# Hospital Bill Errors and 501(r) Financial Assistance. With Patrick Haig. Source: https://ethosbenefits.com/podcast/hospital-bill-errors-patrick-haig Type: Podcast episode Series: The Business of Benefits, Episode 71 Published: 2026-01-20 Duration: PT41M58S Hosts: Donovan Ryckis, Founder and CEO, Ethos Benefits Guests: Patrick Haig, Co-founder and CEO, Good Bill Publisher: Ethos Benefits Cite as: "Hospital Bill Errors and 501(r) Financial Assistance. With Patrick Haig.," The Business of Benefits, Episode 71, Ethos Benefits, https://ethosbenefits.com/podcast/hospital-bill-errors-patrick-haig, 2026-01-20. **Summary:** Employers can lower what employees pay for hospital care without raising premiums or narrowing access. Donovan Ryckis and Patrick Haig explain how IRS Section 501(r) hospital financial assistance works, who typically qualifies, why so few brokers offer it, and how itemized hospital bill review catches billing errors that claims processing misses. ## Key takeaways - Nonprofit hospitals must offer financial assistance under IRS Section 501(r) to justify their tax exemption, and many for-profit hospital systems offer similar programs. - Patrick Haig says most hospitals phase out eligibility near 400% of the federal poverty guideline, which he puts at just under $130,000 of household income for a family of four in 2025. - Donovan Ryckis says traditional brokers rarely offer 501(r) assistance because they are not paid for the extra work it takes. - Patrick Haig reports that about half of the hospital bills his team reviews have something wrong, and the errors add up to around 20% of billed charges. - Bill review matters most when a hospital contract pays a percentage of billed charges, because every line item adds to what the plan pays. - Employees approved for 501(r) assistance can get refunds on recent payments and are protected from collections, according to Patrick Haig. ## Chapters - 00:00 Introduction: fiduciary duty and hospital bills - 03:11 What is 501(r) hospital financial assistance? - 05:43 Why for-profit hospitals offer financial assistance - 08:23 Income limits for hospital financial assistance - 12:12 Why didn't my broker tell me about hospital financial assistance? - 16:05 How hospital bill review works - 21:26 Are employers paying medical claims blind? - 25:28 How often do hospital bills have errors? - 31:13 Helping employees understand hospital bills - 34:28 Bill review with a TPA or a fully insured plan - 36:47 Hospital bill refunds and collections protections - 38:54 Should every health plan offer 501(r) and bill review? ## Quotes > It's like you just paid a six figure bill and you don't even have an itemized account of what you paid. Donovan Ryckis, Ethos Benefits > Like there is no department in a company where you just blindly pay out accounts payable. Donovan Ryckis, Ethos Benefits > I want to pay you for this care rendered. I just want to know what it is and I want to see the receipt. Patrick Haig, Good Bill ## In this episode. Employers often add cost containment by shifting more of the bill to employees. In this episode, Donovan Ryckis of Ethos Benefits and Patrick Haig look at two measures that work the other way: IRS Section 501(r) hospital financial assistance, which lowers what eligible employees owe, and itemized hospital bill review, which catches billing errors before the plan and the member pay for them. They cover who qualifies, why the program rarely comes up in renewals, and how bill review connects to a plan sponsor's duty to pay reasonable rates. Donovan Ryckis frames the consultant's job as reducing the frequency and severity of claims, which he says is never about restricting employees' access to care. - **501(r) eligibility** usually phases out near 400% of the federal poverty guideline, so it can cover a large share of a workforce. - **Why brokers skip it:** Donovan Ryckis points to [how traditional brokers are paid](https://ethosbenefits.com/benefits-101/broker-compensation-disclosure); there is no pay for the extra work. - **Paying claims blind:** some plans pay six-figure hospital bills without an itemized statement, a problem tied to [access to your own claims data](https://ethosbenefits.com/insights/health-plan-claims-data-access). - **Billing errors** Patrick Haig sees most: undocumented care, time-based upcoding and unbundled lab charges. - **Setup** depends on whether the plan's [third-party administrator](https://ethosbenefits.com/benefits-101/third-party-administrator) shares claims and eligibility data, and differs for [self-funded and fully insured plans](https://ethosbenefits.com/benefits-101/self-funded-vs-fully-insured). - **Fiduciary oversight:** reviewing what the plan pays fits the work of a [health plan fiduciary committee](https://ethosbenefits.com/benefits-101/health-plan-fiduciary-committee). ## About the guest. Patrick Haig is co-founder and CEO of Good Bill, based in Seattle. He moved into healthcare from software after becoming interested in membership-based primary care, which led him to the billing and pricing side of the industry. ## Guests - **Patrick Haig**, Co-founder and CEO, Good Bill. Patrick Haig is co-founder and CEO of Good Bill, a Seattle company he started about four years before this episode to make hospital costs more affordable and easier for patients and health plans to navigate. He came to healthcare from software, after more than a decade of building software businesses with his co-founder. ## Related guides - [Health plan claims data access](https://ethosbenefits.com/insights/health-plan-claims-data-access) - [Third party administrator](https://ethosbenefits.com/benefits-101/third-party-administrator) - [Broker compensation disclosure](https://ethosbenefits.com/benefits-101/broker-compensation-disclosure) - [The health plan fiduciary committee](https://ethosbenefits.com/benefits-101/health-plan-fiduciary-committee) - [Self funded vs. fully insured](https://ethosbenefits.com/benefits-101/self-funded-vs-fully-insured) ## Frequently asked questions ### What is 501(r) hospital financial assistance? 