EP386: What You Need to Know About ER Bills Post the No Surprises Act, With Al Lewis
Relentless Health Value™November 10, 2022
32:2144.42 MB

EP386: What You Need to Know About ER Bills Post the No Surprises Act, With Al Lewis

First of all, let me thank those of you who have left a podcast review in 2022. There was one from Best Healthcare Podcast Around on Apple Podcasts the other day that thanked Relentless Health Value for being singularly responsible for providing a 400-level education in so many complex areas of healthcare, which I personally really appreciated because we aspire to be a master class in healthcare industry strategy, such that those looking to do right by patients understand the dynamics well enough to succeed.

This also echoed a review from February of this year that said that Relentless Health Value distills complex healthcare issues into a highly intuitive and highly accessible narrative that helped the reviewer’s Fortune 500 company get everybody in the C-suite the understanding needed to confidently make some pretty key healthcare-related decisions.

Thanks so much to those of you who left a review for taking the time. As I have said on earlier shows, we really have a Relentless Tribe here working hard to make the healthcare industry in this country much more accountable to the patients that we serve.

And you leaving a rating and a review might be the best thing that you can do if you’re into helping us achieve our mission, because the ratings are so entwined with helping others find the show. If you consider yourself a listener who has gained value from this show and you haven’t yet left a review or a rating, could I ask that you do me a favor and do so? If you don’t know how to do that, there are instructions here for how to do so.


In this healthcare podcast, I am talking with Al Lewis. Al has been on the show before. One thing I did not realize about Al is that he went to Harvard Law School. Today we are discussing using the Quizzify Consent Form in the emergency room. This Quizzify Consent Form quite simply gives patients convenient ways to remember the exact and specific words they need to write on any financial forms they are presented with and told to sign in the emergency room. These words negate a hospital system or ER staffing firm’s claims that the patient agreed in a blanket statement to pay whatever they are charged.

In the past (ie, before the surprise billing legislation that went into effect at the beginning of 2022), this Quizzify Consent Form helped prevent the old $11,000 COVID test somebody got in the emergency room or the million-dollar heart attack. For more on the legislation itself, listen to the show with Loren Adler (EP307).

While it is far from perfect in a few respects, on the whole, the No Surprises Act is good for patients. It’s been terribly bad news, however, for certain private equity–backed ER staffing organizations who used surprise billing as a business model, meaning specifically—and maybe there’s others, but Team Health and Envision are certainly the big dogs here.

This wasn’t any sort of cloaked-in-the-shadows secret, by the way, as far as business models for these two entities. I recall one of them saying without equivocation that the No Surprises Act would be very detrimental to their business. And it turns out, they were right. Here’s from Fierce Healthcare, quoting Moody’s: “Envision ‘faces significant social risk’ due to ‘significant negative publicity relating to the patients … receiving surprise medical bills’ and will remain financially challenged by the No Surprises Act.” Moody’s downgraded Envision’s corporate debt, suggesting that they are at risk of going bankrupt over the next 12-18 months.

To further attenuate my sympathies, both of these companies, Team Health and Envision, cut doctors’ pay during the first COVID-19 wave while simultaneously spending millions on political ads to protect surprise billing practices. Anyway, sad … not sad.

Getting back on track here, the good news in all of this is that patients don’t have to worry about surprise bills either by private equity–backed entities or just your run-of-the-mill hospital down the street who, pre–No Surprises Act, were not opposed to a little surprise billing action of their own or not opposed enough to do anything about out-of-network docs sending these bills in a lot of cases.

But the No Surprises Act doesn’t make going to the ER a safe space from a financial standpoint for patients or their employers, and this is what I talk about today with Al Lewis. This whole conversation reminded me of something that David Contorno has said more than once: Every hospital bill, every physician bill is a surprise bill if the patient does not know ahead of time what the charges will be. You’ve listened to this podcast before and heard guest after guest talk about how payers … frankly not so good at negotiating with hospitals, most of whom have emergency rooms. (Listen to EP346 with Peter Hayes, for example.) If you’re a patient and you go to the ER, you’re gonna see this lack of great negotiating in all of its glory. So, for example, if a payer “negotiated” $10,000 for an emergency MRI or CT scan or some other test or service and the patient has cost sharing, yeah, that patient just got hit with a very, very big bill. Or the whole upcoding thing.

