Frank Lobb: Healthcare Uncovered: Insurance, Rights, and the Fight for Control"

Frank Lobb (: 00:00

where you have just hard black letter law and you have that going for you, you can stand up against any big attorney and kind put them in their place because they can't afford to have the argument.

Mark (: 00:09

Hmm

Frank Lobb (: 00:15

went through that and then I was a consultant across the country on compliance for the Clean Air Act for big companies and so forth that did that for quite a few years. Taking permits and so forth and either writing them or analyzing what they actually meant relative to federal and state rules. And so it gave me a pretty solid background in law and certainly in language. So

Mark (: 00:31

Mm-hmm.

Frank Lobb (: 00:37

In the middle of all that, I lost my first wife to a health care issue. Our insurance company, a very big one, said they wouldn't cover what she needed and the doctor said she needed it to live. And I treated it really like I would have treated a fender bender for my car. I simply looked at it and I said, forget the insurance company. I'll take care of that later. I will pay you directly. And they said I couldn't.

And I'm not the easiest guy to say no to.

Mark (: 01:05

you

Frank Lobb (: 01:06

And it got me hooked on trying to understand how in this land of freedom, a hospital and an insurance company, and it was three hospitals, could tell me I could not pay for the life-saving healthcare my wife needed.

Mark (: 01:23

What was that based on? Why would they deny you that?

Frank Lobb (: 01:25

My wife was an alcoholic and was the first time we had a chance to deal with it. She almost died from it. We pulled her back and what she needed was additional care, which she didn't get and she died from without it. In Pennsylvania, the law specifically says that if

Mark (: 01:29

Mm-hmm.

Frank Lobb (: 01:43

If your doctor prescribes 30 days of additional care, it has to be provided by the insurance company. The insurance industry disputes that. They claim they have the right to decide what the coverage is. So what they do is they do not provide additional care for dependent people. They just cut it.

And they took that to Supreme Court, and the Supreme Court refused to rule on it.

Mark (: 02:13

Mm-hmm.

Frank Lobb (: 02:15

Hey, don't worry. I'm just making sure I'm on the same page.

Mark (: 02:14

edit, so no problem.

yeah, no, no, it's for sure. We're on and any little quick turns or...

Frank Lobb (: 02:21

There's

whatever. All the way back in: 1990

Mark (: 02:27

Yeah, no, go for it.

Frank Lobb (: 02:40

And people were charging the insurance industry, the HMOs represented essentially the entire health insurance industry. There wasn't anything else. The PPOs and so forth didn't exist. ⁓ The insurance industry was taken to court because they were denying care. And the Supreme Court ruled unanimously that health care insurance companies have the right to induce

the doctor in the hospital to provide less care.

We have not many people talk about that, but it's there. Now they say induce. They don't say overrule.

but the insurance industry uses it as overruled. Now, how do they do that? They can't just tell a doctor, well, I disagree with you because the law says they can't do that. But what would you think would happen if the insurance company could block all payments?

Mark (: 03:29

Yeah, was going to... Right, how do they change?

Frank Lobb (: 03:42

Okay, all payment. Even if I went to another in-network hospital, I couldn't get the care. Okay. And that's constitutional because two people can agree not to take money. Okay. They can do that.

Mark (: 03:43

Mm-hmm.

couldn't get it, right?

Mm-hmm.

Sure, makes sense.

Frank Lobb (: 04:02

But on the other hand, in your questions here, you asked me why I represented or mentioned it was unconstitutional. Because what happens is by they blocking the care or the payment, they block my ability to get the care. They can't do that. No, no, I haven't taken it to court and argued a constitutional case. But I'm arguing that I will be very happy to argue that they have no right to block my access.

Mark (: 04:19

Mm-hmm. Right.

And do you base that on an ethical argument? OK.

Frank Lobb (: 04:36

No, no, no. I

I may not have a right to have my care paid for, but I have a right in a free market to go get it. And if you take steps to block me.

Mark (: 04:45

Go get it.

Frank Lobb (: 04:48

You block me and then you hide it. I'd love to see somebody try to defend that in front of the Supreme Court.

Mark (: 04:49

Mm-hmm.

Mm-hmm.

Frank Lobb (: 04:57

So what you really have is the insurance industry has done a magnificent job of misleading us in order to hide that little fact. Because in the back of the book, I suggest that one of the ways to deal with all this is simply to insist that you have a right to pay and offer to pay. Because the laws in every state say basically that so long as the doctor prescribes it,

and there is an offer to pay for a hospital most provide it.

Mark (: 05:26

And so you can make that claim and that should get you what you need or they're telling you that you can't get it and people are just taking that at word and walking away. You can challenge it.

Frank Lobb (: 05:37

I'm saying the laws of the state. Yes, because remember

one thing, very important, the laws on health care are state laws, not federal. Federal has very little to do with health care and very little to do with insurance. It's state. Now, the good part is the state laws are essentially identical. And across the country, if we have properly prescribed care,

and there's an offer to pay for it, the license of the hospital or the doctor requires you to get it. The issue of payment is separate. Okay? And the key part, the takeaway from the contracts that I talk so much about, these hidden contracts, is that in order to escape the liability of overruling a doctor, what the insurance companies do is simply

Mark (: 06:08

Mm-hmm.

Frank Lobb (: 06:27

bar all payment, but get the doctors and the hospitals to agree contractually to provide the care regardless of payment.

Mark (: 06:38

How do they do that?

