6 Tips for Powering Up Your Brain

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Between 2000 and 2017 deaths from heart disease have decreased 9% while deaths from alzheimer’s have increased 145%.

According to the Alzheimer’s Association, an estimated 5.8 million Americans of all ages are living with Alzheimer’s dementia in 2019.

By 2050, the number of people age 65 and older with Alzheimer’s dementia may grow to a projected 13.8 million, barring no medical breakthroughs to prevent, slow or cure the disease.

Not only is it difficult coming to terms with a loved one’s memory loss, but it can add additional stress to everyday activities around the house.

This is why dementia is such a difficult road to navigate for so many people and families around the world. While there’s no cure for Alzheimer’s dementia yet, a lot of research is being done to try to find treatments and practices that can slow or prevent cognitive decline.

The Cleveland Clinic Lou Ruvo Center for Brain Health in Ohio is one of the leading research centers for dementia. And so far, they’ve found six lifestyle changes that can improve brain health.

If you’re struggling with memory problems or you have a family history of dementia, it’s never too late to make some simple changes to your lifestyle that can improve your chances of fighting memory loss.

Here are the Cleveland Clinic’s six pillars of a healthy brain:

Pillar 1: Physical Exercise

“What’s good for your heart is good for your brain.”

People who exercise regularly have a lower risk of developing Alzheimer’s disease, says the Cleveland Clinic.

Exercise improves blood flow and memory; it stimulates chemical changes in the brain that enhance learning, mood and thinking. Even if you’ve never exercised, any physical activity is better than none at all.

What kind of exercise is best?

Endurance exercise, like running, swimming or biking, has been shown to foster new brain cell growth and preserve existing brain cells.

Strength training, like lifting weights or using resistance bands, builds muscle, strengthens your bones, and improves your mood. It can also enhance concentration and increase your decision-making skills.

Flexibility/balance training, like Yoga and Tai Chi can improve your posture, reduce risk of injuries and falls, and improve your overall movement and ability to do things better throughout life. Even simple exercises like standing on one foot or walking backward have proven helpful.

Pillar 2: Food & Nutrition

“Eat smart, think better.”

As you age, your brain is exposed to more harmful stress due to lifestyle and environmental factors. This leads to oxidation of your brain cells.

Imagine what a cut apple looks like after it’s left on a counter for 5 minutes. That browning is oxidation and the same general idea is what’s happening to your brain as you get old.

Luckily, there are lots of antioxidants available in food that can help protect your brain from these harmful effects.

Research shows that a Mediterranean-style diet rich in fish, whole grains, green leafy vegetables, olives, and nuts helps maintain brain health and may reduce the risk of Alzheimer’s disease, says the Cleveland Clinic.

The MIND and DASH diets are also good options to consider. Of course, if you’re at risk of developing diabetes, follow the diet your doctor recommends.

There is a high correlation between diabetes and dementia. Some researchers have even referred to dementia as Type 3 Diabetes. To protect your brain, you need to keep your blood sugar levels in check and that starts with what you eat.

Pillar 3: Medical Health

“Control medical risks.”

Hypertension, diabetes, obesity, depression, head trauma, higher cholesterol, and smoking all increase the risk of dementia, says the Cleveland Clinic. However, you can control and reduce almost all these risks if you’re proactive.

Getting your annual check-up, following your doctor’s recommendations and taking medications as prescribed can all help lower your risks.

If you have diabetes or are on the verge of becoming diabetic, you can reduce the risk by following these tips says the Cleveland Clinic:

  • Avoid white sugar, white flour and hydrogenated fat.
  • Eat more fiber.
  • Eat some protein with every meal.
  • Control portion size.
  • Exercise for at least 30 minutes 5 times a week.
  • Include aerobic, strength, flexibility and balance.

Another major risk factor for dementia is high blood pressure. The Cleveland Clinic recommends following these tips to reduce hypertension:

  • Cut down on salt (less than one teaspoon a day).
  • Check your blood pressure regularly.
  • Keep active.
  • Maintain a healthy weight.
  • Take your medication.
  • Aim to keep blood pressure under 120/80 mmHg.

Pillar 4: Sleep & Relaxation

“Rest well.”

Sleep energizes you, improves your mood and your immune system, and may reduce buildup in the brain of an abnormal protein called beta-amyloid plaque, which is associated with Alzheimer’s disease, says the Cleveland Clinic.

Getting 7-8 hours of sleep every night is a must. And to ensure a good night’s sleep, you need a completely dark, quiet, and cool bedroom. You should not be able to see your hand five inches away from your face with the lights out.

Meditation is also a great way to relax and has been shown to reduce cognitive decline. Other ways to reduce stress are saying “no” more often, writing down all the things that bother you, and using imagery to anchor your emotions.

Pillar 5: Mental Fitness

“Use your mind, or lose it.”

You have something called “brain reserve,” which helps your brain adapt and respond to changes and resist damage, says the Cleveland Clinic.

