WEBVTT - Episode 1: Six Levels Down 0:00:15.276 --> 0:00:21.796 Pushkin. The first time I since we all had a 0:00:21.836 --> 0:00:25.036 serious problem that might one day lead to our doom 0:00:25.196 --> 0:00:32.276 was when I was working on Wall Street. The problem 0:00:32.316 --> 0:00:36.436 had to do with experts. People making important decisions had 0:00:36.556 --> 0:00:39.756 no idea who they should listen to or who they shouldn't, 0:00:40.396 --> 0:00:43.636 even when millions of dollars were at stake. I was 0:00:43.676 --> 0:00:46.596 a twenty five year old art history major with zero 0:00:46.716 --> 0:00:49.596 training in finance. Then I got hired to work on 0:00:49.636 --> 0:00:52.716 Wall Street, where I got paid hundreds of thousands of 0:00:52.716 --> 0:00:55.836 dollars to persuade professional money managers to do things with 0:00:55.956 --> 0:00:59.556 millions of dollars. Obviously, I had no real idea what 0:00:59.596 --> 0:01:03.996 to do with money, yet I was taken as the expert. Hello, 0:01:03.996 --> 0:01:06.596 and welcome once again to this is Wall Street here 0:01:06.676 --> 0:01:10.956 on wmi N Radio. Today's special guest is Michael Lewis. 0:01:11.116 --> 0:01:13.356 He's the author of The Money Culture and former bond 0:01:13.396 --> 0:01:15.796 trader for Solomon Brother. What's in the future for yourself? 0:01:15.836 --> 0:01:18.316 I know you're a pretty young man, aren't you. I 0:01:18.476 --> 0:01:21.836 just turned thirty one. That young well feel and all 0:01:21.916 --> 0:01:26.596 would say so it feels old. In nineteen eighty nine, 0:01:26.636 --> 0:01:29.596 I wrote a book called Liars Poker, in which I 0:01:29.676 --> 0:01:32.076 explained how I and a lot of other people on 0:01:32.116 --> 0:01:34.716 Wall Street got paid a bunch of money to give 0:01:34.756 --> 0:01:38.796 advice that was either wrong or pointless. In this book, 0:01:39.076 --> 0:01:41.676 I proved beyond a shadow of a doubt that I 0:01:41.756 --> 0:01:44.956 was not a financial expert. And yet when I hit 0:01:44.996 --> 0:01:48.196 the road to sell liars poker, people still ask me 0:01:49.116 --> 0:01:53.116 what should I do with my money? From the Midwest, 0:01:53.316 --> 0:01:56.276 especially for some reason, from Ohio, I am inundated with 0:01:56.356 --> 0:01:59.996 letters from young people who have treated everything I've written 0:02:00.076 --> 0:02:03.756 is sort of a how to manual, and it's almost 0:02:03.796 --> 0:02:05.796 that they can't conceive as a book as anything but 0:02:05.876 --> 0:02:11.436 advice and self help. All my books are the same 0:02:11.476 --> 0:02:15.476 in one crude way. I start out knowing very little 0:02:15.516 --> 0:02:20.076 about the subject. I go find actual experts, people who 0:02:20.156 --> 0:02:24.476 know stuff, and write stories about them. To my mind, 0:02:24.716 --> 0:02:27.676 all I'm doing is describing great characters in some interesting 0:02:27.756 --> 0:02:33.716 situation a financial crisis, a professional sport and turmoil, a pandemic. Yeah. 0:02:33.756 --> 0:02:37.156 I learn some things about those situations, but pretty much 0:02:37.196 --> 0:02:39.836 everything I know about, say, the origins of the two 0:02:39.876 --> 0:02:43.156 thousand and eight financial crisis, I know from the people 0:02:43.196 --> 0:02:47.316 I've written about. They are the experts. I'm just a 0:02:47.356 --> 0:02:51.036 guy who writes books about them. Still, the pressure from 0:02:51.076 --> 0:02:53.876 me to swan around as the true expert is incredible. 