501(r) financial assistance is a program nonprofit hospitals must offer under IRS Section 501(r) to justify their tax exemption. Patrick Haig explains that hospitals approve applicants themselves and must then limit the charges on medically necessary and emergency care. Donovan Ryckis adds that many for-profit hospitals run a version of the program too. ### What income qualifies for hospital financial assistance? There is no federal income limit yet, so each hospital sets its own. Patrick Haig says most hospitals phase out eligibility at about 400% of the federal poverty guideline, which he estimates at just under $130,000 of household income for a family of four in 2025. ### Why don't more brokers offer hospital financial assistance to employers? Donovan Ryckis says a traditional broker is not paid to offer it, so it is all additional work. Patrick Haig adds that awareness is low and applying is hard: each hospital has its own form, often a PDF several clicks deep on its website. ### How often do hospital bills have errors? Patrick Haig says about half of the claims his team reviews have something wrong when compared with the medical record, and the errors add up to around 20% of billed charges. Common examples are undocumented care, time-based charges billed for longer than the documented time, and a separate charge for a blood draw on top of the lab. ### What dollar amount should trigger hospital bill review? Patrick Haig says individuals tend to stop caring below about $500, and plans set the line closer to $1,000. He suggests letting the plan sponsor's and members' appetite set the threshold. ### Can employees get a refund on a hospital bill they already paid? In some cases, yes. Patrick Haig explains that if a patient paid more than $5, applies within 240 days of the first bill and is approved, the hospital is required to refund the payment. He adds that approved patients cannot be sent to collections, sued or denied future care over the balance. ### Does hospital bill review work for a fully insured plan? Yes, although it works differently. Patrick Haig says the best case is a plan whose TPA shares claims and eligibility data, which allows proactive outreach to employees. Under a fully insured plan the carrier usually will not share claims, so employees are given an easy way to submit hospital bills themselves. ## Full transcript [00:00] Patrick Haig: And I think what we're seeing is more of a conversation around, wait, hold on. These health plans, employer sponsored health plans, the employer, the plan sponsor, which is like a proxy entity for the employer, has a fiduciary duty to make sure they're paying best rate possible. [00:17] Donovan Ryckis: Why do more people not know about this? Why is this not part of everybody's conversation every single day? [00:24] Patrick Haig: I think that people are not aware of it because even if you were, again, we're a software company. Like, what is our job? Our job is to make easy for members. Because what we saw was that despite hospitals having the regulatory obligation to make people aware of it's kind of in direct conflict with their incentive to collect balances. Hospital or provider, I want to pay you for this care rendered. I just want to know what it is and I want to see the receipt and that's it. And at the magnitude of dollars we're talking, it feels like not an unreasonable request. Yet the intermediaries say that is an unreasonable request. Which then obviously always begs the question of like why? What, what are you afraid of? You're just looking. Welcome. Welcome. The business of benefits is your. [01:16] Chelsea Ryckis: No bs, no sales guide to real. [01:19] Donovan Ryckis: Solutions, no gimmicks, just the truth about how to take control, transform your benefits and care for your most valuable asset, your people. [01:27] Chelsea Ryckis: If you're tired of the same old sales pitch and you're ready to rethink your benefits, this podcast is for you. The truth is out there. Are you ready to hear it? [01:39] Donovan Ryckis: Hey Patrick, thanks for joining us today on the Business of Benefits. [01:43] Patrick Haig: Thanks for having me, Donovan. [01:44] Donovan Ryckis: Absolutely, man. So you and I know each other and we use your solution with our clients, our employers and plan sponsors. But give everybody a 90 second intro kind of into you first your background in the healthcare industry and then we'll kind of get into Good Bill and what you guys do. [02:04] Patrick Haig: Sounds good. My name is Patrick Haig, co founder, CEO of Good Bill, based here in Seattle. I am a think of me as like a software guy. That's how I got into this industry. Thirteen years ago, my co founder and I started software businesses. We eventually made our way to healthcare. Really? We got obsessed with maybe some of your clients have this but membership based primary care. It was just a very easy thing to understand of how people could just have unfettered access to primary care at cash rates and understand exactly what they're going to be paying for certain things. And that just got us wrapped around the billing and cost side and pricing side of healthcare, which is as you probably know, really deeply insane, generally speaking. [02:51] Patrick Haig: And so we've been spending a lot of time there since we started Good Bill about four years ago, really driving towards how do we make the cost and price of healthcare cheaper, more affordable and easier for people to navigate and ultimately drive savings for plans and members together. [03:11] Donovan Ryckis: Yeah, I love it. So let's talk about kind of one of the main functions of Good Bill and let's just start simply. What is 501R? [03:22] Patrick Haig: Yeah. So to keep it really simple, what we try to do is save people money. How do we do that? And we're focused on hospital bills. These are the big ticket items that usually hit people, especially people on high deductible plans. We're trying to basically pull out the stops on every strategy that could possibly lower their cost of care. So 501 R. This is IRS section 501 R. It's actually an IRS regulation and it applies to all nonprofit hospitals. And it's actually came out of the aca, the Affordable Care Act. What it says is, hey, all non profit hospitals, you get a tax exemption. You have to justify your tax exemption by having these types of financial assistance programs. [04:00] Patrick Haig: It doesn't say how people are going to be deemed eligible or not, but all it says is that when you have somebody that applies to these, this assistance program that you have to publish on your website and you approve them because the hospital's in control of approving them, you have to discount their care, or rather said differently, you have to limit the charges that they're receiving on that care. And this applies to all medically necessary