People who continue to learn, embrace new activities, and develop new skills and interests are building and improving their brain reserve. That’s why working at a challenging job, going back to school, or taking classes can all expand your brain reserve.

Other mentally stimulating activities, like crossword puzzles, chess, puzzles, and card games have all been shown to help improve brain health. Even playing electronic “brain games” may help improve your reaction time and problem-solving ability.

Pillar 6: Social Interaction

“Stay connected.”

A rich social network provides sources of support, reduces stress, combats depression and enhances intellectual stimulation. Studies have shown that those with the most social interaction within their community experience the slowest rate of memory decline, says the Cleveland Clinic.

Leading an active social life is the key to protecting your memory. Joining clubs and volunteering are great ways to keep your network alive. Even adopting a pet can improve your brain health.

Pets can calm us down, boost our immunity, improve our heart health, keep us moving, and enhance our social life, says the Cleveland Clinic.

Overall, lifestyle has a profound effect on your brain health. What you eat and drink, how much you exercise, how well you sleep, the way you socialize, and how you manage stress all play important roles in keeping your brain healthy. It’s never too late to make some of these small changes, you can even start today.

To a richer life,

Nilus Mattive

Nilus Mattive

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How My Medical Mishap Could Save You Hundreds

This post How My Medical Mishap Could Save You Hundreds appeared first on Daily Reckoning.

Okay, let’s just get it out there…

A few months ago, I had another surfing-related trip to the ER.

Without going into all the gory details, here’s a quick picture:


As you can see, I ended up with a small sideways smile right below my original one.

Essentially, I was tumbling under the water and the pointy nose of my surfboard went straight under my lip – all the way through, in fact – and eventually stopped when it hit my gums.


“Hey, how does this look?” I asked a friend after it happened.

“Uh, yeah, that’s definitely stitches,” came the reply.

An hour and a half later, stitches it was – five on the outside and one on the inside. Also a quick trip to the dentist the following day since the blow had damaged a tooth.

In the grand scheme of my major lifetime injuries…

  • Four broken ribs and a collapsed lung from surfing back in December (I know… I know…  Two surfing injuries in 12 months!?)
  • A middle finger bent at a 90-degree angle while mountain biking back in college
  • A torn medial collateral ligament spinning off a jump on my snowboard
  • A broken metatarsal skateboarding on a ramp

This one was relatively minor. Painful, and a bit demoralizing to be sure, but with a one-week heal time, not too big of a deal…


… Until it was time to get the stitches out.

That’s where the real pain (and self-discovery) began.

Do as the Doctors Say

Now, before you suggest giving up my favorite hobby, recommend I buy a soft board from Costco, or blame me for skyrocketing insurance premiums…

Let me just say one thing.

I do these things for you!

How else would I have discovered the money-saving power of self-surgery?

My high-deductible health insurance plan requires me to pay out of pocket for most medical procedures until an annual cap is met. However, it does typically provide discounts on services performed by in-network facilities and specialists.

When I was discharged from the ER, they told me I had several options for getting my stitches removed:

1. Go back to the ER. (“The downside is you might have to wait a while.”)

2. Go to an urgent care facility.

3. See if a primary care physician (PCP) would do it.

I first called the ER. After a discussion with their billing department, I learned that I would be charged for another visit if I came in to get the stitches removed.


Emergency Room Alternatives?

Next, I started calling PCPs.

I don’t currently have one since I’m healthy as a horse unless I’m going to the ER from sports-related injuries.

One wasn’t taking new patients. Another couldn’t see me for four months. In a nutshell, it started becoming clear that even if I could get in to see someone, it wouldn’t just be a “get stitches out” appointment. Instead, it would be a full office visit and then another charge for the stitches part.

So I moved on to urgent care facilities.

The one in my network couldn’t tell me how much it would cost.

Minimum charge of $160. And then, once you get in there, it could be more depending on a lot of factors.”

What about my in-network discount?

“Don’t have any information on that. You’d have to pay and then submit everything.”

We went around in circles like this for quite some time. Multiple phone calls to all the different groups involved.

At the end of it all, they still couldn’t tell me what it would cost for a simple procedure.

I thought maybe it would be better to just go in person.

Once they saw me, and the simple procedure we’re talking about, perhaps it would all crystallize.


The first thing I saw was a 1.5-hour wait time prominently displayed on a big digital clock.

Urgent care, indeed.

Next, I started discussing my situation with the receptionist.

It was pretty much the same conversation all over again. There was no guarantee on how much the process would cost.

Mystery Medical Charges

This is where I like to step back and think about the same type of idea in a different context – say, a car mechanic.

You pull up to your favorite oil change place and ask how much it is to swap out the 10W-30.

Maybe they ask you if you want synthetic or regular, but either way they can give you a price right upfront.

You can shop that price around.

Or, if you don’t like the prices, you can simply go get some oil and open the hood yourself.