0:02:54.436 --> 0:02:58.396 Do you think that's what they believe? Well, that's not 0:02:58.556 --> 0:03:01.076 true right now, but I think do I think they 0:03:01.076 --> 0:03:04.676 believe that after they pass this legislation that will be true? Yes, 0:03:04.796 --> 0:03:07.396 I do think that. I do believe that. I think 0:03:07.396 --> 0:03:10.196 that it's flattering to be treated as the guy with 0:03:10.276 --> 0:03:15.076 the answers, more than flattering, seductive. But still, after a 0:03:15.156 --> 0:03:19.436 book comes out, I usually find myself thinking, why on 0:03:19.476 --> 0:03:22.876 earth are you asking me? Ask the people who told 0:03:22.916 --> 0:03:25.596 me everything I know. I pick him because I thought 0:03:25.636 --> 0:03:28.356 we should all be listening to them. They're the ones 0:03:28.396 --> 0:03:31.556 you should ask why were they unable to convince those 0:03:31.596 --> 0:03:36.116 in power to do something sooner? And I think the 0:03:36.156 --> 0:03:42.756 answer is that this particular threat, when you're on TV, 0:03:42.956 --> 0:03:46.116 you can never just say I don't know. But but 0:03:46.716 --> 0:03:49.316 beyond that, I mean, with a threat like this, he 0:03:49.436 --> 0:03:52.636 almost requires you can't say I don't know because you're 0:03:52.676 --> 0:03:55.676 the expert, and you're the expert because you're on TV 0:03:55.876 --> 0:03:59.836 that you're dealing with You're dealing with an invisible enemy 0:03:59.916 --> 0:04:12.196 that replicates exponentially, and by the time I'm Michael Lewis. 0:04:12.636 --> 0:04:16.356 Welcome back to season three of Against the Rules, where 0:04:16.356 --> 0:04:20.356 we explore unfairness in American life by looking at what's 0:04:20.356 --> 0:04:24.516 happened to various characters in American life. Our first season 0:04:24.596 --> 0:04:29.556 was about referees, Our second was about coaches. This season's 0:04:29.596 --> 0:04:34.436 about experts. We're going to tell seven stories about them. 0:04:34.556 --> 0:04:36.836 Each contains a clue to a mystery at the heart 0:04:36.836 --> 0:04:40.476 of American life. How come a society so great at 0:04:40.476 --> 0:04:45.876 creating knowledge is so bad at using it. How can 0:04:45.916 --> 0:04:48.476 we know more and more yet behave as if we 0:04:48.556 --> 0:04:52.476 know less and less. How can one people be so 0:04:52.556 --> 0:05:00.236 incredibly smart and so breathtakingly moronic? The experts are terrible. 0:05:00.956 --> 0:05:04.036 The Pandemics taught us a bunch of things. That bosses 0:05:04.036 --> 0:05:06.676 missed the office more than their employees, That our centers 0:05:06.716 --> 0:05:09.636 for disease control aren't very good at controlling disease. That 0:05:09.716 --> 0:05:12.836 these United States aren't all that interested in being united 0:05:12.956 --> 0:05:17.196 even in a crisis. Mister President, Please listen to your 0:05:17.196 --> 0:05:22.156 public health experts instead of denigrating them. But the Pandemics 0:05:22.196 --> 0:05:26.476 also taught us something about experts. How fraught our relationship 0:05:26.476 --> 0:05:29.556 with him has become, how hard it is for us 0:05:29.556 --> 0:05:31.956 to decide who they are and how to use them, 0:05:32.676 --> 0:05:35.636 even when it's a matter of life and death. But 0:05:35.716 --> 0:05:39.036 who cares what I think. I'm not an expert. I 0:05:39.116 --> 0:05:42.236 just find the people who are. Hi. I'm Todd Park, 0:05:42.756 --> 0:05:46.476 healthcare and tech entrepreneur and former public servant. Case in point. 0:05:46.516 --> 0:05:52.596 I've been in the succession of situations of great opportunity 0:05:53.276 --> 0:05:58.196 or great crisis and had to help figure out what 0:05:58.276 --> 0:06:03.596 to do very quickly. Todd Parks created three different billion 0:06:03.596 --> 0:06:07.916 dollar companies. He solved some very big problems on behalf 0:06:07.956 --> 0:06:11.276 of the American government. But he built his career on 0:06:11.316 --> 0:06:15.276 a single insight that the experts you most need are 0:06:15.356 --> 0:06:19.156 often not who you think they are. Just finding the 0:06:19.236 --> 0:06:23.276 expert can be incredibly difficult, especially when all hell is 0:06:23.276 --> 0:06:29.876 breaking loose called blue back. In nineteen ninety seven, Todd 0:06:29.956 --> 0:06:32.396 was a consultant fresh out of the Harvard Business School. 