or emergent emergency care. That's like a lot of care. And when we talk about like scope of this applies to all nonprofit hospitals, which is the first question. It's like, well like how many is that? It's basically 60% of all hospitals in the country. [04:39] Patrick Haig: And if you look at all the hospitals in the country and you added up all the beds that they have, which say all the capacity they could absorb, it's about 80% of all hospital beds in this country are at these nonprofit hospitals. [04:53] Donovan Ryckis: So something. So this program is universal against all of those. And I know we did this recently on a proposal too, were showing them and it happened to be like all the hospitals in this particular area in central Florida, but it's not only just not for profit hospitals, a lot of for profit hospitals have a version of this program as well. Is that right? [05:15] Patrick Haig: That's right. Definitely. The nonprofits, they have to do it for compliance reasons. But I think what's happened is that the for profits think of like your [company removed] hospitals or your [company removed] hospitals, they also offer financial assistance programs. They're just not required to do so. If I were to hazard a guess, it's because they're staying competitive and because they are often running into situations where people just simply cannot pay the balances that are remaining after coverage or if they have no coverage at all. [05:43] Donovan Ryckis: I was going to say this might be getting a little in the weeds, but like what would be the motivation for a for profit hospital to do this? I, in my mind it would be one, this is a balance they'll probably never collect on and then there's probably some sort of write off for them if they accept it as like a financial assistance. Would I be correct in that or. [06:02] Patrick Haig: I think if I were, I mean, I, I don't know. Oh, like caveat with. I don't know what any. How a [company removed] thinks about it or a [company removed] thinks about it. These are publicly traded companies typically. But if I were them, I would think about it as my competitors are doing this. It engenders a certain amount of goodwill in the community. It also becomes a bit of an expectation to a certain degree. Even though I think we suffer from like a massive awareness problem with 501R. So I would probably put it as like, it's kind of like branding differentiation or marketing. If I'm a system, I'm like, I. [06:37] Donovan Ryckis: I'd be fascinated to find out because I'm sure it's not the heart function of a corporation that does it, I suspect. [06:44] Patrick Haig: Yeah. Financially like, yeah, certainly they have a mission at the center of what they do to a certain extent. I don't want to discount that, but I think they don't have a regulatory requirement to do so. But so they must be living and dying by a business reason. [06:59] Donovan Ryckis: Yeah. From my side of it, seeing like the ridiculous reimbursement rates they request, you know, regularly 4 or 5x Medicare, occasionally 16x18x Medicare. It's like, okay, so they're doing that one end. Like there's got to be a function, a reason for them to offer the financial assistance because they're blowing the charges up at the front end and then accepting financial assistance, you know, programs on the back end. [07:30] Patrick Haig: Yeah, I think, well, I think that, yeah, there's just kind of a necessity. And I have seen, I can't say this because we've seen the data. Like a [company removed] for example, you know, not every single [company removed] institution But certainly a lot of their hospitals, we've seen those machine readable files, which are the files that they have to publish and they are subject to this requirement to publish their prices. They're like, think of like their msrp, their charge master rates tend to be really high compared to even nonprofits. So I'm sure there's some amount of that of like they're simply not going to collect. They charge really high rates. [08:06] Patrick Haig: I suspect most of the kind of like the network, like the health plan negotiator rates they have with large payers or carriers like an [company removed] or [company removed], whatever might be off a percent of bill charges. So either way, at the end of the day, you're dealing with a big number remaining. [08:23] Donovan Ryckis: So financial assistance, not for profit, a lot of for profit hospitals. So what we're talking about is the employee's cost share of whatever their claim is. What I was surprised about, what my clients are surprised about when I present how this works, is the amount of basically like income a household could receive and still qualify either for that partial, basically waived deductible or coinsurance or full. Right. So let's talk about kind of the income limits that are set on this 501r program and who eligible. [09:01] Patrick Haig: Yeah, so, yeah, first question is always, you know, what percent of hospitals does this even apply to? We kind of covered that. And most plans, like you mentioned, one client was, it was like all of the facilities that their employees go to, we tend to see that it's like 85 to 98% of the hospitals that they're seeing claims for are this type. So then the next question is, what you're asking is, okay, but how applicable is this to my employee base? There is no regulatory set limit, although we're about to see it, I think, because the U.S. treasury just came out with a recommendation with the IRS saying, hey, you actually need to codify the actual eligibility requirements to at least establish a baseline. [09:39] Patrick Haig: But when this came out, the American Hospital association put out a memo saying, hey, I think we should probably all adhere to a eligibility framework that is a percent of the federal poverty guidelines. But we're gonna use like a multiple. And that's what most do. So what you tend to see out there is most hospitals will phase out eligibility for this program at about 400% of the federal poverty guideline, which for 2025 comes out to just under for like a family of four to index people like 130 grand in household income. It covers a lot of people. I think that's probably Somewhere around half of the country. [10:18] Donovan Ryckis: Yeah. [10:18] Patrick Haig: Would probably fit there. Yeah. [10:20] Donovan Ryckis: A family of four making under 130 grand would be eligible for partial at least of this. 501. What's the, what's