Can you see where I’m going with this?

When faced with the idea of paying at least $160 … waiting several hours … and then possibly ending up paying far more once in the actual room … I opted to just open the darn hood myself and change the oil.

Now before I go any further, let me just put this out here. I’m not a doctor (obviously). So don’t take what I’m about to do as the “right” way to solve your medical problems. In this situation I was able to shop around and take matters into my own hands, but that isn’t the right reaction in every circumstance, especially when you have a medical emergency.

Anyway, back to my story…

I headed to CVS and bought a pair of small scissors.

Then I went on Youtube and watched a quick tutorial on stitch removal.

A couple minutes later, I was snipping my way to massive time and money savings.

Hey, it’s only my face, right?

Of course, I’m not telling you this story because I think WebMD should be your default care provider.

I just want to highlight a couple important points:

First, in some cases, it is entirely possible to avoid our frustrating medical system. In my case, removing stitches is now one of them.

Second, there should be no reason why our medical system is this frustrating in the first place.

I had a minor injury and I have health insurance.

Why on earth should a simple procedure like a few stitches cost me a couple thousand dollars at my local hospital and still not even include taking the darn things back out?

I’ll give you some more of my own thoughts on that soon… Until then, if you have the opportunity, and it’s not a medical emergency, consider shopping around a little.

Don’t be afraid to ask what procedures are going to cost. If you aren’t comfortable with the price, get a quote from someone else!

Just because it’s a medical procedure doesn’t mean that you have to pay whatever the first person quotes you. Make sure you get the best price available for your care, like you would with any other major purchase.

To a richer life,

Nilus Mattive

— Nilus Mattive
Editor, The Rich Life Roadmap

The post How My Medical Mishap Could Save You Hundreds appeared first on Daily Reckoning.

Before You Pay Your Hospital Bill, Read This

This post Before You Pay Your Hospital Bill, Read This appeared first on Daily Reckoning.

Have you run up a huge hospital bill that you’re having difficulty paying?

The stress can be overwhelming, especially while you’re recovering from a complicated procedure and feeling like you’ve been hit by a truck. 

But you’re not alone…

The Consumer Financial Protection Bureau (CFPB) found that 43 million Americans have overdue medical debt on their credit reports.

You may have already pleaded with your insurance company and battled with debt collectors. But you still can’t get a break.

One resource you might consider is…

Hospital Financial Assistance

As part of the Affordable Care Act (Obamacare), all nonprofit hospitals must offer hospital financial assistance, also known as charity care. It’s optional at for-profit facilities.

The programs offer free or reduced-rates for certain patients. Yet the federal government doesn’t have any clear rules on how much assistance should be provided and who qualifies.

So that gives hospitals a lot of flexibility on what they offer and to whom.

Many base assistance on federal poverty guidelines (FPG). This is a measure of income and family size used by Washington to determine who is eligible for some federal programs. 

Others might have a sliding scale, which eliminates hospital debt for lower-income folks. Or there could simply be a standard amount of forgiveness.

Many hospitals post specifics about their financial assistance program on their website.

For instance, Jupiter Medical Center in Florida gives patients a 100% discount if their income is less than or equal to 200% of the FPG. If income is over 200% but not more than 400% of FPG, they’ll get an 80% discount.

The University of Pittsburgh Medical Center has a sliding scale. If patients have income below 251% of FPG, they’re eligible for 100% assistance. An income between 251% and 400% will get them partial debt forgiveness.

Here in California, USC hospitals grant a 100% discount for patients whose income is less than 200% of FPG. Those with family income between 201% and 350% will be eligible for a sliding scale discount.

Loyola University Medical Center is one of the more generous. The Chicago hospital has discounts for patients with family income as high as 600% of the FPG.

Other Criteria

Besides financial need, eligibility can depend on why you were in the hospital since some procedures, such as cosmetic and dental, might not be covered in your hospital’s program.

Also before requesting hospital financial assistance, you must have used all of any insurance benefits you were entitled to. That includes: insurance from your employer, auto insurance, and workers comp.

Patients with sufficient assets to pay for care are ineligible for financial assistance.

How to Apply

Hospitals have application forms online that you can download, print, and submit. You’ll likely have to include proof of income with pay stubs and tax returns as well as a list of assets, liabilities, and family members.

You have up to 240 days after the initial billing to file your application for assistance.

Call the facility’s billing office if you have questions on the application process.

And if You Don’t Qualify…

There are still steps you can take to get this monkey off your back.

The most important: don’t ignore it.

Because once a debt like that goes to collections, it can hurt your FICO credit report for up to seven years. And even land you in court.

So before your bill is sold to a collection agency, request an itemized statement from the hospital and ask that they put a hold on your account for 30 days. That gives you time to look for errors, such as double-billing and unexpected fees.

If you have medical insurance, they should have sent you or posted online an explanation of benefits (EOB) form. Compare it to the hospital’s itemized bill.