This whole thing is what I talk about with Al Lewis today: post–No Surprises Act, what’s happening in emergency rooms and how can we protect patients/members/employees from excessive financial toxicity that is still rampant when it comes to going to the emergency room in many cases.

Al talks about how the employers can really help employees and members protect themselves from profiteering hospitals or physician staffing companies the patient doesn’t even realize are gonna be sending bills.

You can get and learn more about the Quizzify Consent Form as well as Quizzify’s Doctor Visit PrepKits here.

Another episode along these lines to listen to is EP328 with Marshall Allen.

You can get the free version of the card by emailing al@quizzify.com.

You can also connect with Al by emailing al@quizzify.com, visiting the Web site at quizzify.com, on LinkedIn, or on Twitter at @quizzify and @whynobodybeliev.


Al Lewis wears multiple hats, both professionally and also to cover his bald spot.

Hat #1: Employee Health Literacy. He is the founder and “quizmeister-in-chief” of Quizzify, whose mission is to help companies teach their employees to utilize health care services appropriately, using a format best described as “Jeopardy meets Choosing Wisely meets Comedy Central.” Quizzify is the only vendor authorized to display the Harvard Medical School “Veritas” shield and has received excellent reviews from users.

Quizzify is also well known for its ER Sticker Shock Prevent Consent, which has been endorsed by Dr. Marty Makary and Dave Chase, among others. It can be taped to an insurance card, used as a stand-alone card, or downloaded into your Apple or Google Wallet and will “pop up” when you enter an ER. It limits ER bills (both in- and out-of-network) to 2x Medicare, which is less than half of most “negotiated” rates.

His quiz-specific background includes authorship of the best-selling Newsweek Presents the Ultimate Trivia Game, which Games magazine lauded as having the best questions of any trivia game; hosting two quiz shows on Boston network affiliates; and appearing on Jeopardy.

Hat #2: Outcomes Measurement. As an author, his critically acclaimed category best-selling book on outcomes measurement, Why Nobody Believes the Numbers, chronicling and exposing the innumeracy of the health management field, was named digital health book of the year in Forbes. Cracking Health Costs, written in conjunction with Walmart alum Tom Emerick, was also a trade best seller.

He was the cofounder of the World Health Care Congress’s Validation Institute.

His expertise in outcomes measurement got him named one of the unsung heroes changing healthcare forever.

He graduated Phi Beta Kappa with honors from Harvard, where he taught economics as well. He also graduated from Harvard Law School, albeit with no honors that time—other than winning their annual trivia contest, of course.

06:34 What is the evolving problem around surprise bills?

07:08 What are the two issues with the No Surprises Act?

9:13 Why are ER bills in network still so high?

17:27 How does the Quizzify Consent Form work for patients with insurance who unexpectedly visit the hospital?

20:50 “They’re basically saying, ‘We don’t abide by federal law.’ Good luck with that.”

22:20 “The better question is, why aren’t other vendors copying it?”

23:56 How would Quizzify affect the hospital bottom line if employers start utilizing it as part of their employee healthcare?

27:35 Is there any potential downside to Quizzify?

You can get the free version of the card by emailing al@quizzify.com.

You can also connect with Al by emailing al@quizzify.com, visiting the Web site at quizzify.com, on LinkedIn, or on Twitter at @quizzify and @whynobodybeliev.

Recent past interviews:

Click a guest’s name for their latest RHV episode!

Dan Mendelson, Wendell PotterBrian Klepper (Encore! EP335)Dr Aaron Mitchell (EP382)Karen RootMark MillerAJ LoiaconoJosh LaRosaStacey Richter (INBW35)Rebecca Etz (Encore! EP295)Olivia Webb (Encore! EP337)Mike BaldzickiLisa BariBetsy Seals (EP375)Dave ChaseCora Opsahl (EP373)Cora Opsahl (EP372)Dr Mark Fendrick (Encore! EP308)Erik Davis and Autumn Yongchu (EP371)Erik Davis and Autumn Yongchu (EP370)Keith HartmanDr Aaron Mitchell (Encore! EP282)Stacey Richter (INBW34)Ashleigh GunterDoug HetheringtonDr Kevin SchulmanScott Haas



Billing,Costs,Patients,hospital billing,insurance carriers,providers,surprisebilling,quizzify,