the proper term for the 501R program? Like financial assistance, I guess. Financial assistance. [10:36] Patrick Haig: It kind of goes by a bunch of things. We go by 501r because that's just that kind of like immediately differentiates it between something that might be like a for profit financial assistance. But you can hear 501r financial assistance or charity care. We tend to hear mostly the first two. [10:52] Donovan Ryckis: Okay, yeah, I'll stick with 501R financial assistance. Those, those kind of two. Because this is a, this is, at the end of the day, it's a government program that these hospitals have to offer. So it's like either the employees take that program or they have to pay it like it's there for use. [11:12] Patrick Haig: Right. Hospitals, literally. So every single year, if you're a CMS registered hospital, which you probably are most are, every single year you have to file a cost report with the government. And it's like, think of it as like, it's almost like filing your full accounting, like your financial books as a hospital. And one of those worksheets or one of those forms, there's a line item for how much did you write off under your financial assistance 501r program? And the hospital will write it off at cost. So yeah, they literally have to put a number in that value. And if they don't, that's not signaling very well to the IRS that you're justifying your tax exempt status. And so the law requires them to make reasonable efforts, you know, publish these things. So you're right. [12:01] Patrick Haig: If people aren't using it's just sitting there when people are. Most people are entitled to use it and thus reduce the cost and burden of care. [12:12] Donovan Ryckis: I love this. I love this particularly for when we first engage with a new plan sponsor because the first thing we're doing is kind of benchmarking costs. Like we're benchmarking their deductible versus their state versus their industry average, their premiums, the employees percentage of that premiums. And often what we see when we get started is all those numbers are high, right? The employees deductibles are high and their coinsurance is high and their share of the premium is high. And also what's left of the employer is also contributing to is high. So this program is something that you can put in day one and offer the employees a significant reduction. I mean, down to zero. You know, hypothetically for some people. [12:51] Patrick Haig: Yeah. [12:52] Donovan Ryckis: Right. So this is just like an amazing program. And I know the first time, I rolled it out, it was a new client we just started working with. Actually, we hadn't even started as part of our proposal because we had benchmarked that and we said, look, here's this program, here's how many of your employees would qualify based off your census. And like what I had turned out to be like 90% plus of them qualified also. It was one of those scenarios where they were all going to not for profit hospitals anyway. And the first thing they said is like, well, why didn't my broker tell me? And I was kind of, I didn't know. I honestly didn't know what to say. But what is your take on that? Why do more people not know about this? [13:35] Donovan Ryckis: Why is this not part of everybody's conversation every single day? [13:41] Patrick Haig: It's a good question. Well, number one, yeah, it suffers from like a general awareness problem. I think that people are not aware of it because even if you were, again, we're a software company. What, like what is our job? Our job is to make it easy for members. Because what we saw was that despite hospitals having the regulatory obligation to make people aware of it's kind of in direct conflict with their incentive to collect balances. Of course they don't want to lose their tax, their 501c3 nonprofit status, but they don't or they're not incentivized other than that, to drive it harder. Plans have all the incentive in the world, but it's kind of hard to make it easy for members to actually take advantage of. [14:28] Patrick Haig: So without software actually reaching out to employees and saying, hey, we'll take you into the hospital, let's screen you for this and let's run you through the application. You can do it on your phone, et cetera. The status quo is you have to go to the hospital website. You have to navigate usually like five clicks deep. You have to find a PDF, maybe they'll have an online form. Maybe I would say the far minority. You have to get that PDF, you have to fill it out, every single hospital own form like it's a bear. And so I think it suffers from awareness problem. But even if you were to think about it, actually putting into place before a product like ours existed was. [15:07] Patrick Haig: I mean, I've talked to like literally like the one to two brokers that were Doing this and they had someone on their team mainly doing it, but before that, it's just not even feasible. It's not practicable to actually get it done for somebody. Yeah, so that's usually what I attribute it to. [15:25] Donovan Ryckis: No, I, I'd agree. I mean, and the, you know, that question kind of took me aback. But I mean, the only thing I could say is like, there is no mode of compensation for, you know, a broker in the traditional sense to offer something like this and to do all like there's no method of compensation. So it's just all additional work, which is kind of why unfortunately it hasn't been rolled out, which is, I mean, it sucks to say, which is, you know, why you're on today, so. [15:55] Patrick Haig: Yeah, exactly. Like, I think if you don't have somebody doing it for you, it's, yeah, like you said, it's additional costs. It's eating into my margin. Like, I can't do it. Yeah. [16:05] Donovan Ryckis: But, yeah, so this is a great program to get going because it's straight. It's, it's for the employees. It's reducing their cost share. So there's a second aspect to this which is also the bill review piece. Right. So let's talk about that. Because there's, you know, in addition to offering the employee something, building some goodwill and some trust as you try to change and adapt the healthcare plan for sustainable and predictable premiums. You know, that's a great thing. But there's also a measure of some cost containment for the employer and for the plan as well under the bill review aspect. So let's talk about that. [16:46] Patrick Haig: Yeah, I think I'll kind of give you a little bit of like