Is there something that you think the company should have paid but didn’t?

There could be a coding error, which may be why it was not paid…

For example, removing stitches from a gash on your arm, applying antiseptic cream, and covering it with a bandage at a walk-in clinic could have been coded as a much-more expensive emergency room visit.

Or tests done by technicians could’ve been coded as being done by doctors.

Or is there a large unpaid amount on the EOB form that you have no idea where it came from?

Get on the phone with your insurer and request to speak with a representative.

You can also delve deeper by comparing your bill to your medical records to see if the services invoiced were actually performed.

Extreme? Perhaps. But doing this legwork could save you thousands.

One study found errors in 99% of bills analyzed for 2017. Double-billing for services and procedures were among the most common.

Finally, if you’re uninsured or haven’t hit your deductible yet, remember that almost everything is negotiable, even hospital bills.

Not sure how much to offer? The Healthcare Bluebook lists the fair price for procedures in your area.

You might also see if the hospital will let you repay the bill on a low-or no-interest installment plan.

And in case you end up in the hospital again, you may want to reapply for financial assistance. Your family circumstances might change, and the FPG adjusts annually.

To a richer life,

Nilus Mattive

— Nilus Mattive
Editor, The Rich Life Roadmap

The post Before You Pay Your Hospital Bill, Read This appeared first on Daily Reckoning.

7 Retirement Sins You Don’t Want to Commit

This post 7 Retirement Sins You Don’t Want to Commit appeared first on Daily Reckoning.

In general, Americans are pretty fearful about retirement and it’s easy to see why.

So today I want to talk about seven different things that can totally derail anyone trying to work toward more financial stability in their golden years.

Retirement Planning Sin #1: Counting on Social Security, Pensions, and Other Traditional Plans

At this point, I’ve probably written a million words on the problems with our traditional retirement systems and you’re free to read my thoughts in past articles and interviews I’ve done over the years.

But just to recap:

  • Social Security is now taking in less than it pays out and is projected to do so every year going forward…
  • Without changes, the program’s trust fund will be exhausted in 15 years and only 75% of promised benefits will be paid out…
  • Many pension plans – both governmental and private – have been suffering from similar shortfalls and systemic problems…
  • A number of pension plans are already trying to go back on the promises they’ve made to retirees…
  • And while near-term retirees will probably be the least affected group, I wouldn’t treat any guarantee as sacred.

Now, it needs to be said: These are not just abstract concepts. I’m not saying these things for shock value.  These are real issues that impact a lot of people in my own life.

For example, my father has two different state retirement plans after working in various mental health facilities for four decades.

My mother-in-law receives her retirement income from a pension provided by Dupont, her life-long employer.

And even I have a small pension from more than a half decade working at Standard & Poor’s.

I hope all of our payments keep coming as they should. But I’m telling my father, my mother-in-law, and everyone else not to just blindly depend on it!

Instead, you should always be saving and investing somewhere else on the side… just as a fall-back plan. 

Retirement Planning Sin #2: Failing to Have a Budget

For about 15 years, I urged my mom to keep track of her spending so she would have a good understanding of what her cash flows looked like.

In response, she gave me all kinds of excuses. She didn’t have time. She already had a basic idea of what she was spending. That there was no possible way to even keep track between her credit cards, her check payments, and all the various cash transactions she was making.

Then she turned 66 and got serious about retiring.

Sure, she knew what all the big numbers looked like – property taxes, car payments, etc. But did she have any idea how much was being spent eating out with her friends? Or going overboard buying Christmas gifts for my daughter?

Not really. Without that knowledge it was going to be impossible for her to design a sustainable life on a very fixed income.

Now she’s actually retired and keeps better track of the money coming in and going out because she has to. But she could have been even better prepared… and probably saved a lot more money ahead of time… if she had started sooner.

So please, if you don’t currently have a budget… one that accounts for ALL your expenses… please get one up and running.

I do this in an excel spreadsheet for my own family and we meet at the end of every year to revisit things.

But the process can be as simple as a $1 notebook from the drug store. And all you have to do is write down how much you spent and on what – no matter what payment form you use.

Then, after a few months, add up the numbers and put them into basic categories. I think you’ll be surprised at the patterns you see… and where you might have room for additional savings.

One other thing – if you share your finances with anyone else, it’s absolutely crucial that you include them in this process and that you have open and honest discussions about how the money is getting spent.

Speaking of which, there’s one major expense you might NOT be factoring in. And that’s why the third deadly sin is

Retirement Planning Sin #3: Ignoring Inflation, Especially in Health Care Costs

I’m sure you understand the general concept of inflation and you already have a sense that today’s budget might look different ten years from now simply because of rising prices.

But perhaps no single expense is rising faster – or impacting more retirees – than soaring healthcare costs.

Every year, Fidelity takes a look at how much a typical 65-year-old couple will spend on out-of-pocket healthcare costs during retirement.

This year the number was an eye-popping $280,000.