0:06:33.436 --> 0:06:34.876 Like a lot of people who go by the name 0:06:34.916 --> 0:06:37.716 of consultant, he didn't really want to be a consultant, 0:06:38.676 --> 0:06:41.556 so he went looking for a business idea, a problem 0:06:41.596 --> 0:06:45.116 to solve. He and another consultant, who was married to 0:06:45.156 --> 0:06:49.916 a midwife, nurse and training settled on a really big idea. 0:06:50.076 --> 0:06:55.836 The beginning of life, specifically pregnancy. To the eyes of 0:06:55.876 --> 0:06:59.596 a male management consultant in nineteen ninety seven, pregnancy is 0:06:59.636 --> 0:07:04.796 conducted in the United States seemed wildly inefficient. Women and 0:07:04.836 --> 0:07:07.796 their babies were having all kinds of expensive medical problems 0:07:08.076 --> 0:07:11.396 that could have been avoided with better prenatal care. By 0:07:11.476 --> 0:07:14.876 keeping women healthier during their pregnancies, you could also make 0:07:14.956 --> 0:07:19.316 childbirth less risky and cheaper. And so these two twenty 0:07:19.316 --> 0:07:21.236 four year old guys set out on this new mission. 0:07:21.756 --> 0:07:25.636 It was a bit weird. They weren't doctors, they didn't 0:07:25.636 --> 0:07:29.676 even have children. And essentially the whole idea is that 0:07:29.756 --> 0:07:34.276 you deploy a whole team of folks, not just the doctor, 0:07:34.316 --> 0:07:39.556 but surfinder's midwife, social worker, educator, case manager, nutritionist to 0:07:39.956 --> 0:07:43.556 love on a mom to be and get her the 0:07:43.716 --> 0:07:47.876 right care, including very importantly non clinical support. Todd and 0:07:47.956 --> 0:07:51.956 his partner named their company Athena Health. They hired a 0:07:51.956 --> 0:07:56.036 few more people much like themselves, smart young guys. They 0:07:56.116 --> 0:07:58.676 raised millions of dollars and used some of the money 0:07:58.676 --> 0:08:02.116 to buy a childbirth clinic in San Diego. It mainly 0:08:02.156 --> 0:08:07.236 served women especially prone to bad outcomes during pregnancy. Undocumented immigrants, 0:08:07.236 --> 0:08:11.116 for instance, The clinic was the test case for Athene 0:08:11.116 --> 0:08:14.956 of Health. If it worked, the company would create a 0:08:15.036 --> 0:08:18.236 lot more of them. So you know, now, all of 0:08:18.276 --> 0:08:23.236 a literally overnight, we are now on the hook for payroll, rent, 0:08:23.276 --> 0:08:27.076 all of this stuff and the revenue. That's Bob Gatewood. 0:08:27.516 --> 0:08:30.956 Todd had hired him to help. So almost immediately we 0:08:30.996 --> 0:08:34.716 started hemorrhaging money. You know, claims were going out, but 0:08:34.756 --> 0:08:37.676 no money was coming in. The first pregnancy clinic was 0:08:37.716 --> 0:08:41.116 supposed to be like the first McDonald's or Starbucks proof 0:08:41.156 --> 0:08:44.876 of concept. The concept never had a chance because they 0:08:44.916 --> 0:08:47.756 couldn't get insurance companies to pay them to make pregnancy 0:08:47.876 --> 0:08:51.756 cheaper and better. In fact, they couldn't really get anyone 0:08:51.796 --> 0:08:54.236 to pay them for anything. Did you have any sense 0:08:54.276 --> 0:08:56.796 that was going to be a problem when you started. No, 0:08:57.196 --> 0:08:59.956 we thought, oh, billing is a solved problem. Everybody knows 0:08:59.956 --> 0:09:01.796 how to do that. The interesting thing is that electronic 0:09:01.836 --> 0:09:04.756 health records, the young entrepreneurs had thought they'd bought a 0:09:04.796 --> 0:09:08.916 business with they'd really bought was a crisis and a cause. 0:09:09.556 --> 0:09:13.036 We then said, okay, this is a very special practice. 0:09:13.356 --> 0:09:16.316 It's the public health safety net for so many women 0:09:16.316 --> 0:09:19.876 in San Diego County. We must save this practice. We 0:09:19.956 --> 0:09:22.996 cannot allow this practice to sink beneath the surface of 0:09:22.996 --> 0:09:25.676 the sea. And so we got plug all the stops 0:09:25.676 --> 0:09:28.676 and fight and figure out how to keep this thing afloat. 