Frank Lobb (: 06:39

It's easy. I mean, I can get I can put a contract in front of you and say, we're going to have this webcast and I'm not going to get paid or you're not going to get paid or you can only do this or you only do that with it. Right. And if you sign it, I can hold you to it. Nothing illegal about it. That's what they do in health care. Every in-network doctor has signed essentially the same contract, every hospital, every pharmaceutical company.

Mark (: 06:48

Mm-hmm.

Right.

Mm-hmm.

Frank Lobb (: 07:08

If they are an in-network provider, they have signed an in-network contract, making them a subcontractor. And those contracts are essentially identical. Now I throw the word secret around quite a bit. So let me defend it for a moment with a good example. I was, it goes back a little while ago and I was having dinner with my wife at the local golf club.

and we were sitting at the bar and there was a guy sitting next to me and I had a copy of my book with me and he started asking questions and I got into a conversation with him and it became very evident early on that he was trying to belittle me. I didn't know anything about healthcare. The minute he realized I had read the contracts,

He got up in the middle of his meal and left.

Mark (: 08:01

That was it.

Frank Lobb (: 08:01

That was it. I was on a plane just a month ago and was sitting next to a young woman and got into talking about the book. And she got this smirk on her face and she said, ha ha ha ha.

I negotiate those contracts. ⁓ So I went out on a limb and I said, but I'll bet you've never read the actual contract. And she paused and then she said, well, you're right. I never have, I never get to see them. I only see the costs.

Mark (: 08:16

Really?

Frank Lobb (: 08:31

They are, I mean, I could show you lots of references, but they are not as secret as you can get. I've read them. Now, the reason I read them is because I was in the Clean Air Act and I learned how to play lawyer.

Mark (: 08:34

Mm-hmm.

Frank Lobb (: 08:43

I sued the insurance company to get access. But it took me years. I mean, if it was any other market, this is what they call a third party beneficiary contract. If you have health insurance and it's private insurance and that includes Medicare Advantage, there's a contract with the in-network provider that you're using that states exactly what you are owed in care and coverage. And if that were any other market,

you would have free access to it, but not this one.

Mark (: 09:13

So how do they get

the doctors and the hospitals to agree to sign these contracts? What's the motivation? Yeah.

Frank Lobb (: 09:18

The number that's

been kicked around is that the big hospitals in the metropolitan areas owe 70 % of their business to the insurance company. You can find references where the insurers view themselves as the bank for all healthcare. And if you look at the vast majority of the United States have health insurance, they're paying the bills.

Mark (: 09:42

Mm-hmm.

Frank Lobb (: 09:43

So if you were a doctor, let's say just a, well, say a hospital and the biggest insurance company in the area comes to you and say, this is the contract. may sign it or we won't do business with you.

I mean, and there's nothing illegal about it. And I'm not saying there is. Contracts are contracts. And I have a free right to write a contract with you or anybody if you're willing to accept it. Matter of fact, the Constitution bars government from interfering in a contract. I can't contract to shoot somebody, but I can certainly contract to exchange goods and so forth for as much

Mark (: 10:00

Mm-hmm.

Of course, of course.

Mm-hmm.

Frank Lobb (: 10:21

as I want to pay or as little as I want to pay.

Mark (: 10:23

And we can get more into what's going on today with the government because there's a lot of intrusion to a lot of things, a lot of assumptions, and a lot of not paying attention to laws. So I'd like to talk about that and about this new bill that's been passed that's going to really impact millions of people. But I just want to ask you quickly before we get to that, if we're claiming that this is all for profit basically is the implication, right? That the insurance companies, that health care basically is for profit, correct?

Frank Lobb (: 10:50

They're like any other company.

Mark (: 10:52

Right. So

when you say that these contracts are agreed to, what about the doctors and the nurses and these nonprofits that are out there trying to help people? What's the impact on them? And if they're coming from this more ethical place of wanting to help people, they get caught up in this system.

Talk a little bit about that because this is all very, you I don't have a lot of knowledge and background on this stuff,

Frank Lobb (: 11:19

I'll

do it with a quick story. had a good friend who had a problem and I had breakfast with him he was describing this big black and blue mark down the side of his body and I said, Dave, you need to be in hospital. You're bleeding internally. Well, he went to the emergency room and they treated him what they call treating street. He was back out almost before he was in. He was home. Okay. And I happened to see him the next morning.

Mark (: 11:44

Street street. ⁓

Frank Lobb (: 11:49

And what did they find? Well, they didn't really know. I'm saying, see my doctor, but it's going to take me six weeks to see him. They had to airlift him that night into the large hospital in Philadelphia. died there.

Mark (: 12:02

So the emergency room sent him away without doing any kind of examination on him.

Frank Lobb (: 12:05

Yeah.

I

told him to his doctor. It's called treat and street. That's not my words. Do as little as you have to do as little as you have to get them out the door and tell them to go see their own doctor, which is interesting because I saw his doctor, I think it was two days later. Cause I hadn't just happened to coincidentally had an appointment with it. And the first thing the doctor said to me, and this doctor had been my doctor and Dave's doctor for 30 years.

Mark (: 12:12

heard of that.

Frank Lobb (: 12:34

And the first thing he said to me was, Frank, what did Dave die from? And I said, no, he did not. And I said, he died because the hospital didn't take the time to figure out what was wrong. And he, no, no, you're wrong, because he died in the hospital. And I said, no, you're wrong, doctor. He died in the second hospital. And he sat down, he put his head in his hands, and I still woke up. ⁓ And he said,

Mark (: 12:40

You didn't know.

