that the provider, the service provider in this case, a retailer is charging. Same thing with CPT codes. There is no payer that is going to even think– They’re going to be like, “What is this garbage?” There is just no such thing as a provider sending an insurance company, a payer, a bill or a claim that doesn’t have CPT codes. So, why would they generate one for the public, period? There should just be one bill. Why do they do it? Because it works. My point is, Dr. Jen, it’s not a mistake.

Jen: And when those egregious totals come up on a bill for something that seems simple and then you’re seeing at other institutions it’s a much, much lower price, what has happened in those kind of cases? How is that even possible that it could accumulate to these astronomical figures?

Dr. Virgie: There was a study that came out, I want to say in the past week, that demonstrated that for- profit hospital systems charges on average more than $1,000 more than non-profit facilities for their facility fees like, per case. That just gives you an idea. The differences essentially is what the, there are some market differences, but it comes down to what the market will bear. It’s a capitalist system. It’s a for-profit system. It’s a reflection of the hospitals that are caught in the middle of this for-profit system. I have a lot of mottos, Dr. Jen, and one of them is, “I never hate a hustler.” Don’t hate the player, hate the game.” Well, the providers and medical centers have to charge their MRSP, the retail manufacturer’s sticker price, this huge astronomical increase because they have to negotiate with the folks that run the US healthcare system, which is the for-profit, publicly traded, commercial insurance companies. That’s the issue.

So in order to be able to get their rates negotiated, something that the insurance company will say, “Okay, yeah, we’ll pay this.” They have to create this astronomical rate that’s just not meant to be real. It’s fictional, so that they have a negotiating point. But fast forward, for the rest of us that don’t have insurance, commercial insurance, cash paying, out of pocket paying, they’re going to send you their full MRSP, full retail sticker price. It’s an artificial made-up number to begin with. And that’s why I say, “Look, go back down to a real number and start at Medicare rates.”

Some people who are doing this, working with folks to help people struggling with medical bills in the medical financial literacy work say, “You know what, two times Medicare rate is a great place to start.” I’m like, “Okay, fine.” I think if it’s good enough for the government, it’s good enough for me. I tend to start at Medicare, but Medicare rate or two times Medicare rate is a good place to start your negotiation. The other numbers are fictional, just like the bills that are sent that don’t have CPT codes.

Jen: I think a lot of our listeners, even as physicians, I think this is really helpful information for us. For a lot of us, who are either employed or like me who just prefer to let someone else handle the billing, I don’t want to even think about that. I want to treat the patient however I see best and just not deal with that side of it. I think that obviously there are downsides to having that approach because when push comes to shove, we really don’t even realize what might be going on on the other side. So, some of the things that you’ve mentioned are eye opening to me and I hope they will be to our audience as well. For people who might want to reach you with additional questions and also who want to listen to your radio show, please tell us how people can find you.

Dr. Virgie: You can find me at voiceamerica.com and we’re not doing live shows right now. You can’t call in, but you can email in. Eventually I’ll start doing live shows. But in the meantime, you can email me with [email protected] and you can find me there on Thursdays at 5 PM Eastern, 2 PM Pacific. And you can find me otherwise at crushmedicaldebt.com.

Jen: We will also link to the book and to the radio show on the show notes. If you’re listening and you want to come back and click that link, you’ll be able to find it in the show notes.

Dr. Virgie: Yeah, thank you so much for having me. It’s been awesome talking with you.

Jen: And if you’re listening and you’re interested in learning more about how to put yourself in the driver’s seat of your own life and how to prioritize your own self-care in the context of a super busy schedule, one thing I hear all the time is people say, “I know I need this, but how in the world do I find time for it?” We have created DocWorking THRIVE specifically with you in mind. You can make progress in just a few minutes a week. Please check us out docworking.com and I really, really appreciate your insights and coming to talk with me about this. I’m excited to schedule some more conversations with you, because I think there’s so much to talk about here. We’ve barely scratched the surface on a number of different topics. So, thank you so much Dr. Virgie Bright-Ellington for joining me on DocWorking: The Whole Physician Podcast. 

[music]

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