0:09:28.836 --> 0:09:32.356 So you go from like whiz bang entrepreneur who's going 0:09:32.356 --> 0:09:36.076 to build a huge company on the basis of an idea, 0:09:36.196 --> 0:09:40.556 to being philanthropist trying to save the safety net for 0:09:40.676 --> 0:09:43.716 San Diego County. That's exactly right. But in order to 0:09:43.756 --> 0:09:46.236 save the safety net, Todd Park realized he and his 0:09:46.316 --> 0:09:48.796 partners had to solve the problem that hadn't even occurred 0:09:48.796 --> 0:09:51.956 to them, the problem of not getting paid by the 0:09:51.996 --> 0:09:55.036 health insurance system. Those system is maybe too kind a 0:09:55.076 --> 0:09:58.676 word for it. Essentially, what's happened in the United States 0:09:58.876 --> 0:10:00.436 is that you've got a lot of different health insurance 0:10:00.476 --> 0:10:03.316 companies and they have invented a lot of different kinds 0:10:03.356 --> 0:10:08.116 of health insurance products HMO Ppo pos m bas pos 0:10:08.236 --> 0:10:11.636 pos pos, all right, and then like employers like to 0:10:11.756 --> 0:10:14.676 customize those just for them. So there's like the ge 0:10:14.916 --> 0:10:19.796 version of the HMO based pos product for Wisconsin. There's 0:10:19.836 --> 0:10:22.636 not even an alternate universe. With the design of the 0:10:22.716 --> 0:10:26.676 US health insurance system makes sense, you could not build 0:10:26.716 --> 0:10:29.876 it to be more confusing. But now that system was 0:10:29.916 --> 0:10:34.916 Todd's problem. There are countless called them insurance packages, like 0:10:35.036 --> 0:10:37.996 different flavors of insurance that have probleagate across the country, 0:10:38.436 --> 0:10:42.916 each of which has different rules associated with it with 0:10:43.076 --> 0:10:48.356 respect to how to build them. And these rules are 0:10:48.796 --> 0:10:54.196 really poorly documented. They're very opaque, they're changing all the time, 0:10:54.956 --> 0:10:57.996 and medical doctors and medical officers have no idea what 0:10:58.116 --> 0:11:01.916 they are right, so they'll basically put together a claim 0:11:02.356 --> 0:11:05.876 to bill for their medical office visit. They'll send in 0:11:05.956 --> 0:11:11.276 the claim and it will get rejected. No one insurance 0:11:11.316 --> 0:11:14.316 company set out to create the confusion, but no one 0:11:14.436 --> 0:11:16.796 had any incentive to clear it up. I mean, the 0:11:16.876 --> 0:11:18.716 harder it was for doctors to figure out how to 0:11:18.716 --> 0:11:21.596 get insurance companies to pay them, the less the insurance 0:11:21.636 --> 0:11:24.836 companies ultimately paid out to the doctors. Todd Park now 0:11:24.956 --> 0:11:27.836 knows this because his last resort clinic full of pregnant women, 0:11:28.356 --> 0:11:32.436 is getting buried under unpaid bills. The payers send back 0:11:32.516 --> 0:11:35.316 this thing called explanation of benefits, which is really kind 0:11:35.316 --> 0:11:37.996 of misstormers doesn't really explain anything, says, here's your claim. 0:11:38.156 --> 0:11:40.756 It was denied for denial code zero five B and 0:11:40.996 --> 0:11:43.316 you look at the code at in the legend at 0:11:43.316 --> 0:11:45.356 the bottom of the EOB and you know it says 0:11:45.396 --> 0:11:48.356 something like, you know, insufficient documentation or something like something 0:11:48.396 --> 0:11:51.276 incredibly vague and not helpful. So then you pick up 0:11:51.316 --> 0:11:53.716 the phone and you call the health insurance company and 0:11:53.716 --> 0:11:55.756 get some port animals who also has no idea what 0:11:55.916 --> 0:11:59.116 that code means. Right as a super frustrating Right. But 0:11:59.196 --> 0:12:01.676 the problem is there is a knowledge base of rules 0:12:01.716 --> 0:12:04.756 at the payer that's totally opaque to the doctor and 0:12:04.836 --> 0:12:07.596 frankly pretty opaque to the payer, so they don't even 0:12:07.636 --> 0:12:12.836 know their own rules exactly. Todd and his fellow company 0:12:12.876 --> 0:12:16.436 founders needed an expert, someone who had mastered all the 0:12:16.516 --> 0:12:20.596 rules created by America's health insurance companies, someone who knew 0:12:20.596 --> 0:12:24.636 how to get those companies to pay a bill. Bob 0:12:24.756 --> 0:12:28.756 Gatewood kept seeing artifacts of this expertise. Every one of 0:12:28.756 --> 0:12:32.956 these doing offices we walked into. Every single screen monitor 0:12:33.156 --> 0:12:36.596 was covered in sticky nose like the whole margin of 0:12:36.676 --> 