our origin and how we even got here because it kind of helps paint the picture. We actually started Good Bill direct to consumer of like, let's just. You can be a consumer whomever with a hospital bill come to us and we'll try to reduce it and we'll again apply any strategy possible. And we actually started with bill review and I'll kind of like tease that apart a little bit. We actually built out direct integrations with the. Think of like the, my charts of the world where we could get medical record data and then we would go get the actual underlying claim and the itemized bill and we'd marry all of that together to review the thing. And what we learned is were seeing clear mistakes. [17:29] Patrick Haig: Like this is not like super technical jargon. It's like, oh, you know, that thing didn't happen or the bill says it happened this many times, but it didn't actually. Or that it was actually not as severe according to the medical documentation as what you're billing, et cetera. These things started to come out. We're like, well why are these even here? Right. This is like someone who's insured. And that claim has in theory been run through some kind of machine people or software has been run through some kind of machine. And I think we gradually started to see, oh wait, no, that's actually not true. It wasn't because these things are just being highly adjudicated. And so that's as we started to see that. [18:07] Patrick Haig: Oh, so just the state of the art in the industry is not such that these are getting the scrutiny that they need to get to ensure that the provider is reimbursed fairly inaccurately, but the plan is paying fairly inaccurately. And so that is. Yeah, exactly as we started transition towards. Okay, well again all of these incentives are most aligned with patients and their plans which are the payers of all these services. We start incorporating bill review into it. And again we're not trying to like pull one over on hospitals and never trying to say something that is not justified, but we just simply ran into the truth is that this is not always done for various reasons we can go into, but it's not always done. [18:51] Donovan Ryckis: I find that it's not done at all. The bill review and results that we've seen from bill review are just stunning. And also you start to see like how little care and effort your TPA who may or may not be owned by the insurance company and also be the network and the PBM and your healthcare plan, how little care they took to even have the data for these claims on file. I know we've gone through bill review for six figure bills and they don't have an itemized statement. It's like you just paid a six figure bill and you don't even have an itemized account of what you paid. Like it was absurd. [19:30] Donovan Ryckis: And when we finally got it, you know, six figure bill, I think in that particular scenario are able to knock off like 18k in duplicate charges and you know, dogs and individuals and all kinds of stuff. [19:45] Patrick Haig: Yeah, I, I mean so we'll go a little like a layer deeper into why do we see these things. Number one. Yeah, if you're on a plan where it's a large, well call carrier or insurance company, the way in which you review something should be a function of how that provider is paid. So like Some contracts are percent of bill charges, in which case it's literally like every single item is going to add up to a number that then your health plan will pay. I'm making a number up 60% of that number. So naturally you're like, I really want to know was everything right? Because at the end of the day I'm paying for that. Versus some contracts are structured as like, we're actually going to bundle some things together and then put a price on that. [20:36] Patrick Haig: So maybe the composition of the bundle changes, but I don't really care as much because I'm paying that flat dollar for that bundle. That's a much more sane way. But this type of information is typically like, oh no, that's a trade secret under the provider contract. I can't know that. [20:52] Donovan Ryckis: Yeah. [20:53] Patrick Haig: And then you don't know how to review the thing. And then if you do eventually do it, you run into what you ran into, which is like sometimes, many times the claim is not being reviewed. Because also certain networks are scared of showing that data to hospitals and saying actually on this instance you shouldn't get paid this much because this is wrong according to this policy. And if a, if a carrier upsets certain health systems in hospitals, they don't have a product anymore, they don't have a network. [21:22] Donovan Ryckis: Yeah, you really start to untangle the. [21:24] Patrick Haig: Web. [21:26] Donovan Ryckis: And what's going on with this and what's shocking is one not even having that information on file, how little care they put into it before they actually paid. And then also like they want to restrict plan sponsors access and ability to even do this kind of bill review, which is wild. Like there is no department in a company where you just blindly pay out accounts payable. And I mean that's just not a thing. And then particularly like you're, let's say you don't think you're doing it blind because you hired an insurance carrier, but everybody in that chain makes more money when the plan sponsor pays more. [22:09] Patrick Haig: That is, that is a big problem, is that you've introduced a complex problem now you overcomplicated it. And then there's kind of like bites out of every layer. And then it is, yeah, like you don't even have access to it. And I think what we're seeing is more of a conversation around, wait, hold on. These health plans, employer sponsored health plans, the employer, the plan sponsor, which is like a proxy entity for the employer, has a fiduciary duty to make sure they're paying the best rate possible. Right. They're being good Stewards of their money, like the plan's money, which is their money and employee dollars. [22:48] Patrick Haig: And so I think this type of conversation, this type of concern is only going to bubble up more and more as that becomes more of a concrete problem for employers of like, oh my God, just like a retirement or 401k, I hire somebody to manage that. I have to be doing the right thing. And I think we're at a point in our industry where there's tension between, I think people like us that want to do the right thing. Employers are like, yeah, I think I'd like