Yeah.

Frank Lobb (: 13:03

Frank, I'm old enough to remember when I could take care of my patients. They won't let me anymore.

When I began with that doctor, if I needed hospitalization, he was certified and able to put me in the hospital and then would follow me into the hospital. Today, the doctor is a PCP, not allowed to treat, to put me in the hospital. He has no admission privileges, okay? And he can't follow me into the hospital. He probably won't even know I'm there. The only way can get there is go to the emergency room.

Mark (: 13:36

So if the emergency room is rejecting you and sending you to doctor who is telling you you need to go to the emergency room, go to the hospital, and the hospital's not accepting it, is that what you're saying?

Frank Lobb (: 13:43

Yeah. What you're doing, it's, hey, look, I can come across it just like everybody else telling you the healthcare system's broken. And what can we do? You know, we need to talk to Washington and get him to fix it. That's not where I'm coming from.

Yes, I forced a change in the Clean Air Act and I got a letter to prove it out of the EPA. But I didn't get it by arguing the economics or the merits, the ethics of that issue. I won that by recognizing that they were going to pass something and then taking down to Washington six little words they couldn't go around and then making the system work.

I helped them write regulations for monitoring that were at least within the construct of what Congress would allow. So that's how I want. And what I'm going to tell you here is the healthcare system is the system we have. And anybody who thinks we could change it fundamentally, I think it's out of their mind. It's too big. It's too sprawling. There are too many bits and pieces. Law and other.

But the laws that my father, my mom, used to guarantee health care are still there.

And the doctors that you mentioned that are in the business to help people want to help us. So if you understand what they're doing through these contracts, the game changes. Cause all you're doing is asking these fine people to honor their contracts and the law. They're happy to do it. I haven't had any one of them.

Well, just the case, the doctor sitting down and saying he was old enough to remember when he could take care of his patients. We've discussed my book. Every doctor I have has just I've discussed the book with me and they are receptive because they're as much a victim as we are. Yeah, the biggest complaints they have is the time they spend chasing bills, trying to get paid.

Mark (: 15:43

I was going to say, yeah, they're kind of held prisoner here, right? Yeah.

Frank Lobb (: 15:54

Okay. I put a bunch of podcasts out about the shooting up in New York. obviously there's no way you can justify something like that, the rage, the CEO, ⁓ and the rage, the public rage that in support of the shooter that cropped up.

Mark (: 15:59

Which one was that?

Which shooting is, which one are you speaking about? The shooting in New York. yes, okay, right.

Frank Lobb (: 16:17

The numbers of people that have been hurt by the system is legion. mean, it's huge. what I'm going to argue is there's enough material in the book to change how we get our health care individually, if we're willing to take care of ourselves. Because in today's world, it may come out another way. When I was a young man, the system was something I could trust.

Mark (: 16:24

Mm-hmm.

Frank Lobb (: 16:44

Whether it was right or wrong, it did a pretty decent job. I could trust my doctor. I can't anymore. I need to take care of myself. And what I've tried to do with the book is not redo the healthcare system, but give people just enough information to make it work for them.

And shit. Go ahead.

Mark (: 17:03

What do

you say to, when we're talking about peer-reviewed research and we're talking about people that can't take care of themselves, people who need cancer treatment, people who have infectious diseases, things like that, what are their options? They have to trust the healthcare system. They have to use the healthcare system.

Frank Lobb (: 17:23

Well, when I use the word care, I'm not talking about health care. I'm just talking about how you manage the health care system or what you.

Mark (: 17:34

Okay,

you're not saying healthcare doesn't work. You're just saying, okay.

Frank Lobb (: 17:37

No, no, no,

No, in no way. Matter of fact, I had that marked in the question. I'm not saying the healthcare out there doesn't work in any way, or form. We've got tremendous technology, and it gets better every day. And we have really good doctors that would like to treat you and want to do the right thing.

Mark (: 17:43

Yes, so I wanted to ask that,

Frank Lobb (: 17:57

I'm just arguing there's a way to facilitate that.

because there's a key in the middle of this. They cannot afford to let us know that we don't have to pay for the health care that our doctor prescribes and they deny, the insurer denies. boy, does that change things.

Mark (: 18:16

Can you talk about that a little bit? I also want to mention the name of your book since I keep referring to the book.

Frank Lobb (: 18:20

the book is the big lie of my health care bill Yes, and that's the one you want to read all the others are dated They were right in their time, but the one you want to read today is the one I've most recently put out the big lie of my health care bill It's That is written and as I explained simply to allow the individual

Mark (: 18:24

Okay, that's a new book.

Okay.

Frank Lobb (: 18:42

to make the existing healthcare system work. Because the reason the insurance companies are so powerful is because we don't understand all the misdirection that they've thrown at us. I mean, they call it insurance. It's not insurance. It is not. That's not an opinion. That's fact.

Mark (: 18:56

Okay.

explain

that.

Frank Lobb (: 19:07

But as long as we think it's insurance, then we think we owe whatever the insurer doesn't pay. Because if it was a car insurance policy, we'd owe it. Okay.

Mark (: 19:17

Mm-hmm. Right. Can

you just elaborate a little bit about that?

Frank Lobb (: 19:22

Insurance by law is defined as a contract between me and my insurance company.

