FRANK LOBB TELLS US THE HIDDEN TRUTH THAT COULD SAVE YOU THOUSANDS–You Don’t Owe What Your Insurance Won’t Pay

NEW RESOURCE: YOHO’S APOCALYPSE ALMANAC tells how to treat many diseases. It is a little tongue-in-cheek, but it has references and links.

Episode note: This information is so valuable and foreign to my prior thinking that I did the interview, summarized it, and also summarized Frank’s book. Do not miss the audio. If, after you read this, you want to interview Mr. Lobb, his email is [email protected].

Frank is a retired U.S. Navy pilot with a distinguished career outside the Navy, including General Manager for DuPont Process Instruments and then for DuPont’s Environmental Services business. After retiring from DuPont, Frank served as a Principal Consultant at Monsanto and later at Clean Air Engineering, specializing in regulatory law and compliance. It was this background in the law and compliance that allowed Frank to be credited with forcing the EPA to scrap three years of work on the Clean Air Act and rewrite the compliance section of the Act around his recommendations. It was this same background and expertise that allowed Frank to both access and dissect the carefully hidden contractual provisions that the healthcare insurance industry uses to deny the care and coverage patients are owed from their health insurance.

Now 86, Frank lives on a 200-acre working farm with Angie, his English wife, in Chester County, Pennsylvania, along with Angie’s 17 ducks and their two English Springer Spaniels. From there, they own and operate, together with their son and son-in-law, the leading hardware and supply business in the region.

Frank Lobb’s interview: Cracking the Healthcare Code: Why 80% of Hospital Bills Are Illegal and How to Fight Back

The interview reveals explosive findings about healthcare billing practices through the perspective of Frank Lobb, an 86-year-old retired Navy pilot and engineer with extensive experience in regulatory law and compliance. Having worked on the Clean Air Act and served as general manager for DuPont process instruments, Lobb brings a unique analytical approach to understanding healthcare contracts. His eight-year legal battle with insurance companies uncovered widespread fraud that pervades the entire healthcare billing system.

Frank tells of his wife’s death and his legal discovery

The investigation began with personal tragedy. When my wife became critically ill, our insurance company refused coverage for prescribed additional care. Following standard insurance protocol, I offered to pay directly for her treatment, reasoning that once provided, the doctor would testify the care was medically necessary, enabling me to sue successfully for coverage. However, the hospital refused payment, revealing they were contractually barred from accepting money for any care denied by insurance companies.

Three other hospitals similarly refused admission despite my willingness to pay privately. My wife ultimately died without receiving the needed care, and I never paid a healthcare bill. This seemingly impossible situation triggered an eight-year legal battle across three courts—two state and one federal. Through discovery proceedings spanning several years, I systematically extracted insurance company documents that exposed the true nature of healthcare contracts.

The insurance industry eventually declared victory in court, but I achieved my real objective—access to their confidential documents. These contracts, marked with warnings against disclosure, revealed the fundamental deception underlying American healthcare. The state of Maryland’s subsequent study confirmed these contracts are legally identical nationwide and unchanged for thirty years.

The Congressional Framework: Creating Insurance Company Control

Thirty years ago, Congress recognized healthcare costs were escalating beyond control and tasked the insurance industry with restraining hospital and physician charges. Since only doctors can prescribe healthcare, insurance companies initially lacked authority to deny medically necessary care. The Supreme Court resolved this dilemma through a unanimous decision granting insurance companies “absolute right to induce rationing of healthcare through insurance.”

The word “induce” proves critical to understanding the mechanism. Insurance companies gained power to eliminate all payment for denied care, creating a system where providers cannot bill, accept payment, or charge anything for services the insurer refuses to cover. This extends beyond upfront denials to post-treatment reviews where insurance companies examine completed bills like laundry lists, checking off unwanted charges.