Five years ago, the number was $220,000.

That’s a 27% surge in just half a decade!

What’s more, this is assuming you have traditional Medicare coverage. Plus it doesn’t include costs associated with nursing-home care.

And that’s where things get really scary.

Unless you’re essentially destitute and qualify for Medicaid – or you’ve already purchased long-term care insurance – medical treatment outside a hospital is going to be your cost to bear.

The total outlay depends on a number of factors, including your local area. But according to Senior Living, the national average for a semi-private nursing home runs $82,128 a year!

Look, I’m not trying to depress you here. But the reality is that 70% of us will need long-term care services at some point in our lives… and sometimes it happens sooner than we think. In fact, 40% of the Americans in long-term care are between the ages of 16 and 64.

So whether you consider long-term care insurance or you simply set aside a big chunk of money and hope for the best, you at least need to consider the huge impact that health care costs will have on your family during retirement.

You’re looking at a quarter of a million bare minimum. And another $100,000 a year if long-term care becomes necessary.

That could be enough to drain even a very well-prepared retiree.

Which is why you should also seriously explore how you can protect your income and assets before they get taken or disqualify you from Medicaid.

The rules vary from state to state, and they’re always changing, but at the bare minimum you want to start thinking about this at least five years before long-term care becomes a real possibility.

For example, if you have a second home or rental real estate, you might consider signing it over to a trustworthy heir before you end up signing it over to a nursing home.

And speaking of protecting your assets…

Retirement Planning Sin #4 Is Not Using Tax Shelters!   

It doesn’t matter if you’re 30 or 60 – you should be using tax-advantaged accounts for the vast majority of your saving and investing.

Obviously, choosing which particular accounts make the most sense is going to vary based on your individual circumstances. But in general I recommend using the following process:

First, contribute enough to any employer-sponsored plan to get the maximum match…

Second, if you’re self-employed – which includes people who merely have side businesses – also consider opening a Solo 401(k) plan…

And third, use IRA accounts – traditional and/or Roth varieties depending on your goals and tax situation – to sock away even more.

This is what I do personally, and the same thing I recommend to everyone else I talk to regardless of age or income.

Retirement Planning Sin #5: Not Having “A Post-Work Plan.”

A lot of people don’t think this really matters – especially if they’re still relatively far away from retirement.

Heck, how could NOT working be hard, right? I mean, most people figure waking up without anything to do is a great problem to have.

However, I know someone who retired – from a job she didn’t even like – and she found the transition to be VERY difficult.

So much so that she had to take a class at her local senior center titled “Every Day Is a Saturday.”

In what amounted to a support group, she witnessed countless other new retirees literally breaking down because they didn’t know how to handle their newfound freedom – including a 70-year-old heart surgeon who cried profusely!

Rather than figuring this out as you go, start thinking about it now… and always keep that budget in the back of your mind, too.

There are countless resources available to retirees – free classes (even college educations in some places!)… special exercise groups… volunteer opportunities… mentoring programs… the sky is literally the limit.

The key is envisioning your future before it arrives.

And on a similar note…

Retirement Planning Sin #6 Is Being Inflexible

We never have any idea how things are going to turn out – in investing or life. So all we can do is plan for the best and prepare for the unforeseen twists and turns.

If you have a very narrow vision of what your future looks like, and you’re unwilling to change course, you’re setting yourself up for potential disappointment.

Just consider the thousands of retirees who are now discovering whole new lives in foreign countries they had never thought of visiting ten years ago!

Am I saying you should have to move to Thailand to get a comfortable retirement? Of course not. I’m simply saying that we should try to find joy no matter what… and embrace the excitement of trying new things no matter our age or circumstances.

That’s the real secret to a long, healthy, and happy life.

Which brings me to our final retirement planning sin… perhaps the biggest of them all…

Retirement Planning Sin #7: Procrastinating!

I started saving in a 401(k) the very first paycheck I got and I have increased the amount I sock away at every possible opportunity ever since then.

Two decades in, I have quite a lot in the bank already. Meanwhile, most of my friends are still treating retirement as some far-off thing.

Sure, there might be another two decades to go for anyone in my age bracket. But time flies!

That’s something to remember no matter how old you are… no matter where you’re at in terms of your goals… and no matter how much money you currently have.

To a richer life,

Nilus Mattive

— Nilus Mattive
Editor, The Rich Life Roadmap

The post 7 Retirement Sins You Don’t Want to Commit appeared first on Daily Reckoning.

5 Ways to Haggle with Hospitals

This post 5 Ways to Haggle with Hospitals appeared first on Daily Reckoning.

I recently told you about my weekend hospital visit that totaled $30,124 from a surfing accident I had back in December.  

Fortunately, my insurance erased more than 90% of that bill and the total cost for the stay ended up being just a couple grand. But what if I didn’t have insurance or what if my visit wasn’t covered? 

I’ve been thinking more about what people do when they’re stuck with high hospital bills. What are your options? How much can you negotiate? 