So I pay him to take a risk as defined in the contract or policy. So if it's a case of let's take a car, your car insurance, you get a contract. It's signed by you and the insurance company and it'll tell you exactly what you're covered for. if, if, if you're gonna somebody hits your fender, puts a big dent in it, as long as you didn't drive into them purposely, it's covered.

and it's covered by contractual language. You could enforce it. Where's that contract in healthcare?

doesn't exist. That allows the insurance company and they play boy do they play this game.

This is not a covered benefit. What do mean it was covered when I bought the policy?

Mark (: 20:05

So they're changing policy midstream all the time. That's what you're saying?

Frank Lobb (: 20:08

The contract

language allows them to not pay whenever they want. And so they use the word coverage in exchange for pay.

Coverage is everything they defined in that secret contract, which is all the care your doctor prescribes.

Payment is what they have afforded themselves whenever there's a bill. They can decide, we only want to pay 20 percent or we want to pay nothing or we'll pay all of it. They have that choice freely.

and it's their power. Okay. So while we're arguing with the insurance company for coverage, the bill really is coming from the, let's just use hospitals. could be anybody, any network provider, but the bill owns the bill. And we're arguing with the insurance company, they ought to cover it or we're arguing we ought to get care because they denied it.

But there's no power to our argument. They have the right to deny payment anytime they

Mark (: 21:07

And they could just deny

any claim. They can just deny.

Frank Lobb (: 21:11

Yeah,

but I'm not going mess with them because I've read the contract. I'm going after the provider. He owes me the care whether he gets paid for it. It's his problem with the insurance company. OK, think of this every year. I'm sitting in an office where every year. An insurance guy comes in here or broker and he lays out about seven or eight plans for the new year. How they've changed the plans.

And you go, well, how's that possible? How did they change the plan so regularly? And I put it to him. That means they'd have to write a different contract, like eight contracts every year. Well, he said, that's impossible. You know, it is. You're not talking thousands. You're not talking hundreds of thousands. You're talking millions of contracts. How do you do that? They don't have to.

If the original contract gives them the right to pay as little as they want to anytime they want, then there's no problem to go from 80 % coverage to 70.

because I'm not trying anything. I don't know, I just do this policy wise, right? But I lay it out to you and in this office, the different plans, well, the plans have changed. You only get 70 % coverage on this item this year. Okay?

Mark (: 22:12

So they have the power to just change the...

So How do you address this?

Frank Lobb (: 22:33

What I'm going to say is I learned a long time ago that in a fight I take my opponent where he can't go. I don't want to sue the insurance industry. You cannot win not because you aren't right, but because they have so much money they could tie you up in court.

Mark (: 22:50

Yeah,

they're just too big. Right,

Frank Lobb (: 22:51

what they can't afford is to have disclosed the contracts that give you all the care you need per your doctor, not theirs.

and make the payment the responsibility of the insurance company, a fight between the insurance company and the provider. I'm out of it. Okay, now there's a wrinkle in the law that really helps us, well, a couple of them. We've been advised by the Financial Consumer Protection Bureau to ask for proof of accuracy of every bill, because quoting them, the bills are rife with error.

like 81 % is what the Becker Hospital review of the bills are in error.

More than 50 % of family bankruptcy is an unpaid healthcare bill. Now, once you ask that, what happens? Well, there's another problem. There's a thing called the Fair Debt Collection Practices Act that's been around a long time. And if I ask for proof of accuracy in a letter to the billing individual or entity, in other words, hospital doctor, what have you,

They have to give it to me or drop the bill. And if they don't, they could be fined, and I think it's $10,000. They do not want to go there.

Mark (: 24:10

How do I know what they're giving me is accurate? I mean, who's creating the bill?

Frank Lobb (: 24:14

Well.

Mark (: 24:15

provider.

Frank Lobb (: 24:16

Well, provider sets the bill. If you get a bill, the bill comes from the hospital. But if you read the contract, the only person who could be billed, the only individual, is the insurance company. So the bill you get is what goes to them and then passes through. Well, we're not paying that 20 % or 30 or 50. Well, they have no authority to do that. But again, under law, if that bill comes to you,

Mark (: 24:19

Right.

Right.

Frank Lobb (: 24:46

and you don't properly refute it for accuracy. 30 days later, it's legal by law for collection. Okay.

Mark (: 24:55

So

when we get a bill from our doctor, should we be questioning it each time? Yeah. Yeah, no, I'm just, asking. mean, this is the opportunity to talk about it. Yeah.

Frank Lobb (: 25:00

Yeah, that's what the book says. That's why you need to look at the recent book. Yeah, what the book does.

I'm not criticizing. I'm having fun with you. I've been around this subject long enough. can enjoy the stuff. I can enjoy it, guess, intellectually. But what you do is you put them in a position where they can't answer you. And if it goes to collection, what I say in the book is, goody, because

Mark (: 25:11

Yeah. ⁓

the lightheartedness of it, right?

Mm-hmm.

Frank Lobb (: 25:27

Under collection, they can't get anything but the bill. And if you have already asked for proof of accuracy, they're done.

because HIPAA prevents the transfer of any personal information, which means they can't give you any of the cost information necessary to show accuracy.

So you handcuff them and you don't have to go to court. You don't have to do anything. Okay? You just use the law as it exists and the contract language as it exists, both of them in our favor and avoid the problem. And when you're talking about handicapped people, I'm going to argue this is really, they need to take the time or whoever their caregiver is.

Mark (: 25:48

Okay, right.