The contracts establish utilization review processes occurring thirty days after treatment completion. Even for procedures initially approved and paid, insurance companies retain contractual rights to demand refunds. One case involved a woman receiving a $1.2 million operation that was initially covered. Through utilization review, the insurance company later “discovered” an error and clawed back the entire amount. The hospital then billed the patient directly, leading to prolonged litigation that settled for $600,000.

Contract Language and Legal Impossibilities

The contracts contain “hold harmless” provisions explicitly stating patients cannot be billed, period. When states are questioned about this language, officials deflect by claiming it applies only to insolvency cases. This interpretation represents either deliberate deception or profound incompetence. Under contract law, there exists no interpretation—only the explicit language matters. Since the contracts never mention insolvency or bankruptcy, the prohibition against billing patients must be absolute.

Supreme Court precedent allows states to interpret their own language if “somewhat reasonable,” but contract law operates differently. The language stands as written, creating an insurmountable legal barrier for healthcare providers attempting to bill patients. When providers understand that patients know contract terms, the entire relationship dynamic shifts because the industry cannot afford public disclosure of these arrangements.

The mathematical impossibility becomes apparent when examining copayments and deductibles. Contract language specifically preserves the ability to charge these amounts, yet if the underlying bill equals zero due to contract restrictions, calculating percentages of zero yields zero. This logical contradiction permeates the entire system, suggesting even that routine copayments violate contractual prohibitions.

The Fraud Infrastructure: Deliberate Patient Deception

Hospital emergency rooms routinely display brochures and contracts stating patients accept responsibility for whatever insurance doesn’t cover. This practice constitutes intentional fraud since the contracts explicitly forbid such billing. The evidence of intent is overwhelming—why would hospitals post these notices unless they deliberately sought to deceive patients into believing they owe money?

Billing departments understand these restrictions perfectly. During a recent minor operation, the hospital demanded $3,000 via credit card machine in the operating room. Despite having four insurance policies, I complied but immediately filed an appeal upon discharge. The bill vanished instantly. The hospital requested two follow-up procedures, which I refused, yet sent birthday cards while never attempting to justify or collect the original charge.

This widespread knowledge among billing personnel contrasts sharply with public ignorance. The industry depends on patients believing they owe money when insurance fails to pay. Emergency room admission forms represent contractual fraud designed to perpetuate this deception. The fundamental misunderstanding stems from treating healthcare arrangements as insurance even though they function as membership clubs comparable to YMCA memberships.

The Burden of Proof Revolution

Recent developments have transformed the strategic landscape. Previously, patients bore the burden of proving bills were incorrect or care was necessary. The Consumer Financial Protection Bureau recently shifted this burden to providers, fundamentally altering the power dynamic. When hospitals send bills, patients now possess the right to demand detailed justification.

The same contracts preventing patient billing also prohibit price disclosure. Hospital bills resemble grocery store receipts with lengthy item lists, but patients cannot access pricing information because contract attachments contain proprietary data marked confidential. When patients request price breakdowns for items like $50 gauze pads, providers cannot comply without violating contractual confidentiality agreements.

This creates an impossible situation for healthcare providers. They cannot defend their charges because contracts forbid sharing pricing information, yet they must justify bills when challenged. The system relies entirely on patient ignorance and passive acceptance of billing statements.

Strategic Recommendations: Working Within the System

Rather than advocating systematic resistance to all healthcare billing, I recommend strategic approaches focused on major expenses. Maintaining positive relationships with primary care physicians remains essential since doctors control access to all healthcare through their prescription authority. A $30 doctor copay shouldn’t trigger confrontation, but $100,000 hospital bills demand scrutiny.

Published studies confirm hospital bills contain errors exceeding 80 percent, with 40 percent representing pure fraud through billing manipulation. When doctors at a Washington metropolitan hospital surveyed their own institution, they discovered 64 percent of charges were “constructed or determined by the billing office, not by care provided.” With 77,000 billing codes, accurate billing becomes virtually impossible.

