Navigating Healthcare Costs on Your Wealth Journey
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Most hospitals in the U.S. are actually non-profits, which means they have to have financial assistance or charity care policies. This is because a lot of these non-profit hospitals get government grants or

funding. And because they are taking that federal money or even sometimes statewide money, they do need to have these charity care policies. If you make below a certain amount, the hospital legally has to waive your medical bill up to a certain percent. Sometimes that's 100%, sometimes that's 50, 75, 25. It's certainly worth checking. What's up, rich friends? Welcome back to another episode of Net Worth and Chill. I'm your host, Vivian Tu, aka Your Rich BFF and your favorite Wall Street girly. And it

It seems like everyone these days is talking about healthcare. What does your insurance even do? Why is everything so damn expensive? And why are there so many acronyms? This conversation was largely spurred by Luigi Mangione killing the United Healthcare CEO. And while certainly I'm not advocating for murder, a lot of the more muted and peaceful efforts

for a healthcare reform seem to have fallen on deaf ears. So this seems like a real wake-up call for citizens and legislators alike, 'cause it feels like regardless of political affiliation, everyone can agree that healthcare is too damn expensive. Americans are struggling through no fault of their own with the costs of living in the system, and 20 million people, nearly one in 12 adults, owe medical debt. The SIPP survey suggests people in the United States owe at least 220 billion.

in medical debt. Today, we're going to be diving into the world of healthcare to help you understand how plans and deductibles actually work, as well as some of my personal favorite tips and tricks to save on drug costs and procedures. Let's get started.

Let's get into it.

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All right, so first and foremost, let's cover what types of healthcare plans there are and what probably makes the most sense for you. My biggest nightmare, when I first started my job, I was trying to figure out what health insurance plan was gonna work best for me. PPO, HMO, HDHP, HSA, like, what?

What is with the healthcare industry and loving acronyms, huh? I like to give this as an analogy because I grew up in a household where my parents were Chinese immigrants. Remember when your mom told you that you could either do chores today and have fun tomorrow, or you could have fun today and you could do your chores tomorrow, but there was under no circumstances any chance for you to have two days of fun in a row? That's essentially how health insurance works, and it's a really easy way to remember.

So think of it as most to least involved. So most involved would probably be a PPO, middle an HMO, and an HDHP would probably be like a quote unquote least involved. And there are other plans aside from these three major types, but these are the most common. So we're going to cover these. Simply put, think about it like a sliding scale. And for those of you watching on YouTube, I'm going to put up a graphic somewhere around my head that you can reference on screen. But for those of you just listening in, just remember,

PPO, HMO, HDHP, most to least involved. The closer you get to a PPO, the higher your monthly upfront costs are gonna be, aka the premiums are going to be high.

But your patient responsibility later on will likely be less. On the flip side, on the right-hand side, closer to an HDHP, a high deductible health plan, you're going to spend much less upfront on monthly premiums, but you're going to pay more out of pocket later if you actually end up needing more care.

And typically, PPOs make sense for folks with a lot of upcoming medical expenses, things like pre-existing conditions, ongoing therapy, family planning, etc.,

Whereas high deductible health plans, HDHPs, make sense for folks who are largely healthy and they don't do too much beyond preventative care, like their annual physical and seeing their gynecologist for an annual pap smear. And maybe they have a one-off visit to their dermatologist. The reason why it's so hard for people to talk about health care in general or as a giant swath is because for most people,

it's not uniform. Our healthcare in the United States has largely been commercialized, so it's only as good as your employer is able to provide benefits. A PPO from one company can differ vastly from another company, and the same goes for HMOs and HDHPs. The coverage you're going to get at

a hedge fund or a Google or a major tech player might be really different than the one that you get at a medium-sized business that has 100 or less employees. So just think about this. Know that everything I say today is in general, but you may need to think a little bit more specifically for your own care. So let's get into all of the associated costs, and we're going to cover the one that you're going to see first. First, so monthly premiums.

When you sign up for your company's health care plan or you get health care through the Affordable Care Act or whatever, your monthly premium is basically what you pay for the privilege of having insurance. I'm going to be honest. For me, this often really just feels like I'm throwing money into a black hole, which is kind of the case. You have to pay for this even just to have insurance and be insured.