Frank Lobb (: 26:14

needs to take the time to read my book and understand it so they can interface with the system because it's real. It's not changing. I just read this morning where the administration is pushing to put reviews in Medicare.

and it said Medicare, but I would assume they'd put it in a Medicaid. ⁓ my goodness. That's rationing. That's not there now. And I don't know how you put it in law. I haven't written anything on that, I do argue that say Medicare Advantage is private insurance. So everything I've said this morning is Medicare Advantage.

Mark (: 26:34

Okay, too, yeah.

Yeah.

Frank Lobb (: 26:53

Medicare is different than I pointed out in the book, in that it's law. So arguing they're going to change, they're going to adopt, say, pre-certification. I don't know how you do that in the law.

Mark (: 27:05

Now you're talking about the law established through Congress, when...

Frank Lobb (: 27:11

Well, all

I hear is a proposal to the administration. How they get there, I have no idea because you have to go back and put it through Congress. You can't just adopt that.

Mark (: 27:14

Mm-hmm.

Right, I mean I would think so, we know the way things are today, a lot of that is stamped approval from Congress right now, so.

Frank Lobb (: 27:27

Okay, let me give you something I would think your listeners would really need to understand. A doctor works for you under a license, the same as an attorney, okay? To have an insurance company tell me that if I were to face an insurance company that told me, our doctors disagree, I would say, wonderful, they have no standing.

They have no legal standing. They have an opinion? Wonderful. My doctor has the only legal standing. They're not going to want that argument. Matter of fact, there was recent testimony that got everybody excited because a retiree who was a medical director for one of the large insurance companies acknowledged he never looked at a medical record. How could that be? Well, it's

Mark (: 28:11

Ha ha.

Frank Lobb (: 28:13

legally necessary. In other words, how many times have you heard somebody say, well, they're overriding my doctor. They won't agree with my doctor, this and that. Who cares? They have no legal position. But if you don't raise that,

then there's no payment, no care, no coverage, nothing.

Mark (: 28:31

So how do

Frank Lobb (: 28:32

So you're arguing, but you're in a baseless argument. Okay, the argument is not more coverage because they have a right to give you nothing. The argument that you want to advance is, what do mean your doctor is overriding my doctor? They have no authority.

Okay? Good.

Mark (: 28:48

Yeah, because I wanted to ask you for practical steps

that people would take, steps that people would understand.

Frank Lobb (: 28:51

You know, if I were playing

that game, I'd probably just ask the doctor to put it in writing. Whoa, whoa, no, no, no, no, no, no. That takes him into liability. He wouldn't touch that with a 10 foot pole.

Mark (: 28:56

Mm-hmm.

You

And we're talking about putting the cost in writing

Frank Lobb (: 29:05

Now,

if my insurance company said that their doctors are denying the care because they have a different opinion than my doctor, I'd say put it in writing.

They can't go there. They have no legal authority. The only the only legal authority is your doctor. He's got to be able to lay hands on it. Matter of fact, a lot of the states, it literally says they have to lay hands on it. I wrote the book primarily for people in private health insurance and working people and so forth, but it carries over very well into a handicap people.

Mark (: 29:25

Mm-hmm.

Mm-hmm.

Frank Lobb (: 29:46

because the systems are same.

you need to understand the system. And in most cases, both private and the public system. If you get the care, we'll start from the beginning. If your doctor prescribes it, they owe it to you.

And they don't want to talk about that. And if you get the care, they can't bill you.

cannot. So I'll give you another story. There was a woman had a some kind of a head problem and I'm not sure what it was. can't remember. But anyway, the point was there was a $1.3 million bill for her care and it was pre approved.

Some months later, the insurance company went back what they call a utilization review, which every contract for a in-network provider contains. And they reviewed it and said, oh, we made a mistake. We're going to deny coverage. So what happened? The provider billed the woman for $1.3 million.

And now the insurance, sorry, the article lauded the fact that they negotiated this and only had to pay $600,000. Now the language of that provision, which I'm sure they never saw, because it's human, says they have a right for months later to revisit coverage, change their mind, and then claw the money back. But when they do that, the provider can't

not bill the patient. So my point to you is the lawyer and the writer were lauded in the fact that they only had to pay $600,000 when they shouldn't have paid anything.

if they read the contract, which they clearly did.

Mark (: 31:27

That's what

they did. yeah, because going back to earlier when you were speaking about asking for an explanation of the bill.

If you do that, would, what did you say you inferred that if you did that, that at certain point, you didn't have to pay it? Could you go over that again? Because I'm just a little, what's that? It goes away, that's what I'm gonna ask. So if you're challenging them and they can't give you the explanation, you don't have to pay it?

Frank Lobb (: 31:42

goes away. It goes away.

No. The law says if you challenge the accuracy of the bill, they have to give you the information you requested to prove the accuracy. That's right.

Mark (: 32:03

And if they don't, then you don't have to pay the bill.

And that's in the law. They can't come after you for that. ⁓

Frank Lobb (: 32:09

No.

They can send it to collection, but collection can't come after you. And they don't want that hassle because what you're really doing, think of it this way. Let's say we really were willing to go to court. And I'm not advising it, but say let's, the insurance company is willing to take it to court. Do you think they really want some judge sitting there looking at one of these secret contracts?

He might just say, we'll make it public.

and there's no control, no, they can't go there. So what you're doing when you challenge the accuracy and they don't have the information, what happens is it just goes away.

Mark (: 32:46

But you can't do that with every bill that you get.

Frank Lobb (: 32:49

you don't want to do it with every bill you get. What would I argue? It's in the book.

You can't get health care without a doctor's prescription. You need a relationship with your doctor, a good one. And the last thing I want to do is not pay my doctor.