The doctor-patient relationship requires careful cultivation. I ensure my physicians understand I’ve studied these issues extensively while maintaining payment for reasonable charges. This approach creates advocacy rather than adversarial relationships. When doctors recognize that patients understand the system’s complexities, they become allies rather than obstacles.

Yoho note: Hospitals account for about 40 percent of our total healthcare costs. Though their greed and criminality are not commonly recognized, they are as bad as Pharma. See Butchered by “Healthcare” for more.

The Systemic Breakdown: Eliminating Medical Responsibility

Modern healthcare has systematically removed responsibility from medical care delivery. Hospital admission occurs only through emergency rooms or specialist referrals for scheduled surgery. Emergency room patients receive whoever works the current shift, creating no continuity of care. When my friend Dave died in a hospital, his doctor—who happened to be my physician—asked me what caused Dave’s death because he didn’t know.

Dave’s case exemplifies the system’s failures. The first hospital failed to diagnose his condition and discharged him to see his doctor, requiring a three-week wait. Dave died the following night. My wife faced similar circumstances when doctors attempted discharge while she was bleeding internally on blood thinners. I demanded she remain hospitalized until the underlying problem was resolved, ultimately developing a working relationship with her cardiologist that saved her life.

Today’s primary care physicians function as gatekeepers charged only with preventing illness and treating minor ailments. They lack hospital admission privileges and cannot follow patients into hospital settings. This fragmentation eliminates the comprehensive care relationships that once characterized medical practice.

Political and Economic Realities

The healthcare industry’s $4.3 trillion annual revenue translates into unprecedented political power. When I approached the Heritage Foundation with documented evidence of these contractual arrangements, they initially expressed interest through a letter from their president. However, after I explained that my findings contradicted rather than confirmed the existing system, communication ceased entirely.

Similar experiences occurred with the Cato Institute, where I offered to demonstrate how insurance mandates violate constitutional principles by eliminating citizens’ rights to pay for their own healthcare. After promising to provide proof, they went silent. These organizations’ entire budgets depend on healthcare industry funding, making honest investigation impossible.

Even state-level reform efforts face insurmountable obstacles. Working with the Pennsylvania Senate leadership, we drafted legislation addressing these contractual problems. The senator later apologized, explaining he couldn’t advance the bill beyond committee because “they will not allow it.” The insurance industry’s power extends far beyond financial influence into direct legislative control.

The Transparency Solution

Unlike quality arguments or coverage debates that enable endless discussion in gray areas, contractual language provides black-and-white clarity that cannot be disputed. These agreements were written thirty years ago and require state approval for modifications. With millions of existing contracts, changing fundamental provisions would demand Herculean efforts and public disclosure in every state—outcomes the industry cannot afford.

The contracts’ language offers no room for interpretation, cost discussions, or quality debates. Once patients understand they don’t owe money, insurance companies lose their ability to bar access to needed care. This represents the “golden spike” capable of piercing the heart of healthcare fraud because the industry cannot deny the evidence or afford court battles over contractual language that must remain secret.

Yoho note: this language is exposed in Frank’s book, which you can download at the end of the post.

Making this information public provides the only viable path for systemic change. The industry cannot fight transparency because court proceedings would expose the very contracts they desperately want to keep secret. Rather than arguing systemic reform, individual knowledge of contractual rights can transform personal healthcare experiences while gradually pressuring industrywide changes.

Conclusion: Individual Action in a Corrupt System

The healthcare billing system operates through systematic fraud designed to extract money patients don’t legally owe. Contracts explicitly prohibit billing patients for care denied by insurance companies, yet hospitals routinely send bills assuming patient ignorance. This deception permeates every level of the industry, from emergency room admission forms to utilization review processes that claw back previously approved payments.

The system’s complexity is intentionally maintained to prevent public understanding. Citizens assume they’re purchasing insurance when they’re actually buying membership in managed care clubs. They think they own their policies, but the insurance companies retain ownership. They expect care when the industry’s primary objective is profit maximization through care limitation.