It’s estimated that hospitals in the U.S. overcharge their patients by about $10 billion total every year. Patients are paying markups of 100-1000% annually without even realizing it. This is a huge problem in our country. 

Before you panic, know that most hospitals are willing to cut you a deal. As long as you know who to talk to and what to look for you can almost always slash a few decimals off your hospital bill. Here are some tips on how to do it.

1. Be Proactive

If you have a procedure that’s not an emergency, ask for a discount ahead of time. Explain your circumstances upfront to your doctor if you’re living on a fixed or low income. A lot of facilities have programs in place to help those who are financially strapped, but they don’t necessarily advertise unless you ask. 

And when you’re negotiating, try to do it through email. It’s best to have a paper trail if you successfully negotiate a discount in case you need to remind the billing department of your agreement. Another tip is keep notes during your hospital stay. 

Have a family member or friend help you out. You want to log all the procedures and services you receive so you can compare when your bill arrives. 

2. Pay in Cash 

Talk to your doctor or the billing manager and ask if they’re willing to give you a discount if you pay in cash. Cash will save the office credit card fees and staff time processing paperwork. 

Make sure you point these out when you make the offer, and if you have the means offer to pay the full amount upfront if they lower the bill even more. 

3. Check for Billing Errors

Eighty percent of medical bills have at least one error. Always ask for an itemized bill so you can determine whether you’ve been overcharged for a service. Medical bills are notoriously hard to decipher and it’ll look like a bunch of numbers next to your costs. 

If you’re unsure of what a code means, track it down online so you can see what you’re being billed for and whether or not you actually received that treatment. Codes might be mismatched, which means they don’t line up with your diagnosis. 

If the codes don’t match, your insurer will most likely decline to pay any portion of this claim. 

Watch out for duplicate billing and unbundling, when services that should have been billed under one umbrella diagnosis or code are broken out, sometimes adding up to additional costs. If you suspect your bill has an error, call your doctor, the hospital or your insurance provider to let them know and ask for a new, accurate bill.

4. Do Your Research on Insurance Rates

Look up the fair market price for the care you received. This is the amount providers regularly accept from insurance companies as payment in full, and it’s the amount you should aim for in your negotiations. 

You can find this information in the Healthcare Bluebook. After you know what you should be paying, contact the billing department and explain the situation. 

Ask to lower your bill to be in-line with the market price. Be polite and keep your composure, no one likes helping someone rude. 

5. Negotiate Payment Terms

Sometimes you’ll run into service providers that won’t budge on price — don’t cave. Ask if there are any payment plans that could meet your needs instead. 

Tell the billing representative exactly how much you can pay and when. If they ask for larger payments — and they will — explain that you can’t afford to do more. Make it crystal clear your ability to make payments. If you’re really having a tough time, drop the word “bankruptcy.” Most providers would rather receive some payment than nothing at all. 

Most of the time if you pay small amounts over an extended period of months, the provider won’t turn you over to collections. They’ll accept your money each month and send you a new bill the next month, unless you miss a payment. 

So don’t commit to more than you can afford, because as soon as you’re late on a payment, you lose all negotiating power. 

6. Hire a Billing Advocate 

If all else fails, consider hiring a medical billing advocate. The downside is most billing advocates cost money, though you typically don’t pay unless they’re successful negotiating you a lower bill.

Lastly, whatever you negotiate, make sure you follow through on your end of the deal. If you said you’d send in regular monthly payments, make sure they’re being sent on time every month. 

Failing to keep up your end of the bargain could lead to the provider rescinding any discount you negotiated and land you in the collections department. 

I hope you don’t find yourself in a situation where you need to use any of these tips. But if you do, know there are ways to reduce the costs.

To a richer life,

Nilus Mattive

— Nilus Mattive
Editor, The Rich Life Roadmap

The post 5 Ways to Haggle with Hospitals appeared first on Daily Reckoning.

Fighting Medical Bills and More…

This post Fighting Medical Bills and More… appeared first on Daily Reckoning.

Back in December, there was an issue where I told you about a surfing accident sent me to the hospital for a weekend. And I said my own experience demonstrated how important it is to fully understand the type of insurance you have before an unexpected event sends you to the ER. 

Despite a little lingering soreness, I’ve pretty much fully recovered from the four broken ribs and collapsed lung. I was back to surfing six weeks later and recently spent five days snowboarding in Lake Tahoe with my daughter going as hard as ever.

But now that the bills are rolling in, it’s obvious that a financial recovery would be the much bigger problem for anyone without an adequate understanding of insurance and medical billing or at least the willingness to learn about such things.

Just to prove the point: The latest summary of charges for my weekend hospital visit totaled $30,124!

That’s roughly equal to the median annual individual income in the United States right now.

Fortunately, my insurance plan has an annual maximum out-of-pocket deductible of $3,500 per individual. 