0:12:39.796 the monitor, and so we would always point at the 0:12:39.916 --> 0:12:43.076 sticky notes and ask the person what's that, and she 0:12:43.156 --> 0:12:45.876 would say, and most often a sheet she would say, Oh, 0:12:46.036 --> 0:12:48.596 that's you know that reminds me that if a midwife 0:12:48.676 --> 0:12:50.636 does the delivery, I have to put a c Z 0:12:50.876 --> 0:12:54.956 modifier on the code or you know. Here, This one 0:12:55.036 --> 0:12:59.076 reminds me that ETNA only reimburses for a gim visit 0:12:59.116 --> 0:13:01.636 every eighteen months, not twelve months. So I got to 0:13:01.676 --> 0:13:04.996 remember not to schedule an ETNA patient too soon. And 0:13:05.116 --> 0:13:07.836 there were thousands and thousands and thousands of these things. 0:13:10.796 --> 0:13:14.996 Medical billing had become so complicated that hospitals were now 0:13:15.076 --> 0:13:19.476 employing a medical biller for each and every doctor. Todd 0:13:19.556 --> 0:13:22.556 and Bob noticed the successful medical billers were all of 0:13:22.596 --> 0:13:27.196 a type. Gladys they called her super type, a you know, 0:13:27.556 --> 0:13:31.316 won't let anything pass her, likes to hold people accountable 0:13:31.596 --> 0:13:34.556 for their mistakes, and it's just kind of pissed all 0:13:34.596 --> 0:13:37.636 the time, like angry that they're not getting paid what 0:13:37.756 --> 0:13:41.636 they should. So at that moment, given what you're you've 0:13:41.756 --> 0:13:46.116 just learned about just how critical Gladys is and how 0:13:46.196 --> 0:13:50.716 important like the business succeeds or fails on whether Gladys 0:13:50.836 --> 0:13:53.996 is on vacation or Gladys is. This strike you how 0:13:54.196 --> 0:14:02.036 odd it is that Gladdis isn't valued. Well, that's part 0:14:02.036 --> 0:14:06.196 of why she's pissed probably unless you know, sometimes Gladys 0:14:06.356 --> 0:14:10.316 was the wife of the surgeon, right right, they were 0:14:10.356 --> 0:14:14.516 all women. I'm not but I'm not being sexist. No, No, 0:14:14.676 --> 0:14:17.916 every single one we met was a woman. But yeah, 0:14:17.956 --> 0:14:20.396 there were a lot of pissed off Gladyses who felt undervalued. 0:14:21.276 --> 0:14:24.076 By the late nineteen nineties, the financial fate of entire 0:14:24.196 --> 0:14:28.476 hospitals turned on Gladys. It occurred to Bob and Todd 0:14:28.556 --> 0:14:32.636 Park that they stumbled under a better business idea, find 0:14:32.716 --> 0:14:36.076 the best Gladdys in the world. If she actually existed. 0:14:39.636 --> 0:14:42.316 If I had found you when you were I don't know, 0:14:42.676 --> 0:14:45.396 twelve years old and asked you what you were going 0:14:45.476 --> 0:14:47.676 to be when you grew up, what might you have said? 0:14:47.836 --> 0:14:50.716 I was going to be an accountant. This is Sue 0:14:50.756 --> 0:14:57.636 Henderson medical biller. Seriously, it's very very, very very exciting. 0:14:58.596 --> 0:15:01.796 And the reason was math was just so simple for me. 0:15:02.196 --> 0:15:05.756 Everything about it was so incredibly logical, and it just 0:15:05.916 --> 0:15:10.196 seemed a great path for me. You killed your dreams early. 0:15:11.556 --> 0:15:15.636 I was very practical and I'm an very very organized individual, 0:15:16.236 --> 0:15:19.876 probably leaning a little bit on the OCD side, and 0:15:20.156 --> 0:15:23.796 so in accounting there isn't any gray. So if you're 0:15:23.836 --> 0:15:27.556 doing the books, then it's a penny off. It's wrong someplace. 0:15:27.636 --> 0:15:30.636 You have to figure out where that penny is, and 0:15:30.756 --> 0:15:32.756 you can't just take it and tape it into the 0:15:32.836 --> 0:15:40.436 books and then close them. Sue Henderson discovered medical billing 0:15:40.716 --> 0:15:45.196 almost by accident back in the nineteen eighties. Accounting had 0:15:45.236 --> 0:15:49.596 captured her imagination. Medical billing she found even more thrilling, 0:15:50.236 --> 0:15:53.836 which was in and of itself kind of amazing. You know, 0:15:54.156 --> 0:16:00.916 medical billers generally are housed in basements I'm not exaggerating 0:16:01.436 --> 0:16:07.836 of hospitals or practices without a window, and they're not appreciated. 