The recent shift in burden of proof requirements provides patients with powerful tools for challenging fraudulent bills. Combined with knowledge of contractual restrictions on patient billing, informed consumers can navigate the system successfully without court battles. The key lies in understanding that providers cannot afford to fight patients who demonstrate knowledge of contractual obligations.

Rather than waiting for political solutions that will never emerge due to industry power, Americans must individually educate themselves about their rights under existing contracts. The legal framework already provides protection—patients simply need knowledge to exercise their rights effectively. As Einstein observed, success requires learning the rules of the game and playing better than anyone else.

The $4.3 trillion healthcare industry will continue operating through deception until transparency forces change. Individual action based on contractual knowledge represents the most effective path forward, enabling people to obtain necessary care while avoiding fraudulent charges. The law stands on the patient’s side—they just need to understand and apply it.

I also summarized Frank’s book:

At the heart of the American healthcare system lies a deception so fundamental that it affects nearly every American who has ever received a medical bill. The “Big Lie,” as Frank Lobb calls it, is the universally accepted belief that patients are financially responsible for whatever their health insurance fails to pay. This seemingly reasonable assumption appears on signs in emergency rooms, on forms patients sign at every doctor’s visit, and in the threatening bills that arrive weeks after treatment. Yet, according to Lobb’s revelations in his book The Big Lie in My Healthcare Bill, this entire premise is fraudulent.

The book exposes how the American healthcare system has constructed an elaborate scheme to shift billions in healthcare costs from insurance companies onto unsuspecting patients. This isn’t merely a case of billing errors or administrative oversight. Instead, it represents a systematic fraud perpetrated by an over $4 trillion industry that has successfully convinced Americans to accept financial responsibility they don’t legally owe.

“We can differ on how to fix the healthcare system,” Lobb declares on his book’s cover, “what we can’t do is let them lie to us.”

The Hidden Architecture of Healthcare Fraud

The deception becomes even more sinister when viewed in light of recent events. Following the killing of United Healthcare’s CEO, Lobb published a Substack article revealing what he calls “The Hidden Rules of Health Insurance.” Drawing on Albert Einstein’s famous quote—”You have to learn the rules of the game. And then play better than anyone else,”—Lobb lays bare the secret contractual framework that enables this massive fraud.

The hidden rules are shockingly simple:

1. The doctor/hospital shall render all medically necessary care without regard to reimbursement

2. Actions by the insurer shall in no way absolve the doctor/hospital of their responsibility to provide all medically necessary care

3. The doctor and hospital agree to look SOLELY to the insurer for payment.

However, the insurer is entirely free to deny payment if:

• The insurer alone decides the care is NOT medically mecessary

• The bill is more than 90 days old

• A later Utilization Review by the insurer determines the care was NOT medically necessary

In ALL such instances, the doctor and hospital shall NOT bill the patient.

To understand the magnitude of this deception, one must first grasp how health insurance fundamentally differs from every other form of insurance Americans purchase. When you buy auto insurance and file a claim, the insurance company either pays the claim or denies it. If denied, you’re free to pay for the repairs yourself. Healthcare insurance operates under a carefully concealed and entirely different set of rules.

At the core of this system are secret contracts called Provider Agreements—documents that every in-network doctor, hospital, and healthcare provider must sign with insurance companies. These agreements contain shocking provisions that the healthcare industry desperately wants to keep hidden. Most critically, they contain what’s known as the “Enrollee Hold Harmless” clause, which explicitly bars healthcare providers from billing patients when insurance denies coverage for medically necessary care.

The language of these clauses is unambiguous. As one representative agreement states: “Provider agrees that in no event, including but not limited to non-payment by Insurance Company, Insurance Company’s insolvency or breach of this agreement, shall Provider bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against an Enrollee.”¹ In plain English, this means that when your insurance company refuses to pay for the care your doctor says you need, the healthcare provider cannot legally bill you for it.

