How a Canadian became a US healthcare cost expert…

While many Canadian kids dreamt of playing hockey, my ambition was to be a US healthcare cost expert. Of course, I’m kidding, but that is where I find myself today as a cost-containment consultant for many companies around the world. How did I get here?

Good question. I was born and raised in Sherbrooke, Quebec, Canada, which meant that I was about a 30-minute drive from the Vermont border. When I was old enough to drive, my friends and I went to the US a lot. Our main activities included skiing, hiking, movies, and, of course, food. What freaks me out now is that I am not sure I had travel insurance; fortunately, I never had an illness or an accident while on this cross-border jaunts, but more on that later.

I was married young, at 22, and in abundance of wisdom I married a marriage and family therapist. Since my wife and I didn’t yet have children (we have 4 now) and we had just got married, we felt that she should get some practical experience. So I agreed to join my wife for a type of internship in Maine where we did therapeutic foster parenting, which was one of the best experiences of my life.

As part of the program, we were encouraged to do activities with the kids under our care – who wanted to do karate. The karate was going well for all involved until my “sensei” had me spar against a black belt. He was much shorter than me and we were only allowed to use punches. Not to brag, but I really dominated him and he took a flurry of punches from me (on account of my reach, I assume). Well, Mr. Black Belt was none too happy with me, and for Round 2 we could punch… and kick (at which I was useless). I’m not sure what happened but in the course of our sparring my opponent hit me in the crotch… hard! I remind the reader this is a black belt kicking me in the junk. I fell to the ground for what felt like many minutes… then crawled to the bathroom and proceeded to lose my lunch.

Why am I telling this story? Later that night, I continued to be sick, vomiting over 20 times and with a deep, sharp pain in my stomach… I could barely walk. My wonderful wife insisted that I needed to go to the hospital, which we did. When I got there, all of a sudden I felt better, but to my surprise this caused my doctor to rush me to the operating room. I’d been diagnosed with acute appendicitis and the doctor believed it had just burst (this relieves the pain, apparently), which in fact it had. So I had an open appendectomy and I have a lovely scar to prove it.

I received good care at the hospital – they even had a “leg massaging apparatus” that I quite liked. Two days in hospital and I went home to recover. About a month later, I received… a bill. A BILL! As a Canadian, I am not familiar with paying for my healthcare on a transactional level… I was incensed! The charges were $12,000, and while the insurance I had (through the foster program) had a special rate agreement with the hospital, I was left with a $2000 “member responsibility” fee to pay. After discussing this with my American friends they explained (broadly) how the US system works. I paid my bill and that was the end of it.

Our time was up for the internship in the US, and so it was time to go back to Canada. I had no job… and my wife was pregnant (I had foiled Mr. Black Belt’s dastardly plans to end my lineage). Sherbrooke seemed like a good place to raise kids and so we bought a house and settled in.

As mentioned, I was jobless, but as fate would have it I received a call from a company that specializes in medical cost-containment for US healthcare claims incurred by travelers to the US. The HR Director at the time asked me if I wanted a job, and advised that they had openings as a “negotiator.” My job would be to review and negotiate claim settlements with physicians in the US. You see, US medical providers can basically charge whatever they want for their services and so I have seen egregious and predatory billing. You remember that $12,000 appendectomy; I saw the same procedure being billed at $120,000 (in Florida).

This was my first “office” job and so I was a little insecure; I recall for the first 3 months, I worked 16-hour days trying to absorb as much information as possible, and in the process I became obsessed with this crazy healthcare system. I studied claim coding, benchmarking, tools, resource centers; basically anything related to the US healthcare system. Still today, I like to spend a minimum of 1-2 hours a day reading about how the system is evolving (or deteriorating). At any rate, I worked my way up through the ranks, and started doing some conference speaking and writing to share what I was learning. Most importantly, I met many amazing people along the way who were generous with their time and taught me what I know today.

After 10 wonderful years, I decided it was time for a new adventure, and so here I am, a Canadian US cost-containment expert. So what does this mean for you? Read more in my next post, (Raised by Wolves, and why you need to listen to me).