But in addition to that, you are going to spend money on something called a deductible. An annual deductible is essentially what you're responsible for paying before your health insurance starts to pay for most covered services. And you're probably wondering, hmm, why am I paying for health insurance to then again pay before it all kicks in? You're

You're asking a great question. I don't have a great answer, but you do have to pay this amount of money before your health insurance really starts to, and I quote, kick in. So deductibles are owed in addition to these monthly premiums, and it is an and not an or. Essentially how this works is your premium, along with a bunch of other people's, goes into a pot, and then the health insurance company invests it so that

when you eventually do need to call them for help and need help paying for larger medical bills, they'll actually have the money to be able to afford your conditions and your treatments. As an example, say you have a health insurance plan with a $1,000 deductible, 20% coinsurance, a $2,000 out-of-pocket limit, and a $2 million annual limit. Essentially what this would look like is for a payment process,

For the first $1,000, you would owe 100% up to that $1,000 deductible, with some exceptions, obviously, for covered services. But then between the $1,000 and the $2,000 out-of-pocket limit for treatments and procedures and things that you're getting, you would essentially pay 20% of that. And then essentially your health insurance would then be able to cover all other expenses once you'd hit your out-of-pocket limit and covered.

they would pay up to that $2 million limit. Again, there are caveats left, right, and center for what procedures, what treatments, what services are covered and what aren't, and there's a lot more to be discussed here, but that's simply how it works. I like to always say this is great in theory, but how does this actually work in practice? Well, not very well.

Our healthcare system is, for lack of a better word, super messed up and it's really confusing. So there's always exceptions to certain rules. And one thing I always like to remind people of is that 80% of medical bills have errors in them.

So even though I'm in theory explaining how a lot of these things work, you're going to have to be reviewing every single bill or document that gets mailed to you, that gets emailed to you, just because you're going to want to make sure that you are actually being billed appropriately. And that is not a given in this industry. Let's actually get into something very, very sexy. We're going to talk a little bit now about HSAs.

And I know when you think of a tax-advantaged account, you're probably thinking of a 401k or a Roth IRA, which, by the way, you should be maxing out every year if you can. But there is a lesser-known way that you can get tax benefits with a health savings account, aka an HSA. You might have seen it talked about on social media, but essentially it is a tax-advantaged savings account that you can use to pay for qualified medical expenses.

And there's a reason why the financial services industry calls this the triple threat tax advantage. So how does it work? You can contribute to an HSA if you have a qualifying high deductible health plan, HDHP.

And what you are able to do is you are able to contribute money that is pre-tax, reducing your taxable income. So that's tax savings number one. These funds roll over year after year. Unlike FSAs, there is no use it or lose it rule. So this is your money to keep. This account belongs to you even if you change jobs or insurance plans. You are able to withdraw this money to spend tax-free on any qualified medical expenses. That's tax benefit number two.

And number three, once you do turn 65, if you have had a very healthy life, which I truly hope for every single person listening to this, you can then actually withdraw those funds for non-medical expenses without penalty. You're just going to have to pay traditional ordinary income tax on it. So it will work essentially like a 401k or an IRA would. Aside from those three amazing tax benefits, if you are still wondering why you should even use an HSA,

Well, it really just allows you to make sure that you are paying as little as possible for your medical expenses. Reason being, when you are paying for those medical expenses,

pre-tax, the government is essentially subsidizing those medical things that you are having done or are paying for. It is also one of the only ways that your medical funds can actually be invested. So

Obviously, an HSA is a great idea to pay for current medical expenses using your HSA funds, but you can actually save and invest that money once you have over $1,000 in most cases. And that essentially allows your money to keep up with inflation. It allows your money to grow, and it gives you an opportunity to essentially put in X, but take out Y. So today you can actually invest for those future healthcare costs.