to do the right thing because it feels like I'm overpaying for a bunch of stuff. [23:14] Patrick Haig: And then the perhaps asymmetrically powerful parties that be on the other side of the table that are saying, I'm not sure I want you to do what you want to do because you're going to upset my apple cart and you're going to change the dynamics to a certain degree. I think we're starting to have that conversation as industry much more than before. [23:32] Donovan Ryckis: Yeah. And I think this is a great example. So, like, one of the three conversations I have, and I repeat often, is like, the only role of a consultant should be how do we reduce the frequency and severity of claims? And the second part of that conversation I have, because when I say that to a plan sponsor, often what they hear or what they're thinking about is like medical conditions. So they're thinking like wellness and different things, like, let's not have the employees be sick. That's not it. Like, this is a perfect example of understanding, like a claim is a request for dollars for a covered incident. Right. And what we're doing is we're taking that claim and saying, yes, covered incident happened, we're going to pay for that. [24:13] Donovan Ryckis: But this claim is overpriced and there's duplicate charges and over billing and upcoding and all kinds of other things going on. So it's not ever about, you know, restricting employees access, putting them in tighter networks, increasing their costs. Like, this is just one of those responsible functions that should exist. And I think most people would think it probably does exist, but it's, it's just not happening. [24:40] Patrick Haig: It doesn't. Yeah, yeah. I, I think to your average consumer, anybody, they think this machinery exists and it just doesn't. And I think that's right. Everybody is. Well, maybe not everybody. All we're trying to do, and I think everybody who's probably listening to this is like, yes, covered Care, we will pay, we pledge to pay for that care possible or provider. I want to pay you for this care rendered. I just want to know what it is and I want to see the receipt. [25:11] Donovan Ryckis: Right. [25:12] Patrick Haig: And that's it. And at the magnitude of dollars we're talking, it feels like not an unreasonable request. Yet the intermediaries say that is an unreasonable request. Which then obviously always begs the question of like, why? What are you afraid of? Just looking. [25:28] Donovan Ryckis: So these are for. I think another important to address is this is not employee facing. Right. This is happening in the back end of the plan. This is something that's kind of written in the spd. This is how the plan is going to operate. So can we talk a little bit about threshold for bill review? Maybe what percentage of bills you see with inaccuracies and then what that percentage is in a dollar amount as well? [25:55] Patrick Haig: Yeah, I guess the one thing I would say on that we have a different perspective on the whole back office versus employee facing is that usually in most of our customers situations, these employees have cost share like they have a deductible, they have CO insurance. And so at the end of the day they're kind of feeling the consequences of all of these. And to date, their health plan or whatever has not really equipped them because the health plan itself has not been equipped to bring them into that equation in a way that is to their advantage. I can't tell you how many times we've done a bill review or negotiation and a member has said, wait, oh, everything's right. Yeah, everything's right. It's right here in your medical record. Here's how it all ties together. And they're like, huh, all right, that's worth it. [26:42] Patrick Haig: Enough. Thank you. I feel good now. Right. And that's it. So I think there's a lot of value to engage members. I think some people, some plans are still scared to do so, but by doing that again. And also employees, like people, consumers, they have natural advantages to data that maybe the plan doesn't like the medical record. Like one snap they could grant that access. Well, like what we do today where we built out of our MY chart integration. So if you're a Good Bill covered member, you can connect your MY chart to Good Bill and we'll instantly get your medical records so that as you have a claim come in, we can review the thing. [27:20] Patrick Haig: Whereas a plan would have to send a fax request to the hospital asking for that data, the hospital is going to take some period of time because they have no legal requirement to respond to the plan. I mean, the repercussions, they don't get paid. But we've seen that not necessarily be like a strong enough incentive, which is odd, but members can do a lot of things. That's all I mean to say is like there is a way in which all of this can be exposed to an employee to their benefit and everybody's benefit. [27:49] Donovan Ryckis: Yeah. And they benefit on the reduction in cost share. If they have, you know, 10% coinsurance and you find some ineligible charges. Yeah, certainly there's tons to benefit the employees. I think what I meant was just like from a punitive standpoint, like the solutions that most plan sponsors are used to is anytime something's, you know, improving or we're trying to contain some costs or reduce exposure, like it's usually directly transferred over to employees in a negative way, you know. [28:19] Patrick Haig: Yeah, yes. Yeah, yeah. Agree. It's usually like an exclusion or. Exactly. I can't do this now. [28:24] Donovan Ryckis: Now before you do this, you have to call. You know, it's like, no, this is there for them and it benefits them in every way. Yeah, but it's not a punitive measure. [28:34] Patrick Haig: Yeah, exactly. So, so thresholds on bill review, we kind of take a rule out of our direct consumer days of kind of like let the plan sponsor and, or the member appetite dictate what you review and what you don't. I think naturally people are going to care most about the things that everybody cares about, which is the higher dollar ticket items. So you. We tend to see most people stop caring at about $500 and below. Like individuals, they just don't care. They're not going to go through any kind of process plans. I'd say it's like a thousand. So it's not such a differentiation there when it comes to. So let's say we're taking all the claims there. What do we tend to see? It depends on the claim