Yet every day, millions of Americans receive bills for exactly such care, accompanied by collection notices and threats to their credit scores. How is this possible? The answer lies in what may be one of the most successful cons in American business history.

The Mechanics of Medical Deception

The scheme works through a deliberate shell game of misdirection and misinformation. Healthcare providers prominently display signs and require patients to sign forms stating they are “financially responsible for all services rendered either through third-party payers (your insurance company) or being personally responsible for payment for any services which are not covered by your insurance policies.”² This statement, displayed at one of the nation’s most prestigious hospitals, is completely false when it comes to medically necessary care provided by in-network providers.

As Lobb explains in another document, “The Why in Health Insurance,” the mechanics work this way:

1. Healthcare is controlled by state law, and there are no corporate or insurer licenses to practice medicine. Therefore, an attending doctor is practicing under their own license and must provide each patient with the best available care.

2. Unfortunately, insurance companies often see themselves as having to induce doctors to provide less than the best available care to reduce costs.

3. So, how can an insurer force an attending doctor to prescribe LESS than the doctor’s license requires?

4. They have all in-network doctors and hospitals sign a secret provider contract that bars any and all payment unless the doctor accepts the insurer’s decisions.

5. Consequently, the insurer can claim that it has no involvement in any medical decision for a patient. They have simply determined the proper level of COVERAGE, which the Supreme Court has allowed.

However, insurers are using contract language that blocks ALL payments whenever they deny coverage. This means they are preventing an individual from self-paying for their care when coverage is denied—something that is blatantly unconstitutional if disclosed.

The genius of the fraud lies in its simplicity. By conditioning patients to accept financial responsibility at every turn, the healthcare system creates a powerful presumption that patients owe whatever insurance doesn’t pay. This presumption is so strong that when patients receive bills, they rarely question their fundamental obligation to pay them. Instead, they exhaust themselves calling insurance companies, writing appeals, and negotiating payment plans—all while accepting the basic premise that they owe the money.

“What makes these rules so ingenious is that they keep us fighting the wrong war,” Lobb writes. “We instinctively see our insurer as the problem when it’s the in-network Doctor/Hospital that owes us the care we need and the coverage we are due.”

Meanwhile, the actual contractual framework governing these transactions remains carefully hidden. Provider Agreements are treated as trade secrets, with the National Association of Insurance Commissioners (NAIC) directing states to protect their confidentiality. Healthcare providers are contractually forbidden from discussing these agreements, and insurance companies refuse to share them even with the patients who are supposedly bound by their terms.

The Consumer Financial Protection Bureau (CFPB) has found that up to 80% of medical bills contain errors.³ But these aren’t simple accounting mistakes. They represent a systematic pattern of billing patients for amounts they don’t legally owe. The errors are so pervasive and consistent that they can only be understood as intentional—a feature of the system, not a bug.

The Human Cost of Healthcare’s Big Lie

The consequences of this fraud are devastating. Medical debt is the leading cause of personal bankruptcy in the United States, with more than 100 million Americans currently burdened by unpaid medical bills.⁴ Families lose their homes, deplete their retirement savings, and destroy their credit trying to pay bills they never legally owed in the first place.

Lobb’s personal story illustrates the ultimate price of this deception. His wife Sandy died after their insurance company denied coverage for life-saving treatment. But the real tragedy wasn’t just the denial of coverage—it was the hospital’s refusal to allow Lobb to pay for the treatment himself. The Provider Agreement between the hospital and the insurance company prohibited the hospital from accepting payment from Lobb, effectively sentencing Sandy to death to protect the integrity of the insurance company’s rationing scheme.

This prohibition on self-payment reveals the true purpose of the Big Lie. It’s not just about shifting costs; it’s about maintaining absolute control over healthcare rationing. If patients could pay for care their insurance denies, it would create a paper trail proving that the care was medically necessary. This would expose insurance companies to liability and undermine their ability to deny similar care to other patients. So, the system ensures that when insurance says no, patients have no recourse—even if they’re willing and able to pay.