Factoring in other unrelated charges already made earlier in the year, that means my total cost for the stay ends up being a couple grand. In other words, more than 90% of the bill was covered. 

Although it’s a small (and somewhat perverse) consolation, that means I actually made money on my insurance premiums for 2018. Hooray!

Okay, now let’s talk about a couple nitty-gritty details.

Choose Your Health Service Facility Wisely

First, as I pointed out in our earlier discussion, going to a different hospital could have meant the vast majority of this tab would NOT have been covered.

You do not want to make a $20,000 or $30,000 mistake like that!

Second, going through some of the individual items and charges was very revealing.

Take blood panels … 

My caregivers wanted to draw my blood once or twice every single day and with the exception of admission and imminent discharge, I refused. 

This was for two reasons:

  • I hate needles and they had a lot of difficulty finding a vein the first time around.
  • The stated reasons for the blood panels were minor concerns. Things like assessing the possibility of infection, when other signs such as my temperature were completely normal.

Now if you happen to work in the medical field, I’m sure you’re cringing a bit. Very few practitioners like the patient who says no to things. 

At the same time, even one of the doctors agreed that administering so many blood tests was unnecessary. And I firmly believe that patients have the final say over their own bodies and treatment choices.

Now that I’ve seen the itemized list of charges, it turns out there was a third reason not to want daily blood tests… each one was several hundred dollars! 

This raises an important point: Some “standard” treatments and protocols are not only medically unnecessary, but the costs are never discussed, either.

Your caregiver comes in and says, “Hi. We need a urine sample” and you oblige. They don’t tell you how much it will run. (In my case, $96.)

They also rarely say exactly why they’re doing the test or procedure. We’ll talk more about how that relates to my urine sample in a second.

But How Much Does It Really Cost?

For now, let’s stick with the economics. 

Plenty of procedures and protocols are more about reducing a medical establishment’s liability than they are about patient outcomes. 

That’s bad enough.

What’s worse is that anyone who studies the issue will quickly discover some outrageous markups on routine items.

Many years ago, a taxi ran over my foot in New York City. 

I distinctly remember getting the itemized list for my brief treatment in the ER, which included gauze at $100 a roll and crutches billed out at $400. The same items at my local CVS would have been $50 total. 

There’s not much an individual can do about this particular aspect of our medical system, though it is possible to dispute the charges if you think they’re too high.

A great example?

The time a surgeon offered to pierce a 5-year-old’s ears while she was having a separate procedure, and ended up billing her parents $1,877!

The girl’s mother, an attorney, got some of the charges reduced … but only after lots of phone calls and a protracted fight.

And here’s another account of someone who fought various charges and ultimately got a 20% reduction even when nothing was technically wrong with the care received.

Speaking of which, you should also go line by line to make sure you’re being billed for the things you actually got!   

All of the procedures and costs are tallied up using various billing codes and errors are rampant. Just as anecdotal evidence, my mother once found several inaccuracies listed on an invoice … including a procedure that had nothing to do with the reason for her visit.

Do You Need Everything You’re Being Tested For?

Last but not least, I was also surprised to see my $96 urine sample labeled as a toxicology screen – i.e. a drug test.

Why would that be needed?

I was completely lucid when I was admitted. I was exhibiting signs of physical trauma completely consistent with the circumstances as described. And I told my caregivers that I wasn’t on any medications nor was I a smoker or an illicit drug user.  

It turns out nearly any ER admission results in a drug test no matter what the patient says. 

They don’t tell you they’re doing it. 

They don’t have to ask for your permission. 

And as one doctor pointed out in Time, there are a lot of thorns to consider even beyond the financial aspects:

“There are some real tradeoffs to testing emergency-department patients for illicit drugs. As practitioners we need to pay attention to the downsides of these tests so we don’t overuse them.

“First there are ethical issues of autonomy and confidentiality. The principle of autonomy states that patients should be able to decide whether or not to undergo testing or treatment for anything. When you check in to a hospital, you sign a form giving consent for routine testing, including blood and urine tests for lots of things. This makes sense — it means that as doctors, we don’t have to check with you for every run-of-the-mill test we order. But the question here is whether or not testing for drugs and alcohol without your explicit consent should be considered routine.

“Confidentiality is, of course, the other major ethical problem with ordering illicit-drug tests on our patients. While the Health Insurance Portability and Accountability Act legally protects all medical information from public disclosure, just ordering the test increases the risk that a breach of confidentiality could expose this sensitive information.

“False-positive tests are another concern. Urine drug tests use immunoassays to screen for multiple illicit drugs. While they tend to be quite accurate, cross-reactions with other medications have been demonstrated — for example, over-the-counter decongestants have been shown to light up the amphetamine test incorrectly. Also, these tests may identify previous drug use but fail to tell us that the patient was using drugs recently (the marijuana test can be positive over a month after use, for instance). This can be confusing to the diagnosticians who are trying to figure out what is causing today’s symptoms.