type. [29:26] Patrick Haig: But overarchingly we tend to see about half of them have something wrong with them as revealed by the medical record. So whether it be undocumented care, so it's just not present. So then you don't know whether it happened or not or it's just the wrong number of things. Whether that be something that is dependent on time. Like. No, actually it wasn't. I'm making this up like 57 minutes. It was 28 minutes. And that actually matters a lot because that means you can't charge for this. You have to charge for this lower one. Some hospitals Again, we'll go back to paying things on a percent of bill charge. You then want to scrutinize every layer. And sometimes one of those items was wrapped really like a logical natural component of another item where you couldn't do that other thing without this thing. [30:18] Patrick Haig: So why are you charging me for both? Just charge me for one. Like, my favorite is you'll get a charge for a lab, like a blood lab, and then you'll get a separate charge for the blood draw. And you're like, just charge me for the lab, man. Like, don't charge me for pulling the blood for the lab. That type of stuff. Then when it comes to actual, like, okay, how does that translate from like a bill charge perspective? You're typically seeing that. I'll just call it like around 20%. So you're finding something half the time and the actual dollar impact is think about like 20% of build charges. [30:56] Donovan Ryckis: It's huge. [30:56] Patrick Haig: It's huge. It's massive. Which is why it's like, number one, review the things. And then number two, if you can structure your way out of needing to review the things where you maybe you pay something on a not a percent of itemized a percent build. But again, now we're getting into like. [31:13] Donovan Ryckis: Deep stuff, like the peace of mind, even for an employee. Like, they go, they get this big bill, they look at it, oh my God, I can't believe I owe that much. I thought I had insurance. And then they're trying to figure out this process. They're trying to, you know, they want to know the same thing. Is this right? Is there some way I can pay less? Like just to be able to send that off to Good Bill in an organized function online, right? Get you guys integrated on your portal and then just wait and have you come back and be like, actually were able to reduce it or even, you know what? Yep, that is correct. [31:45] Donovan Ryckis: Like now, you know you're not being overcharged and you know, you could start to take care of that bill, but hopefully we find some inaccuracies and we can reduce it. [31:54] Patrick Haig: Yeah, exactly. I think like I said, and it was actually one of our first back in the day, four years ago, when it was just my co founder, Ian and I, we had one case that led to a discount. Then we had a second where again, it was that like, hey, it's all right. And let me explain how it's right from both a billing perspective and a price perspective. And that person said, wow, I didn't understand it before. Much better place. I feel very good about it. I'll just pay it today. Can I pay you? And back then were doing everything manually, right? No, no software. He said, I want to send you like a $20Amazon gift card. Right. And we're like, that's really sweet of you. [32:36] Patrick Haig: We're just learning like no, but there's something there right where there's value in just knowing that number one, they learn something, number two, they feel confident and number three, they feel like it's transparent. And I think that's where we are going to be getting to as an industry is make people understand that they can see exactly what happened because if they can't, immediately there's doubt and then they can feel better about paying something. If they do have to pay something. As long as it's fair and transparent. I think you're going to see a shift in how people think about the cost of care today. That just so happens that it's neither of those things. [33:16] Donovan Ryckis: I mean the employee advocacy of both these programs together is just unmatched to help them understand, you know, the finances of healthcare and the affordability of it. Having a resource to vet these things through, walk you through 501R financial assistance if you can. If not, you know, understand your bills and make sure those are accurate, remove any inaccuracies. It's such an awesome measure of trust building, communication, advocacy for the employees. With some, obviously some real time results for them as well. [33:55] Patrick Haig: Yeah, exactly. And I don't think we're going to be getting away as a country from cost sharing, deductibles, co insurance. Right. There will always be that kind of cost split. So as long as there are real dollars at stake, people deserve to know what's going on. [34:10] Donovan Ryckis: I mean especially with this trend of HDHPs and you know, like that's all on the employees right away. [34:18] Patrick Haig: Exactly. And employers are not going to give those up because it allows them to reduce a little bit of their cost because they're bearing most of the premium in most cases. [34:28] Donovan Ryckis: Let's talk about, for the employers listening, this is awesome. I think this is a no brainer. We use it does work. I love it. What a trust building tool to implement your healthcare plan. Let's talk about implementation, integration, maybe with carriers, kind of those things that we need to know to actually put this into effect. [34:52] Patrick Haig: Yeah, I'll go kind of like best case and then settling case. Best case. We're usually integrating straight with a third party Administrator to get claim feed rolling and eligibility rolling, which means we know who people are and we see when they go to the hospital, which means that we can. People don't need to remember us other than to remember the name Good Bill. And they may or may not reach out to you if you go to the hospital. But then we get to be very proactive. And that. That is kind of a delightful moment for some members where they're like, wow, whoa. My plan. We've. We've also triggered our workflows off of prior auth feeds, which means we've caught people literally in the hospital bed. And some people, not all. Some people are like, I've got downtime. Whoa. [35:38] Patrick Haig: I didn't expect my plan or like an arm of it to reach out. But yes, I would like to screen for this program and apply. I'll do that right now. So that's