Mark (: 32:58

Right.

Mm-hmm.

Frank Lobb (: 33:07

Okay, just because I have a hammer doesn't mean I have to hit everybody. My doctor bill typically doesn't, my general doctor, can't, like a PCP, cannot do much for me. It's gonna bill me very heavily. Now, so what I'm talking about is the specialist and the hospitals who get into the tens of thousands and hundreds of thousands.

Mark (: 33:11

Right, right, right, Yeah, I just didn't know how broad this was.

⁓ So you're...

That's what I was going to ask. It's really more of an exorbitant amount of money that you're being charged. OK. OK. It's not that $64 bill that I got last week.

Frank Lobb (: 33:34

It's the big stuff. Okay. Or the

medication side, somebody says, our doctor says you shouldn't have this medication. I would be willing to argue that they have no standing.

Mark (: 33:44

Mm-hmm.

Frank Lobb (: 33:48

Why are you talking to me about your doctor when that doctor has no standing? The issue is not payment, the issue is standing. And you take them where they cannot go and make the system work for you. Now, is there a simple push button one and it all works? No. But everything is, I just got a reply from a post I wrote.

Mark (: 33:55

It's not your doctor.

Frank Lobb (: 34:13

and the guy thanking me for the book, what he said, said, it took a little while to work through it, but once he got through it and he understood what I had written, it gave him the ability to make the system work for him and thank you.

Mark (: 34:25

So as an example, I was in the hospital a few years ago and my debit card had been hacked into like a week prior to that. I thought that I had paid my monthly bill and this was now going to be for August. I get out of the hospital and I found out that my coverage was dropped because I didn't pay my August bill. Now,

This was in like within like a two to three days of the day that it was due and they wouldn't accept payment. And I had paid on September 1st for September. So that money could have gone to August as far as I was concerned. But the bottom line is they charged me $42,000 for treatment because I had no coverage now they were claiming. So it took six to seven months of going back and forth and mediation to get it dwindled down to about $8,000.

what would have been my recourse in that moment?

Frank Lobb (: 35:24

Well, I'm not going to give you legal advice. ⁓

Mark (: 35:26

No, no, no, I'm just

saying what could I have done as far as contracts go and challenging the accuracy.

Frank Lobb (: 35:33

Did you have insurance?

Mark (: 35:35

I did and they dropped it that month because they didn't get the payment because my card didn't go through, which I didn't know when I was in the hospital, I wasn't aware of it.

Frank Lobb (: 35:44

What I would do is I would raise the issue of that you, in good faith, you paid the bill. And the fact that it didn't go through was beyond your knowledge. But on top of that, you didn't owe it. And I'd shift the game. In other words,

Mark (: 36:02

So explain

that, why didn't I owe it then?

Frank Lobb (: 36:05

That's the whole purpose of the book. If you have insurance.

They can't bill you. It is so hard for people to understand.

Mark (: 36:14

Yeah, no, it's confusing because we're all so programmed.

Frank Lobb (: 36:16

First of all, take insurance out of your mind.

This is not insurance. Okay? So you do not owe what your insurer doesn't.

If it's not insurance, what does this statement of, owe whatever my insurer doesn't pay, what's it mean? He's not my insurer. Okay. And once you raise that issue, there's a huge problem for both the insurance company and the hospital to provide.

Mark (: 36:30

Mm-hmm.

Frank Lobb (: 36:41

because you've taken them where they can't go. It's not insurance. And the contract they have in very clear black and white says that they can't bill you for it. They have to accept whatever the insurance company gives you. So if to your particular issue, in good faith, you paid the bill. However, where I want to take the argument is in bad faith.

Mark (: 37:03

Right, that's what I told him.

Frank Lobb (: 37:08

They're misrepresenting the billing

Mark (: 37:10

So I put it on them.

Frank Lobb (: 37:10

what Nikki says,

I'm going shift the game and take them where they can't stand.

It's, we have to learn some way individually to make the system we have work.

There's a, in the back of the book is a contract. You won't get one anywhere else. Fortunately, the contracts across the country are so similar that I could write you one that is accurate in law, but not an exact duplicate of anybody's. Because they

pretty sure of that. And I have several that have big red stamps on them that, know, confidential, blah, blah, blah. I've been very careful not to do that. But.

Mark (: 37:50

Yeah, I

was going to say, because the insurance companies might come after you, right?

Frank Lobb (: 37:54

I wrote a post not long ago that I recommend everybody, or at least the message. It was Einstein, and I tripped over it, and it just kind of blew my mind. It was a quote where he said, you have to learn how to play the game, and then you have to play better than anybody else.

We're stuck and what your listeners, that special needs people, have a couple in the family, need what I'm saying more than the average, but we all need it because insurance is really there to keep us from losing the big dollars.

losing the big chunk of healthcare we need, the critical stuff. It's where the money is, it's where the profit is. Well, if we just trust the system to provide both the care that we really need, the expensive care, and the pay for it, we're in trouble. There's a good chance we're gonna be in big trouble. It's like driving around without car insurance. You can't afford to lose the car.

So at least in car insurance, I have a contract that tells me exactly what my coverage is, right? Exactly. I have no such thing in that in health insurance. And everything they tell me is wrong. And I'm not talking about the care. I'm talking about the payment side.

Mark (: 39:01

Yes.

which they can change apparently as much as they want, willy-nilly.