0:16:08.276 --> 0:16:11.676 And it's kind of fascinating because if you didn't have 0:16:11.796 --> 0:16:14.716 medical billers, you can render all the services you want, 0:16:14.876 --> 0:16:17.116 and if you're never going to get paid, you're gonna 0:16:17.116 --> 0:16:20.996 go out of business. They're definitely unappreciated across the board. 0:16:21.636 --> 0:16:23.916 How do you explain that, given what you just said, 0:16:24.156 --> 0:16:25.516 that you're going to go out of business if your 0:16:25.556 --> 0:16:29.636 medical biller is no good? Because I don't think that 0:16:30.316 --> 0:16:33.796 I shouldn't say I don't think. I know. Doctors are 0:16:33.876 --> 0:16:38.156 not financial people. They care about patients. That's what they 0:16:38.236 --> 0:16:41.196 care about. The doctor. Sue works for it don't really 0:16:41.316 --> 0:16:45.156 get what she does or how she does it. They 0:16:45.236 --> 0:16:47.156 just leave her alone to play what is about to 0:16:47.236 --> 0:16:50.876 become a very high stakes game. So when you first 0:16:50.956 --> 0:16:54.516 get into medical billing, medical billing isn't anything like as 0:16:54.556 --> 0:16:58.396 complicated as is going to become correct. A lot of 0:16:58.476 --> 0:17:02.756 medical billers were overwhelmed by the complexity, but Sue kind 0:17:02.796 --> 0:17:05.836 of liked it. She sat in the basement of a 0:17:05.916 --> 0:17:11.756 hospital in northern Massachusetts, but is ready to fly. When 0:17:11.836 --> 0:17:13.916 would have been the first time where you walked into 0:17:14.156 --> 0:17:18.636 a job and you increased the receipts because you were 0:17:18.716 --> 0:17:23.596 billing better. Well, that definitely would have been Holy Family Hospital. 0:17:23.636 --> 0:17:26.036 And with when and when would that have been? That 0:17:26.116 --> 0:17:28.876 would be in the middle of my career nineteen eighties, 0:17:29.796 --> 0:17:32.396 in the eighties, Ye, in the eighties. Yeah, And so 0:17:33.316 --> 0:17:36.156 that's a moment where you walk in and just by 0:17:36.356 --> 0:17:41.756 virtue of your command of the complexity, you're able to 0:17:41.876 --> 0:17:45.836 generate more payment to the hospital. It was a combination 0:17:45.916 --> 0:17:48.796 of complexity, and it was a combination of looking at 0:17:49.756 --> 0:17:59.116 a department that was just so unbelievably mismanaged. They had 0:17:59.956 --> 0:18:05.316 a quarter of a million dollars in unapplied payments from 0:18:05.716 --> 0:18:11.276 the Medicaid system sitting. What does that mean? What does 0:18:11.316 --> 0:18:14.116 that mean? The moment I asked the question, I knew 0:18:14.116 --> 0:18:17.236 I didn't actually want to know the answer. Well, okay, 0:18:17.356 --> 0:18:21.236 so what happens is Medicaid is sending you all of 0:18:21.276 --> 0:18:25.156 these payments and you don't have a claim to which 0:18:25.236 --> 0:18:28.876 they can to be applied. So either you didn't send 0:18:28.956 --> 0:18:34.196 that claim out. The details of what Sue Henderson does, well, 0:18:34.236 --> 0:18:37.756 even she has trouble making it sound interesting, and she's 0:18:37.796 --> 0:18:40.276 more interested in the details than perhaps anyone in the world. 0:18:40.836 --> 0:18:43.476 What's the secret to getting the revenue getting the money 0:18:43.516 --> 0:18:46.996 out of the insurance? Unfortunately, is playing by their rules. 0:18:47.956 --> 0:18:51.516 That's the unfortunate part. There's simply now no way around that. 0:18:52.196 --> 0:18:56.196 And so if they're saying you need a modifier fifty five, 0:18:56.556 --> 0:18:59.436 you need a modifier fifty five period, end of sentence, 0:18:59.516 --> 0:19:02.276 there's no way around it, and it's just playing by 0:19:02.316 --> 0:19:07.436 their rules. What's a modifier fifty five? I don't actually 0:19:07.516 --> 0:19:11.476 care about a modifier fifty five. The modifier fifty five 0:19:11.596 --> 0:19:16.596 would be a second I won't describe it exactly, but 0:19:16.876 --> 0:19:21.556 it would be a second procedure