As Lobb explains in his document on hidden rules: “The Bottom Line: We are to get all the care OUR doctor says we need and the Insurer’s payment, or ‘non-payment,’ must be accepted as payment in full. However, everyone in the System is contractually barred from telling us.”

The Four Trillion Dollar Gold Rush

Understanding why this fraud persists requires following the money. Healthcare now represents nearly 20% of the U.S. economy, generating over $4 trillion annually.⁵ The industry spends $5.4 billion per year lobbying Congress—more than twice what the defense industry spends.⁶ This massive financial engine depends on the ability to ration care while shifting costs to patients.

The transformation of American healthcare from a service-oriented field to a profit-driven industry accelerated with the HMO Act of 1973. This legislation gave insurance companies the mandate to control healthcare costs, which they interpreted as a license to deny care. But denying care creates a problem: who pays for the treatment patients need, but insurance won’t cover? The Big Lie elegantly solves this problem. By convincing patients they owe whatever insurance doesn’t pay, the industry can ration care while still ensuring providers get paid.

The scheme has been so successful that it’s now expanding beyond traditional insurance. Mark Bertolini, former CEO of Aetna, outlined a chilling vision for the future of American healthcare in which individual needs must “capitulate to the needs of the community.”⁷ This socialist-style healthcare system, already being tested in China, would give insurance companies even greater control over who receives care and who doesn’t.

Meanwhile, the practical delivery of healthcare continues to deteriorate. Primary care physicians are being forced to manage 3,000 patients instead of the traditional 1,000, reducing actual patient contact to a few rushed minutes.⁸ Hospitals operate on a “treat ’em and street ’em” model, discharging patients as quickly as possible to maximize efficiency and profits. The human cost of these “efficiencies” is hidden in statistics that don’t capture how many patients die from conditions that could have been treated if anyone had taken the time to look beyond the most obvious symptoms.

The Legal Framework That Enables Fraud

The Big Lie persists because it’s protected by a complex web of laws, regulations, and court decisions that insulate it from challenge. The Employee Retirement Income Security Act (ERISA) of 1979 strips patients of the right to sue insurance companies for denying care. The U.S. Supreme Court’s decision in Pegram v. Herdrich explicitly recognized that “the inducement to ration care is the very point of any HMO scheme.”⁹

But perhaps the most insidious protection comes from the systematic hiding of Provider Agreements. These documents, which define the actual terms of healthcare coverage, are filed with state insurance departments as public documents. Yet states treat them as trade secrets, refusing to allow patients to see the contracts that supposedly govern their care. The NAIC has directed states to protect the confidentiality of these agreements, ensuring that patients never learn about the Enrollee Hold Harmless clauses that prohibit providers from billing them.

This secrecy extends throughout the system. When Lobb spent eight years in court trying to get justice for his wife’s death, he discovered that records had mysteriously disappeared, healthcare providers refused to testify, and even Sandy’s doctor backed away from the case. The state of Pennsylvania intervened in the lawsuit—not to protect patients but to support the insurance company’s demand for secrecy.

Breaking Free from the Big Lie

Despite the overwhelming power of the healthcare industry, patients aren’t entirely helpless. The Fair Debt Collection Practices Act (FDCPA) provides a powerful tool for challenging medical bills. Under this law, patients have the right to dispute any bill within 30 days and demand verification of the debt. The CFPB has ruled explicitly that medical debt collectors must conduct “reasonable and timely investigations” to verify the accuracy of disputed medical bills.¹⁰

The beauty of this approach is that it forces healthcare providers into an impossible position. To verify a medical bill, they would need to produce the Provider Agreement that shows they’re prohibited from billing the patient in the first place. They would need to document the insurance company’s coverage decisions and prove that the charges comply with their contractual obligations. However, producing these documents would expose the entire fraudulent scheme.