Frank Lobb (: 39:12

Yes, great healthcare, great

doctors, great nurses. Like the Treating Street. Where did I get Treating Street? The gentleman that is my techie you saw early on, his wife is a very high-end nurse, operating room nurse. And she read the book and she was talking about it. She you mean Treating Street? I had never heard it before.

Mark (: 39:35

Yeah,

I never heard of that before either.

Frank Lobb (: 39:37

Well, it's there. wasn't looking for it. I wasn't going to just take her take on it. It's there. It's a policy.

Mark (: 39:39

Yeah. Right, right.

And it's a horrible policy. What a scary preposition.

Frank Lobb (: 39:47

Well, we think I'm

a Republican, so please, none of what I'm saying is Republican, or political. You hear from my party, oh, all we have to do is go to the emergency room and we'll get care. No. The reason you get care in an emergency room is the Medicare law says that if the hospital accepts Medicare patients, then it must take in the emergency room anyone who comes in for care.

and stabilize them regardless of whether they can pay for it. The word is stabilize. Okay. Doesn't mean treat. And so what's in the book is an example. If you come in a merchant's room and you have stomach cancer, you'll probably get aspirin. Ease the pain, shoved out the door and told to go see your doctor. I guarantee it.

Mark (: 40:22

street.

Yeah. So.

Frank Lobb (: 40:35

because they

don't have to do anything. And then the law of every state says that once they begin treatment, they must continue. So they don't get net box. They're going to shove you out the door. Now, there's an interesting other part in the book.

Mark (: 40:44

So they don't want to begin treatment, that is what you're saying.

Mm-hmm.

Frank Lobb (: 40:52

You don't have to go.

Under the laws of the state, there only two ways to get out of a hospital, be discharged. The doctor could order it, or you could discharge yourself. And if you look at the paperwork, you are discharging yourself. The doctor will never order it. What you'll hear is, the doctor has agreed to your discharge.

your discharge.

Mark (: 41:18

So you're discharging yourself is what you're saying.

Frank Lobb (: 41:20

Yeah, and

if you were in a hospital and you really don't feel that you're completely healed, that you have a good treatment, plant treatment, so forth, you have every right to say, I don't feel like I'm ready to leave. No, I'm not leaving. I'm not a grave.

Mark (: 41:30

You have a right to stay.

That's interesting insight. know it. It's the language,

Frank Lobb (: 41:38

I that only because you

have a lot more power than they want you to know under the laws that were there when I was a kid, you were a young man. Still there. They just convinced us that we don't have those freedoms that right.

Mark (: 41:57

Okay. We're getting close to the end of our hour. wanted to ask you and your knowledge Republican as a Republican, how do you feel about this bill that now is taking is cutting Medicaid and leaving a lot of people millions 11 to 17 million the numbers vary and it's affecting people with disabilities and low income families and people who are not able to afford so leaving without health care. Do you have any thoughts on it?

Frank Lobb (: 42:13

you

I

have a good answer for you. It's further than I had typically wanted to go, but I've been around this for a lot of years and I watched it evolve. Years ago, the Heritage Foundation chartered a course for healthcare for the Republican side. And what it is is that health insurance would only be catastrophic insurance.

Mark (: 42:46

That's what they propose.

Frank Lobb (: 42:47

Yes, it should cover nothing other than catastrophic care. And if you look at what they're doing, they're cutting the funding for essentially everything that is not catastrophic. Because catastrophic is where the big bucks are made. So what they really are getting to, and I'm just looking at the facts, not judging it politically, what you have is a march toward less and less coverage.

Mark (: 42:58

not catastrophic.

Frank Lobb (: 43:12

which has been around for some years, very high deductible.

Mark (: 43:15

technology

Frank Lobb (: 43:16

a march toward less of us coverage and the

that when you look at the way they're cutting the funding, they're getting rid of the day-to-day care of average people. And if you can't pay, you're not gonna get it. I mean, that's where it's headed, not because I say so or I'm any smart guy. I mean, you have to be blind not to see it. if you, somebody like me who's been reading this stuff for years, I got a letter from the Heritage Foundation.

Mark (: 43:31

Right.

Frank Lobb (: 43:47

15 years ago that said exactly this, maybe it's 20 years ago, the president of heritage congratulating me on the first book and asking me to help do exactly what I just described. And I went back and said, wait a minute, this is the absolute opposite direction from where I'm trying to go. They never talked to me again. They would never talk to me again. But anyway,

If you look at what they say, they talk about health freedom. I just got an after request for a contribution for health freedom. What do they mean? What they mean in health freedom is that you will be responsible for your own, the spending of your own healthcare dollars. Whoa. What that means is they're going to stick you with a bill.

Mark (: 44:12

So.

Yeah, I mean it's horrendous. It's inhumane, you know, what they're doing as far as I'm

Frank Lobb (: 44:36

Okay.

You have two choices. You can sit

there and you can let them do it. Write nasty letters, ask your congressman. By the way, I have been to Washington and I know that game reasonably well. And going down there and asking these people to stand up and fix this is a wasted effort. Or you can arm yourself with a few facts that have not changed in law.

Mark (: 44:44

Right.

Mm-hmm.

So before we go, what would be your suggestion or your advice for people who are losing their coverage and people who rely on life-saving services, people with medically fragile conditions, et cetera? What does the future look like for them now without their Medicaid?

Frank Lobb (: 45:21

you still have a right to care in an emergency room. And if you can get into the hospital, you still have a right to coverage. Now I can't give you some.

magic solution to where they're trying to take this. You can't. But on the other hand, what I can do is give you the tools you need to at least be in the fight. Let me give you another example. My wife was in the hospital and I did know this was not that long ago and I did know treat and straight and so forth. And they were going to discharge her and she had nearly died.