code that is appropriate 0:19:21.676 --> 0:19:25.156 with the initial procedure code. So it's there. They are 0:19:25.276 --> 0:19:28.196 hundreds of versions of this problem with medical billing where 0:19:28.236 --> 0:19:32.756 there's some nitty detail that if you leave it off, 0:19:32.876 --> 0:19:35.276 you just don't get paid. There are thousands of them, 0:19:35.956 --> 0:19:40.236 and over time they were basically in your head. There 0:19:40.276 --> 0:19:42.396 were a lot of them in my head. Did you 0:19:42.596 --> 0:19:48.476 have you run across anybody, any medical billers who who 0:19:48.556 --> 0:19:52.716 felt like you're equal? Oh, that's a very I can't 0:19:52.716 --> 0:19:57.956 answer that question because because I'm I'm quite sure there are. 0:19:58.116 --> 0:20:00.516 I'm quite sure there are there are other people is 0:20:00.596 --> 0:20:06.796 equally knowledgeable. Absolutely, I don't know. You just haven't met them. 0:20:07.476 --> 0:20:13.796 I haven't met them. Over two decades in windowless rooms 0:20:14.236 --> 0:20:17.596 in clinics and hospitals in the Greater Boston area, Sue 0:20:17.636 --> 0:20:23.556 Henderson makes herself not just valuable, but close to irreplaceable. Then, 0:20:23.676 --> 0:20:26.036 in the summer of nineteen ninety nine, she sees a 0:20:26.116 --> 0:20:30.076 want ad on monster dot Com for a medical biller 0:20:30.916 --> 0:20:34.676 from a startup called Athena Health, based in San Diego 0:20:34.796 --> 0:20:38.636 but with an office in Boston. It's Todd Park, struggling startup. 0:20:39.676 --> 0:20:44.676 Sue applies, She gets an interview, they reject her, but 0:20:44.756 --> 0:20:47.356 a few weeks later they call her back with a 0:20:47.476 --> 0:20:52.156 bizarre request. He wasn't offering me a job. He was 0:20:52.396 --> 0:20:56.276 asking me, could I come for lunch to meet with 0:20:57.636 --> 0:21:03.596 some potential investors that were coming, so that they could 0:21:03.676 --> 0:21:06.476 kind of convince these investors that they had somebody who 0:21:06.556 --> 0:21:10.036 knew what he or she was doing and convinced them 0:21:10.076 --> 0:21:12.276 that this was a good idea to invest in the company. 0:21:13.836 --> 0:21:17.156 So they were bringing you on as an expert in 0:21:17.276 --> 0:21:21.956 medical billing to demonstrate to investors they knew about medical billing. Yep. 0:21:22.356 --> 0:21:27.036 So I said, okay, you don't burn your bridges. So 0:21:27.276 --> 0:21:29.916 I went over and we had lunch in the little 0:21:29.996 --> 0:21:33.956 restaurant and I sat there for an hour and a half, 0:21:34.676 --> 0:21:38.676 having lunch and being grilled by these investors about what 0:21:38.796 --> 0:21:43.316 I knew about medical billing, as though I had already 0:21:43.356 --> 0:21:49.076 been hired. And I did this three times. I didn't 0:21:49.116 --> 0:21:52.236 get paid for anything except I had a lovely free lunch, 0:21:53.396 --> 0:21:56.476 And finally, at the end of the three lunch process, 0:21:56.956 --> 0:21:59.436 Bob Gatewood called and said, we'd really like to hire you. 0:22:00.356 --> 0:22:02.836 Apparently I had convinced everybody I knew what the heck 0:22:02.876 --> 0:22:08.276 I was doing. Of course she knew, and of course 0:22:08.396 --> 0:22:11.036 Todd and Bob could see that they needed her, and 0:22:11.156 --> 0:22:14.236 if they could just bottle her expertise, she might make 0:22:14.316 --> 0:22:31.236 everyone rich. Welcome back to against the rules, we shall, 0:22:31.276 --> 0:22:34.236 I take it without the storm. There's no reason why 0:22:34.316 --> 0:22:42.396 we shall unless the dance blob. There's a strange British 0:22:42.476 --> 0:22:47.036 play written in the early nineteen hundreds called The Admirable Creighton. 0:22:47.556 --> 0:22:49.996 It was written by jam Barry, who's more famous for 0:22:50.076 --> 0:22:53.236 Peter Pan. I only saw it once, but I've never 0:22:53.276 --> 0:22:55.116 been able to get it out of my head. In 0:22:55.196 --> 0:22:58.876 The Admirable Creighton, an upper class British family is shipwrecked. 