Lobb provides a simple example from his own experience. When his dermatologist sent him a suspicious $500 bill (his wife’s identical visit cost the usual $40), he wrote back requesting an explanation and verification of the charges. After several exchanges, the bill magically disappeared. The provider realized it was “cheaper to eat it” than to risk exposing the fraudulent nature of the billing.¹¹

The process works because it flips the burden of proof. Instead of patients having to prove they don’t owe a bill, providers must prove the bill is legitimate. And when the entire bill is based on a fraudulent premise—that patients owe what insurance doesn’t pay—legitimate proof is impossible to provide.

As Lobb emphasizes, “Fortunately, the American Healthcare System has made a huge mistake because a simple letter can stop one of these fraudulent bills dead in its tracks. We just have to be smart enough to send it rather than line up as just another one of the sheep to be fleeced. We need to hoist these folks on their own petard and then simply walk away — Because we really don’t owe it!”

A System Designed to Deceive

The American healthcare system wasn’t always built on deception. In the early days of health insurance, plans covered all medically necessary care. Hospitals and doctors determined what patients needed, and insurance paid for it. The system was transparent, honest, and focused on patient care.

The transformation began when healthcare became a for-profit industry. As costs rose and Wall Street demanded ever-higher returns, insurance companies faced a dilemma: how to maintain profits while healthcare expenses soared? The answer was rationing—denying care to control costs. But rationing creates its own problem: how to deny care without appearing to deny care?

The Big Lie solved this problem brilliantly. By shifting the focus from care to coverage, insurance companies could deny payment while claiming they weren’t denying treatment. Patients could theoretically still get the care they needed—they just had to pay for it themselves. Except, as the Provider Agreements reveal, they actually can’t pay for it themselves. The contracts prohibit providers from accepting payment when insurance denies coverage.

The circular logic creates a perfect trap in that:

– Insurers are free to ration care by denying “ALL” payment for the care we need, thus blocking it.

– At the same time, they can deny any payment for the care they allow us to receive.

– And, of course, whatever doesn’t get paid gets billed to us.

1. 2 I have tried to include a note of caution in my book about refusing to pay your PCP or family /personal doctor. I argued that we need them as our advocates to access care, and they are as much a victim of the system as we are. After all, a bill for a doctor’s visit isn’t likely to break the bank. A hospital bill is entirely different.

The Path Forward

Breaking free from the Big Lie requires understanding that medical bills from in-network providers are often fraudulent and unenforceable. When patients dispute these bills properly under the FDCPA, providers face a choice: expose their fraudulent billing scheme or abandon the bill. Most choose to abandon the bill rather than risk exposing the system.

But individual victories won’t change the system. Real change requires broader awareness of the Big Lie and collective action to challenge it. Every patient who successfully disputes a fraudulent medical bill chips away at the foundation of the system. Every person who demands to see the Provider Agreement forces the industry to confront its deception.

The healthcare industry counts on patient ignorance and resignation. They assume people will exhaust themselves fighting with insurance companies, negotiating payment plans, and declaring bankruptcy rather than challenging the fundamental premise that they owe the bill at all. The system’s greatest vulnerability is that it’s built entirely on deception. Once people understand the truth—that they don’t owe what insurance doesn’t pay for medically necessary care from in-network providers—the entire scheme collapses.

As Lobb concludes in his Substack post: “Therefore, the only open question is whether you are willing to take a few moments of your time to ensure you can get the care and coverage you are owed from your health insurance, or choose to simply sit back and get taken by the biggest fraud in American history. The choice is yours. The New York shooting and the rage it has fostered aren’t likely to be worth a plug-nickel when it comes to getting the care and coverage we’re owed from our health insurance.”