And it doesn't hurt that it is an additional retirement account. We all know that one in five Americans actually has big fat goose egg, zero dollars saved for retirement. So it is more important than ever, especially right now, to make sure that you are planning for the future. And this is a great way to let it grow tax free, let that money grow tax free and also

all the while being able to cover expected major medical expenses. Some people use one strategy of putting their expenses right

right now today on a credit card and then being able to reimburse those costs immediately with their HSA. So say I go and go to the doctor and they say, hey, you have a $40 copay on this. Great. I can then pay for that with my credit card, get the credit card points, and then reimburse that $40 bill with my HSA and get that money back. But

there's actually another school of thought, which is if you don't use this HSA while you're young, it can actually help with bigger and potentially more expensive procedures as you age. So instead of getting that $40 back, you leave it in there, you let it continue to grow, you continue to invest it. But say when you're 60, 65, you need a hip replacement. That is going to be very expensive. And this HSA can really offset some of those costs. And honestly, I'm

Just remember, the healthcare system is going to try and screw you left, right, and center. So you just need to make sure that you are fighting back and using all of these resources to your advantage to optimize so you can make your money go a little bit further. Support for Net Worth and Chill comes from Amazon.

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It's kind of like the room service of medical care. Thanks to Amazon, healthcare just got less painful. Learn more at health.amazon.com. Now let's move on to how you can manage some of these healthcare costs for yourself so you can make the most of your money. First up, let's talk a little bit about hospital bills. Horror story, on the eve of my 25th birthday party,

I was getting ready. I had, you know, just taken a little bit of a nap. I had a crusty little baguette sandwich that I was going to cut into. And I actually took a bread knife to my finger accidentally. I didn't mean to. I just it slipped off the baguette, slashed my finger. And I saw a little chunk of my nail and my skin and my flesh fall onto my kitchen counter.

I was rushed to Mount Sinai Hospital. I had to go through a metal detector. I sat bleeding in the waiting room. It was horrific. And to add insult to injury, by the way, because I ruined my birthday, I was in the hospital for eight hours. I didn't stay overnight, but I was seen by some specialists. I got an x-ray, what have you. To add insult to injury,

I was then given a $16,000 bill for my joy ride to Mount Sinai. I didn't even take an ambulance. I took a yellow cap. Like just the cost of being in the hospital was so, so prohibitively expensive. And I had really good insurance at the time, but even after insurance, I still owed $1,300 and

for me at 25, that felt like an insurmountable amount of money. So one thing I really want to talk about is how hospital bills and unexpected medical costs can be really crippling and they can wipe out your savings. But

Just like everything else in your life, you can negotiate these bills, and you should, and you can end up saving thousands. Hi, friends. Quick pause on our show to take a question from my besties in our new segment called Phone a Friend, presented by Amazon, where we answer your burning questions. What do I do if I have a medical bill I can't afford to pay? Sincerely, broke my arm, and now I'm just broke.

broke. Okay, let's tackle this together. Medical bills can be super overwhelming, but there are steps you can take to manage them. First, we are requesting an itemized bill. Believe it or not, about 80% of medical bills have errors, so you want to ensure that you're not being charged for something you did not receive. Two, once you have that itemized bill, you can head to a platform like Fair Health Consumer to see what your procedure should have cost. Next, we're going to reach out to your healthcare provider. If

If you were way overbilled, ask to make sure that they utilize the correct billing code. If not, ask about waivers, discounts, or relief plans that might be available to you. You might be surprised at what they can offer if you just ask. If your medical provider can't offer any discounts right away, many medical practices do offer payment plans. Let them know that you want to pay but are going to need a little bit of flexibility. They prefer to work with you rather than not get paid at all. Next, seek financial.

financial assistance. Many hospitals have charity care programs or financial assistance options. It's totally worth asking if you qualify, especially if your income is below a certain threshold, typically a couple multiples above the poverty line in your neighborhood. This matters because dealing with medical debt can feel super overwhelming and it can impact your credit score and financial future, but knowing your rights and options can help you navigate this very tricky situation.

Now, back to our show. First things first, let's talk about this. You are going to call the hospital and say, hi, I'd like to receive an itemized bill. And according to 80% of studies, which I mentioned earlier, medical bills do have errors in them. So you really do want to check this. And even if there isn't an error, you want to make sure that each item, line item, has a billing code next to it. So then you know exactly what they are billing you for and how they're coding it.

80% wrong is crazy. Imagine getting a 20% in class. You would be failing. I can't believe the healthcare industry thinks this is appropriate or that they can get away with it, but I want to make sure that you don't have any erroneous charges on your bill. So once you get this itemized bill, you have all the billing codes, you have everything, you are going to go to Fair Health Consumer. This is essentially a website that allows patients to look up what procedures and services, and I quote, should be

cost. Regardless of whether or not you can actually afford to pay this bill, you want to make sure that you know what it is worth. And then, this is the fun part, this is where we start to negotiate. For all my millennials listening, I need you to call. Do not email. I need you to call and I want you to politely ask the medical biller or the insurance specialist on the phone questions that are going to force them to tell you what waivers, discounts, or relief plans are available.