0:22:59.236 --> 0:23:01.916 They all wash up on a deserted island, along with 0:23:01.996 --> 0:23:09.716 their butler named Creighton h Okay, then town a transport 0:23:09.836 --> 0:23:12.556 and bring it back with him. Good my Lord. After 0:23:12.636 --> 0:23:15.476 the shipwreck, the butler, Crichton, behaves at first as he 0:23:15.556 --> 0:23:18.876 always has. He bows and scrapes and speaks only when 0:23:18.956 --> 0:23:22.756 spoken to. But on the island he's the only one 0:23:22.836 --> 0:23:26.636 who has any idea how to survive. The nobility or 0:23:26.676 --> 0:23:29.436 forced to admit it and defer to him lest they starve, 0:23:30.436 --> 0:23:32.996 and by the end he's king of the island. The 0:23:33.076 --> 0:23:36.796 British Lord is Crichton's slave, and his daughters are the 0:23:36.876 --> 0:23:40.996 Butler's harem in waiting, and the Lord is freaking out. 0:23:41.476 --> 0:23:43.716 I should give the honors, and you want abate them 0:23:45.716 --> 0:23:55.116 with the deepest respect, my lord. The reason I can't 0:23:55.116 --> 0:23:57.196 get the admirable Crichton out of my head is because 0:23:57.236 --> 0:24:01.356 it's about the arbitrariness of social status and the way 0:24:01.436 --> 0:24:05.676 that status can disguise people's value. Athena Health is his 0:24:05.756 --> 0:24:08.756 own little island. Todd parks washed up on it with 0:24:08.836 --> 0:24:11.996 Sue Anderson. But he's a first a bit unclear about 0:24:11.996 --> 0:24:15.836 how to maximize her value. So he called his brother. 0:24:16.756 --> 0:24:18.916 Tyd called me up and said, can you we need 0:24:19.036 --> 0:24:21.356 some help? Can you help me? And so I said, 0:24:21.476 --> 0:24:25.436 of course, because when your older brother calls you, you 0:24:25.636 --> 0:24:29.196 basically say yes. This is Ed Park. He was just 0:24:29.396 --> 0:24:32.116 then a twenty two year old graduate of Harvard, where 0:24:32.116 --> 0:24:35.316 he'd run the computer science club. And so I packed 0:24:35.396 --> 0:24:39.476 up all my things and no drove in my ten 0:24:39.556 --> 0:24:42.796 year old Taylor camera in a three day sprint out 0:24:42.836 --> 0:24:45.356 west to join him in San Diego. It wouldn't have 0:24:45.356 --> 0:24:47.036 been a startup if there wasn't a story about an 0:24:47.076 --> 0:24:51.156 old Toyota camera. Once Ed stopped driving, he took a long, 0:24:51.396 --> 0:24:54.996 hard look at the health insurance industry. We went through 0:24:55.116 --> 0:24:58.876 and we tried to figure out what are all these rules, 0:24:58.956 --> 0:25:02.916 and then we pretty quickly figured out that the rules 0:25:02.996 --> 0:25:06.756 weren't written down anywhere. The only people who knew the 0:25:06.916 --> 0:25:10.156 rules were people who would actually worked in the industry 0:25:10.516 --> 0:25:14.996 and had been incredibly observant for the last five years, 0:25:16.516 --> 0:25:22.116 people like Sue Henderson, or perhaps no one but Sue Henderson. Anyway, 0:25:22.436 --> 0:25:24.476 Todd ned figured out that what Ed needed to do 0:25:24.716 --> 0:25:27.436 was go into a room with Sue to see if 0:25:27.436 --> 0:25:30.876 he could replicate her brain in computer code. And so 0:25:31.196 --> 0:25:34.316 Ed drove his camera back to the Boston suburbs. I 0:25:34.796 --> 0:25:37.556 still remember the offices that we were working in. There 0:25:37.596 --> 0:25:41.876 were these tiny little offices, I think, with the requisite 0:25:42.036 --> 0:25:43.956 three or four people to an office. She's sort of 0:25:43.996 --> 0:25:46.876 the next office over, and I was heads down coding, 0:25:46.996 --> 0:25:48.436 and that was like, what do I need to code 0:25:48.476 --> 0:25:52.316 to make this thing work? And so her job was 0:25:52.356 --> 0:25:54.316 to basically help us get paid, and my job was 0:25:54.356 --> 0:25:56.236 to try and figure out how to write a bunch 0:25:56.236 --> 0:25:59.196 of code to make it so that we could start 0:25:59.316 --> 0:26:04.356 doing it in a way that was semi replicable. For 0:26:04.516 --> 0:26:06.676 her part, Sue was struck by just how much was 0:26:06.756 --> 0:26:09.676 in her head that was not in theirs. Yeah, I think, 0:26:10.236 --> 0:26:13.796