Mark (: 45:43

Mm-hmm. Okay.

Frank Lobb (: 46:01

internal from internal bleeding. And so I got the doctor who now works for me, not the insurance company, not the hospital. And I explained that to it. And I said, we need to understand something. If you try to discharge my wife before I know exactly what's wrong with her and have a detailed plan that I can agree with for treating it, there's going to be trouble because you are not discharging her.

Mark (: 46:09

true.

Frank Lobb (: 46:30

And he became a helper. OK? He became, I'm going to say, a willing participant in the solution for my wife. I didn't even lost my wife. This would have the second one. I can't afford to lose anymore.

Mark (: 46:34

Okay, so we just need to speak up, use our voices.

Right, right.

Frank Lobb (: 46:49

It was a different game from sitting there and having them tell me she's going out the door.

and say no, no, no. Part of that was she was a blood thinner and she's bleeding to death. said.

Why is she on blood thinner? Well, we don't like to take her off. What's the risk factor, both, you know, her dying from a stroke versus bleeding to death? Well, 10 to 1. Take her off the thinner. Put it in the record. Well, we don't like to it in the record. But all I'm trying to convey here is it's nice to sit here and hope somebody will take care of you. But that's not the world we're building.

And in that book is enough information that at least you can say, doctor, you work for me. I don't care what those other people are saying. I need to know what's right for me.

Mark (: 47:39

So you're arming us with some information, which is wonderful. Tell me the name of that book again, your new book.

Frank Lobb (: 47:46

the big lie in my healthcare bill.

Mark (: 47:48

Okay, I'll put that in the show notes so people know. And can people reach out to you if they have any questions regarding your book?

Frank Lobb (: 47:54

Yeah, there's a good way to get to the book. And it's easy to remember. Killabill.com. K-I-L, small case, capital A, B-I-L-L.

Mark (: 48:06

.

Frank Lobb (: 48:07

And it has my contact information and I'll be happy to and I'm up on the sub stack and yet I can be found and and I'm foolish enough to ask help people understand that we're being really Living conned and it's hurting far too many people

Mark (: 48:16

Well, you'd want to stand behind, you want to,

Frank Lobb (: 48:28

If the industry doesn't agree with what's in the book, I've said very many times, tell me. I'd love to hear it.

Mark (: 48:36

Yeah, I you know, I wanted to give you the platform to be able to talk about this. I thought it was important.

Frank Lobb (: 48:41

There's

a guy who publishes nationally, was a vice president in one of the largest healthcare companies in the country. And he lambasts the insurance industry left and right of what's wrong with it. But he won't talk to me. Now, if my book is so wrong, all he's got to do is say, hey, this just makes no sense. But he won't do that. He won't answer. And there's a reason why he won't answer.

Mark (: 49:04

Mm-hmm.

Frank Lobb (: 49:06

because he's under contract still not to disclose those contracts.

Mark (: 49:10

secret contracts.

Frank Lobb (: 49:11

And if you don't think you're talking big money about those contracts, think again. I wouldn't be surprised that the liability would be in the millions. You're talking about, I mean, these companies handle hundreds of millions of dollars, and you're going to get on the hook for disclosing their contract? Now, you and I can do it because we have no legal liability. He can't.

But he could go to Congress. One last point and then I'll shut up. They've written two large studies on the structure of the healthcare industry in Congress. In only one case, for half a dozen words, do they mention the contracts.

And they are the foundation blocks for the entire thing. If you haven't read them, you don't understand what health insurance is.

Mark (: 49:57

How do you how would one access these contracts?

Frank Lobb (: 49:58

Sorry.

the back of the book. You can't get them anywhere else. Okay. And the only, they are confidential proprietary documents in every state. they, nobody's going to let you see them. And I, the only reason I can read them is because I've read enough of them that I can write one that's similar, but I cannot be accused of writing one in particular. That makes sense to you?

Mark (: 50:06

Thank you.

Frank Lobb (: 50:32

I mean, there's Etna, there's Blue Cross, and so forth. Humana, well, I'll tell you that my contract's close enough to theirs that you'll understand what's there. But they can't tell me it's a duplicate of theirs. OK? Yes. Yes. I was very careful about that.

Mark (: 50:45

was going say, you didn't forge it, right?

Well, you're taking on the insurance companies, health insurance companies, so you have to be careful, Frank, thanks so much for your time today. I really appreciate it.

Frank Lobb (: 50:54

Look, I deeply appreciate

it. It's real pleasure. And if you can help me get the word out, because I'm not in the book business, I'm in the truth business.

Mark (: 50:58

Absolutely.

Yeah, no, I I use this platform because I want to help people. And this is a big issue. And if anybody has any questions or challenges of you, I'd say take it up with you. But I appreciate what you've taught us today and talked about. It's opened my eyes a lot. And now I want to do some more research. So thank you.

Frank Lobb (: 51:20

And if you ask questions yourself, don't ever hesitate to you have my contact information. Give me a yell and we'll work it out. Hey, thank you much. It's a real pleasure.

Mark (: 51:25

Absolutely. Wonderful. Will do. That's awesome. My pleasure too.

have a great day, Frank.

Frank Lobb (: 51:33

Thank you I will try to do my best. You do the same. Pleasure. Thank you.

Mark (: 51:35

Okay. Thank you.