So you can ask questions like, hey, which of these fees can be waived? I know a lot of hospitals have medical bill relief plans. Can you tell me about yours? What discounts do you offer for financial hardship?

This is going to be a way to ask open-ended questions so you don't get a yes or no, you get an explanation. You are also going to ask if they have payment plans available because you're going to mention that you'd love to be able to pay the bill off in full but would only be able to do so if some of those fees were waived.

This really helps to incentivize an administrator to cut you a break if those earlier questions didn't work, though I am hoping that these hospitals that you are getting treatment at are going to be very transparent and share all of their waivers and discount plans with you because legally they should.

Additionally, you should remember that a lot of medical practices will work with patients to set up monthly installment plans. So oftentimes, no interest to you, you can pay your bill off over the period of time

12 months, 24 months, 36, 48 months. You can do this until the bill is paid off. And as long as you are on that payment plan and you've made that pre-negotiated contract with the medical provider, that means that your bill will not go to collections. It will not impact you in any way. You will not get people cold calling you at all hours of the night trying to get that money. And that can be a big relief for a lot of people.

Additionally, like I mentioned in my earlier story, when I went to Mount Sinai to get my finger fixed, I was 25 and I certainly was not yet a millionaire. I was not making the kind of money that I make now or even have in the past five years. I was very young. I was not making a lot of money. I certainly wasn't making a lot of money in regards to New York City rent, New York City cost of living. So what is important for me to mention here is that I was 25 when I went to Mount Sinai.

is that most hospitals in the U.S. are actually non-profits, which means they have to have financial assistance or charity care policies. This is because

A lot of these nonprofit hospitals get government grants or funding or anything like that. And because they are taking that federal money or even sometimes statewide money, they do need to have these charity care policies. So essentially, if you make below a certain amount, the hospital legally has to waive your medical bill up to a certain percent. Sometimes that's 100 percent. Sometimes that's 50, 75, 25. But it's certainly worth checking.

What you are going to do is you are essentially going to just Google the name of the hospital you went to and charity care policies. Normally, it's going to be one of the first search results, and you are going to be looking for either a PDF or a landing page, typically a PDF, and you are going to find their charity care policies and their sliding scale. This is why it's important.

The sliding scale is essentially going to show how much money you can make up to while still qualifying for this charity care. So, for example, at NYU Langone Hospital in New York City, I'm speaking, you know, in this backyard, you can actually make up to 8x the poverty line before you phase out of charity care.

If you make less than 6x the poverty line, you can actually get almost 100% of your medical bill from that hospital waived.

And this is so powerful because I think people oftentimes get in their head, oh, well, I need to make $20,000 a year to qualify for this. No, it oftentimes does depend on the cost of living in your area. So especially in major cities, these charity care policies are very flexible and honestly very generous. So if you qualify, you certainly should be taking advantage of

For the most part, these hospitals, unless you catch like a really, really kind administrator or a doctor or nurse who makes an offhanded comment to you, they're not going to offer this information up to you. So you are going to have to go dig for it yourself. I know it can be hard. I know it can be tedious, but it's very much worth your time.

Additionally, if you don't have the time or you're just overwhelmed, you've tried to do a little bit of this research, I do want to plug a really amazing nonprofit. It's called Dollar Four.

If you are struggling with this process of applying for charity care and you don't know where to start or you don't know what to do, just go to dollar4.org. They've already helped relieve over $74 million in medical debt. It is awesome because every dollar that is donated to Dollar 4 actually comes out the other end.

as more money saved for these folks that need this help. Now let's take it out of the hospital and head into more traditional regular care that you might be receiving from your family doctor or just a specialist. Think less emergency, but more ongoing medical care that you're going to need. Something that all of us have probably struggled with is we go to the doctor, the doctor tells us, you need to do X, Y, and Z. It is imperative to your health. It's important. It is medically necessary. And you say, great, I'm going to go

get this blood work done or I'm gonna get this treatment. I'm gonna get this service. I'm gonna get this procedure and everything is great. They run it through your insurance and then your insurance says you're denied on this claim. That is so, so frustrating and

The insurance companies oftentimes are using AI or technology to send out these denials. And there isn't even a human looking at your claim, which is incredibly frustrating because you're paying money into the system in the hopes that it'll cover those bigger medical costs for you. So why are you spending all this money if they're not actually going to hold up their end of the bargain? One thing that I think has been such an amazing new technological tool. So we are going to fight AI with AI.