kind of like, best case is we have data coming and allows us to be very proactive, drive engagement, drive results, and then reduce the load on employees. The second is maybe you're in, like, a full insured plan, and, you know, if you go to [company removed] or [company removed] or a [company removed], they're going to say, like, no, I'm not giving you claims. [36:07] Donovan Ryckis: No way. [36:08] Patrick Haig: Giving you. Yeah, right. Then we arm every single layer of this, right? Donovan yourself, you and your team, the employer, the HR team, the HR lead down to employees with everything possible to remember, if you get a hospital bill, you're not alone. You can go to goodbill.com, whatever personalized website we have for you, and just one click, add it there, and we'll take care of everything else. So you can put this in any kind of environment. We, of course, would love to get. I mean, most of our clients are on the integrated path, where we can just make it something that runs in the background and we'll reach out when we need to. But it can be pretty straightforward. [36:47] Donovan Ryckis: Yeah. Yeah. I love it. And another thing that I really like about the program is the timing. So this could be a past hospital bill that, you know, maybe employee has not paid all the way or any of it, and they're trying to get that mitigated. Or it could be something that, you know, they fill out 501R this year, and then they happen to go back to the hospital. So let's talk about kind of those timing guidelines of past and Future. [37:15] Patrick Haig: Yeah. So 501R has many really fun things other than an initial discount, which is many hospitals, I would say most hospitals, if you're approved for their 501r program, they will give you a duration of that approval. Right. People's financial situations, they change, of course, but they don't often change that frequently within a given year. So you might be approved. And that approval is good for like six months, nine months. So if you go to that same hospital or health system for subsequent necessary or emergent care, you're going to be discharging, you're going to get that approval and you'll have no balance or you have an immediately reduced balance. [37:55] Patrick Haig: The second thing that's really cool about it is if you've already paid a bill and you paid more than $5 and you apply within a certain window, within 240 days of whenever you got the first bill and you're approved, the hospital is required by law to refund you. So, like, for anybody out there that has spent more than $5 on a hospital bill that you think might qualify for this and you're within that range, you should just simply apply and see what happens. Because you could get your money back, all of it. And then if you're approved, it comes with other things too. If you're approved and you have an unpaid balance, they can't send you to collections, they can't sue you, they can't ding your credit score, they can't deny you future care because you have an outstanding balance. [38:46] Patrick Haig: There's all these other things. Cause you can see the spirit of the law is let's protect patients. And it really does a decent job of that. [38:54] Donovan Ryckis: Any kind of closing thoughts or anything? I didn't cover that. People listening to this and thinking like, how did I not know about this? Anything else they should kind of know about the solution or implementation, getting it started? [39:10] Patrick Haig: No, I mean, I kind of view it as, like, of course, I'm very biased here. Every plan should have this. I frankly think we're the best at what we do. But every single plan should have this. I think increasingly becomes a bit of a fiduciary thing of make sure you're taking care of members. Of course, if you think 0% of your employees would qualify under this type of rubric, fine. But naturally I think everybody should have it. And it just gets people thinking more about questioning, I think, their status quo of, you know, am I really looking at everything I should be looking at? Am I doing everything I possibly can to manage these costs? Because it's now becoming increasingly like the number two line item for any business, certainly for employees. [39:56] Donovan Ryckis: Yeah, I think particularly if you're in a plan that's restricting your data and you don't know what's there, like this will give you some insights and it'll give you insights to the very largest bills because that's the ones that your employees are going to be most concerned with and get over to Good Bill and then you get to see kind of wow, there's that much like waste and abuse in that invoice like what the heck else is going on in my healthcare. [40:22] Patrick Haig: Right. And now you can start to have some kind of data for some kind of conversation whether it be on a renewal or mid year. So I agreed. [40:31] Donovan Ryckis: Agreed. Well, thank you Patrick. I think, I'm sure you opened up a lot of eyes today. This is something we use, like I said, I think for certain employers, you know, depending on salary range, it's a absolute no brainer. And then I think for most other companies it's just a really great idea. I think a lot of industries should just absolutely have it no matter what. And then for most others it would just be a really good measure of cost containment and advocacy. Just on the billing perspective, even if they, you know, reasonably nobody's going to qualify for a 501R because they're all, you know, professionals or whatever, you know, white collar professionals. Like they probably definitely, they almost definitely don't want to look at a hospital bill and check it for accuracy in. [41:17] Patrick Haig: That case and Exactly. We've seen a lot of people, private equity folk like we're a venture backed start. We've had investors use us not because they would qualify for 501R but rather because they have that exact problem of like, man, this is expensive. Why? And I just want to know more and if I can get a discount that feels right. So yeah, fully agree with that. Thank you for having me on. Like always good to spread 501R again even if it's not through us. Like put 501R on your plan. [41:47] Donovan Ryckis: Absolutely. Where can people find you if they want to find out more? [41:51] Patrick Haig: Always. goodbill.com if you want to email me personally, it's patrick@goodbill.com Easy. [41:57] Donovan Ryckis: Sounds good. Thanks man. [41:58] Patrick Haig: All right, thanks.