The Ultimate Cost

Perhaps the most tragic aspect of the Big Lie is its corrupting influence on the practice of medicine. Doctors who entered the profession to help people find themselves trapped in a system that forces them to deny care. Hospitals that should be sanctuaries of healing become collection agencies. The trust between patients and providers erodes as medical decisions become financial calculations.

Lobb’s account of his wife Sandy’s death epitomizes this corruption. Her doctor prescribed life-saving treatment. The hospital could provide it. Lobb was willing to pay for it. Yet Sandy died because the system’s contractual structure made it impossible for the hospital to accept payment. The Provider Agreement’s prohibition on billing patients when insurance denies coverage cost her her life.

This is the ultimate price of the Big Lie: not just financial ruin but human lives. Every day, Americans die from treatable conditions because the system prioritizes profits over patients. The rationing that the Supreme Court recognized as “the very point” of managed care translates directly into preventable deaths.

Yet even as patients die and families go bankrupt, the healthcare industry continues its relentless expansion. New construction projects dot the landscape—gleaming towers that Steven Brill compared to Dubai’s skyline.¹² Hospital executives earn millions while patients can’t afford basic care. The industry has become, in Brill’s words, “a uniquely American gold rush.”

Conclusion: The Choice Before Us

The Big Lie in American healthcare represents more than just fraudulent billing. It embodies a fundamental betrayal of the social contract between healers and the sick, between institutions and the people they’re supposed to serve. It transforms healthcare from a human right into a financial trap, from a noble profession into a predatory industry.

But the Big Lie also contains the seeds of its own destruction. Built on deception rather than law, sustained by secrecy rather than transparency, it cannot survive exposure to truth. Every patient who successfully challenges a fraudulent bill, every person who demands to see the hidden Provider Agreements, and every voice that speaks out against corruption weakens the system’s foundation.

The choice before us is clear. We can continue to accept the Big Lie, paying bills we don’t owe, going bankrupt for the care we’re legally entitled to receive, and watching loved ones die because insurance companies prioritize profits over lives. Or we can arm ourselves with knowledge, challenge fraudulent bills, demand transparency, and reclaim our right to healthcare.

The $4 trillion healthcare industry relies on our ignorance, resignation, and willingness to be taken advantage of. They’ve built an empire on the simple lie that we owe what insurance doesn’t pay. But lies, no matter how big, no matter how profitable, cannot stand forever against truth. And the truth is this: when it comes to medically necessary care from in-network providers, you don’t owe what your insurer fails to pay. You never did.

Footnotes

1. Provider Agreement, Section 6.1, as cited in Lobb’s analysis of industry-standard contracts ↩

2. Emergency room notice, major Philadelphia hospital, as documented by Lobb ↩

3. Consumer Financial Protection Bureau Bulletin 2022-01 ↩

4. U.S. Consumer Financial Protection Bureau statistics on medical debt ↩

5. Healthcare industry revenue projections for 2024 ↩

6. Healthcare industry lobbying expenditures versus other major industries ↩

7. Mark Bertolini interview with Governing magazine’s Dylan Scott ↩

8. Industry analysis of primary care physician patient loads ↩

9. Pegram et al. v. Herdrich, U.S. Supreme Court decision ↩

10. CFPB Bulletin: “Know your Rights and Protections When it Comes to Medical Bills and Collections,” April 11, 2022 ↩

11. Frank Lobb’s account of disputing a dermatologist’s bill ↩

12. Steven Brill, “Bitter Pill,” Time magazine, March 4, 2013 ↩

Here is Frank’s ebook. Feel free to download and share it. Hard copies are available on Amazon.

Frank’s suggestions to avoid paying fraudulent medical bills:

1. Challenge every outrageous hospital bill in writing within 14 to 30 days.

2. Send your document certified with return receipt requested to both the provider and insurance company.

3. In it, demand a copy of the provider-insurer contract.

4. Follow up in writing several times.

5. If they do not reply, you can consider the debt cancelled.

6. Leave your doctors alone and pay their bills.

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