If you are getting claim denials, coverage denials from your insurance, you can check out a website called fighthealthinsurance.com. If your insurance is denying you that medically necessary care, this is the first place I'd go. It is an AI software tool created by...

a woman named Holden Karau. She's a talented software engineer out of Silicon Valley. She has obviously a very unique skillset. And this tech genius who kept getting her own medical costs denied got so mad, so frustrated and so pissed off that she built a service and a software that is completely free to use and she made it completely open to everybody so that you can fight your health insurance.

And what this system does is it can write an appeal for a denied insurance claim in 10 minutes or less. You just input your information. Again, it's 100% free to use. And what a hero, right? You have your own problem. You find a solution and then you make it free for everybody else knowing that this system absolutely sucks and is not fair. I mean, I can't...

I can't speak highly of her enough. We actually connected on LinkedIn when I created the first short form piece of content mentioning this resource. And she has just been so wonderful and truly deserves everything wonderful coming to her. And please, please check out fighthealthinsurance.com. It is an incredible resource. What I think is so powerful to remind people of is that when these AI software tools are denying your health insurance claims, most people don't appeal.

And that's bad because if you are not appealing, then some completely relevant, completely approved things are being denied and you are just taking no for an answer. So please try this AI software to see if your insurance claim can be reassessed by often a human being and this go around, you are going to be able to get it covered. If you continue to get denied and denied again, you can try something else. It is called a fair hearing trial.

and you are going to tell your insurance that you want this fair hearing trial. It essentially is a formal appeals process where you can contest a decision made by your insurance company. Insurance companies do not want to go through the bad PR. They do not want to go through the headache. So as soon as your insurance company hears that you want a fair hearing trial, they're probably going to offer you an appeal. They're going to say, oh, you know what? Actually, we can cover it. Maybe we can cover half of it. You

You want to make sure that it is fully covered under the policy of your insurance. So if you want, you can take that small coverage or that discount. But what you could potentially do is also actually take it to your trial. And a fair hearing trial will essentially force your insurance company to provide evidence as to why you don't

this treatment or this procedure or the service, while your doctor, a medical practitioner with a license, will provide testimony that you do. And this is a really great way to stick it to the man. If you have time, if you have the resources to be able to go through this and potentially, if you need that service immediately, cover it out of pocket, this is certainly a great option. Now let's go from hospitals to everyday medical care with a doctor.

all the way down to some of the smaller costs, which frankly aren't as small as they should be. Let's talk about your everyday expenses, like your medications. We do want to shout out a billionaire who is doing something correct. Thank you, Mark Cuban. Mark Cuban started a company called

cost plus drugs. And it is an incredible way to help consumers avoid high drug prices by charging manufacturers prices plus a flat 15% markup with a pharmacist fee. And I know I just said 15% markup plus pharmacist fee, but

Friendly reminder, healthcare, pharmaceutical industry, this is an industry where 500 to 1,000% markups aren't uncommon. So 15% feels very fair, helps them keep the lights on, make sure that they can continue to staff employees. But what's really powerful about this is that Cost Plus Drugs also established its own pharmacy benefit manager. So it's a company that works directly with drug makers and pharmacies to negotiate down the prices of

of prescription medicines. Given that they're significantly lower markup is going to lead to a lower cost, your medications are going to be sold for a lot less than what an insurance copay might even total at your local pharmacy. So I highly encourage you to check it out, price compare, and see if your medication is cheaper online. Unfortunately, most of the medications that they offer do have to be shelf stable. So things like, you know, my

specialty medication for my eczema that requires me to jab in my leg or insulin, things like that that need to be refrigerated still aren't being offered yet. But I do hope to see this improve in the future as well. Other things you can consider are GoodRx. This is another site that does something very similar and...