“Last, there are issues of cognitive biases, mental prejudices on the part of doctors that can interfere with our ability to make the best decisions for our patients. Fundamental attribution error is one such bias, in which a health care provider inadvertently — and wrongly — blames a patient for her illness. Take the case of the patient with belly pain, who tests positive for cocaine: she becomes the “drug user in Room 2.”

The Bottom Line

Any time you’re receiving medical treatment, it pays to get as much information as possible before any treatment or procedure is performed …

It pays even more to scrutinize the statements you receive in the wake of a visit …

And you should never hesitate to question a billing department when you think a treatment was overpriced, mislabeled, or unnecessary.

To a richer life,

Nilus Mattive

— Nilus Mattive
Editor, The Rich Life Roadmap

The post Fighting Medical Bills and More… appeared first on Daily Reckoning.

5 Ways to Make Money with Your Body (Legally)

This post 5 Ways to Make Money with Your Body (Legally) appeared first on Daily Reckoning.

Could you use some extra cash? Donating body materials can be akin to a part-time job. And the pay is often better than driving for a ridesharing company or working as a retail clerk. 

We’ll start with the easiest way to earn money with your body and work our way to the more complex.

1. Hair — up to $1,500 … or more!

Buyers want healthy, attractive hair for wigs, extensions, and art projects. Hair that has never been dyed is the most popular. The longer the better — at least 15-35 inches. 
Color is also important. Redheads fetch the biggest bucks followed by natural blondes and brunettes. Not much demand for gray.

You can get an idea on how much your hair is worth here. Once you have that, there are online markets such as HAIRSELLON.com and BuyAndSellHair.com where you can post your locks for sale. 

2. Blood plasma — up to $400 per month

Plasma is the light-yellow liquid portion of blood that remains after it is separated by a machine. 

Donating is like giving blood, and you can do it up to two times a week. 

Plasma therapies help people with genetic, chronic conditions such as hemophilia and Kawasaki disease lead healthier and more productive lives.

And patients need a lot of it … 

For instance, it takes more than 1,200 plasma donations to treat one hemophilia patient.  

Red Cross and similar organizations won’t pay for your plasma. But pharmaceutical companies will. 

There are licensed and International Quality Plasma Program (IQPP) certified plasma collection centers throughout the U.S. You can search for one in your area by clicking here. 

3. Sperm — $500 to $2,000 per month 

Guys, this isn’t as simple as going to a clinic and handing over a mason jar containing your sperm. 

The qualifications are tough because sperm seekers are paying big bucks. And they want the perfect specimen …

They’re looking for men who are healthy, well-educated, and maybe even a minimum height. 

Once you pass the initial screening, you’ll have to provide your family’s medical history, undergo STD testing, submit a sample to measure the quality, and undergo genetic testing.

A longer-term consideration is that with the rise of more DNA testing services, the offspring you helped create could one day look you up.

Click here to find a sperm bank directory in your area. And if you’re married, I suggest you check with your wife first. 

4. Eggs — $6,000 to $8,000 or more

Egg donation is a complex process in which an egg is surgically removed from a fertile woman and donated to another woman in order to help her conceive. 

A series of screenings, tests for diseases, counseling, and genetic tests are required and take about two months.

This isn’t for everyone … generally fertility centers are looking for healthy donors age 21 to 35. Potential participants who smoke, use drugs, have a high body mass index, or have mental health issues aren’t eligible.  

Another thought to keep in mind …

While some donors might get satisfaction knowing they’ve created a new life, others may find that giving up a child is psychologically troubling. And like sperm donors, there’s the possibility that the children you helped create may someday try to contact you.

If this is of interest, fertility centers are in almost every community. You could also check with your gynecologist. 

5. Surrogate — $35,000 to $53,000 or more 

Carrying a couple’s sperm and egg until a child is born is a long-term commitment … 15 to 18 months.

Also, the screening process is much more intense. It can include medical and psychological evaluations, criminal background check, home visits, and even financial status. 

You may also be required to follow a certain diet and lifestyle. 

For instance, Kim Kardashian and Kanye West, paid a surrogate $45,000 to carry their third child. 

They stipulated that their surrogate could not smoke, drink, or do drugs during the pregnancy and had to refrain from going in hot tubs, handling cat litter, and applying hair dye. Nor could she eat raw fish or drink more than one caffeinated beverage a day. 

The legality can be an issue since some states ban surrogacy contracts. So you might want to obtain legal representation beforehand. 

Bottom Line

A final point when making the decision to sell your body’s materials … 

It’s not only about the extra cash you’ll receive, there’s the altruistic point …

You might make a chemo patient feel better about herself, create a life when helping a childless-couple become parents, or save a life when your donation is for the research needed to treat a rare disease.

To a richer life,

Nilus Mattive

— Nilus Mattive
Editor, The Rich Life Roadmap

The post 5 Ways to Make Money with Your Body (Legally) appeared first on Daily Reckoning.