People absolutely love the fact that they are able to get their medication for less without running it through their insurance. And additionally, if you live in a pharma desert, this is another big concern. If the nearest pharmacy to you is literally a two-hour drive away, Amazon One Medical and their pharmacy is actually providing door-to-door medical service. So you can actually order things from your pharmacy online and have it mailed to you the same way that

you know, your packages are mailed to you. And this is a really great way to save time because I do know, you know, pharmacies often close roughly around business hours. And if you have a full-time job, this can be very, very challenging. Last but not least, I do want to talk about one little tip trick that I actually recently learned about, and it's something called a copay card. So I was recently at my dermatologist and this was incredibly frustrating to me.

I have had eczema since I was like 12 and people are like, okay, so you have like dry skin. It's a little itchy, like big whoop. No, when you have more moderate severe eczema, which I don't, I have moderate eczema. It can actually be really distracting to the point where I'm on camera and I don't feel confident or I can't sit still at work because my back itches so bad. Um, so I'm

Treating my eczema has been a lifelong thing. I've been on topical steroids. I've been on TAC cream. I've been on Opsalora, which is a brand name cream. And they've all been helpful, but only to a certain extent. And I really wanted to try and address this cause from the inside out. So recently, my doctor prescribed me Dupixent, which is an injectable medication. You can jab it into your leg or into your stomach. But it really, really has been

Honestly, I want to say like a miracle drug. It has really, really helped me a lot.

But what was really scary to me was the first fill that I did through my specialty pharmacy, again, because it has to be refrigerated. It comes with needles. The bill was $3,500. And as someone who feels really confident in their financial situation, I still balked. I can't pay $3,500 every 28 days to live my life, to have this medication. And that was incredibly frustrating. But this is the smart part.

The pharmaceutical company that creates Dupixent actually provides something called a copay card. And how this works is you sign up for this card as long as you have commercial insurance through an employer, you are able to be eligible for this. And they will cover those up to, I believe it's $10,000 a year in those expenses. And while they are covering those costs through this copay card,

those dollars that are being spent, that are being paid for not out of your pocket, but towards your deductible, get you closer and closer to your insurance covering this medication. So for the first $10,000 or so, the company pays for it. And then since you've already qualified for your insurance to start kicking in,

they will then start paying for this very expensive medication. I transparently didn't even know how copay cards work. I'm very fortunate to have been very healthy almost all of my life, but this was such an incredible tool and it took my $3,500 Dupixent shot to $0 and has made it really accessible for me to feel confident in my own skin. So certainly if you have an expensive medication, oftentimes,

There are no generic alternatives. Oftentimes it's relatively new. It's, you know, sometimes a biologic, things like that. Consider a copay card if available to you. It can really, really help you save. So that generally wraps up this episode all around health care. I do hope that this helps give you a better understanding of the health care system and what you can do to help decrease this burden on your wallet.

But remember, when in doubt, negotiate, negotiate, negotiate. The health care system is not set up to help you get medical care, even though it should be. It is set up to make sure that these for-profit companies make as much money as humanly possible for their shareholders and for their stakeholders. So their interests and yours, transparently, are misaligned.

this is frustrating. I truly hope that there is legislative reform that allows us to get the medical care we need in this country versus all of our other developed nation partners who have much more effective systems. But until then, make sure that you are doing right by yourself, doing right by your finances, and getting every single dollar that you can from this industry to help cover all of your medical needs. Thank you so much, and I'll see you guys next week.

Thanks for tuning into this week's episode of Net Worth and Chill, part of the Vox Media Podcast Network. If you liked the episode, make sure to leave a rating and review and subscribe so you never miss an episode. Got a burning financial question that you want covered in a future episode? Write to us via podcast at yourrichbff.com. Follow Net Worth and Chill Pod on Instagram to stay up to date on all podcast related news. And you can follow me at yourrichbff for even more financial know-how. See you next week.

Thanks to Amazon for their support. Have you ever been so sick that the thought of standing up to go to the doctor made you even more sick? Amazon One Medical has 24-7 virtual care so you can get help while horizontal. And with Amazon Pharmacy, you can get medicine delivered fast, right to your door. You just have to make it to your door. Thanks to Amazon, healthcare just got less painful. Learn more at health.amazon.com.