Max Out of Pocket – June

The Max Out of Pocket crew pretty much maxed out June 2019 to its fullest. We started the month in Boston playing golf and ended it with a little staycation in our home (vacation) town in New England. We also squeezed in a four day trip to Canada to see the highest tides in the world. We were even able to stay pretty busy around here at the blog. All of this while holding down a full time job. I wonder how things would look if I actually pulled the trigger on early retirement?  

A Local Travel Month

The golf trip to Boston was just my second time playing golf in my lifetime and the first for Mrs. Max OOP. So as expected, our overall performance was pretty miserable. But we were able to show some improvement as the day went on. We played in groups of four and used the “best ball” from each member of the team after every hit. It is a really good way for beginners to learn the game since someone who actually knows how to play golf can carry the team forward while those with less experience still get a chance to practice their swing at each stop. We probably came in last in the tournament, but still had a great time. I don’t imagine we will pick up golfing too regularly though. I am thinking a frequency of once every 10 years will be good for me.   

Driving golf carts is fun.

The very next weekend I blew out of work early on a Friday to head up to New Brunswick, Canada for a nice long four day weekend. We spent a lot of time just hanging around my mother-in-law’s homestead and pretending I was on sabbatical. We did manage to get a few day trips in though. We made it out to a farmers market one day where we scored some fresh salmon sandwiches for only $5 CAD. The next day we took a two hour road trip to Hopewell Rocks and the Bay of Fundy. I also got my fair share of Moosehead Lager.

Happy Canada Day by the way!

For the fourth weekend in June, we took a day trip to Sugar Hill, New Hampshire to check out the Lupines in bloom. I guess Max OOP is to a point in his life where he takes photos of flowers. This place actually smells like sugar. They have a Lupine festival in Sugar Hill every year, but this year the Lupines were late and didn’t even blossom until a few weeks after the festival. Translation, Max OOP didn’t have to deal with a bunch of tourists with selfie sticks. Move along tourists, no lupines to see here. Max Out of Pocket readers are always welcome, though, and it is worth the trip if you are ever in the area. We stopped for a nice lunch at the Hungry Bear Café. Max Out of Pocket for lunch was about $23 for two delicious sandwiches. I normally try to avoid eating out in the pursuit of early retirement, but sometimes you have to make exceptions. Also, Mrs. Max OOP enjoys eating out more than I do and we don’t want to let my frugal tendencies take away from her fun.

Sugar Hill, NH
I want that house.

I closed out the month spending a whole day in Portland, Maine by myself. I was able to get some “day job” work done, get a haircut, and pick up some family from the airport. The Old Port is awesome.

Portland, Maine


Mr. and Mrs. Max OOP spent zero dollars on healthcare expenses in June. My freak abdomen pain from last month didn’t come back, and Mrs. Max OOP’s back pain from April stayed away. So we are both feeling pretty good about our health. I am still doing really well with my weight lifting routine and maxed out at 215lbs early in June. I tried 225lbs on June 24th but wasn’t able to get it up. Having the blog will be nice since it will be easy to look back on our personal healthcare journal as things come up. 

Although my $39/month gym is closing at the end of August, I did fork another $39 over to them to cover the June membership fee. I will probably only have to pay them two more times in 2019. Hopefully I can get something lined up before they close down.


Max OOP continued full speed ahead with the healthcare REIT experiment. I made two more purchases of medical office buildings in June. The first one was made during my lunch break where we mentioned that Max OOP has been loosely applying dollar-cost averaging principals to the healthcare REIT investment. That’s because I have been regularly investing in Physicians Realty Trust (DOC) every two weeks on payday. The second purchase was made after we took a look at who is living in my medical office buildings. We found out that not all of our tenants are Triple AAA+ platinum renters like Max OOP, but we do have some pretty solid tenants.  

The Max Out of Pocket healthcare REIT portfolio is quickly approaching $25,000 and should spit out $1,250 in passive ‘rental’ dividends over the next year. I will probably be tightening up this investment over the next few months as we decide where we want to go from here. We still have a lot to learn about REITS, but as this investment becomes a larger bucket in the overall Max Out of Pocket investment portfolio, we will need to put some structure around it so Max OOP doesn’t mistakenly think he can time the market or pick stocks. Total stock market index investing still seems like the path to the promised land, but tunnel vision is dangerous and that’s why we are always looking to learn and consider other options.

It looks like our overall net worth went up about 2.8%. Max OOP has been getting pretty loose with spending lately, so I will be tightening things up around here again soon. My personal laptop shut down a few months ago so I completely stopped reviewing our monthly spending. So once I drop a few hundred on a new computer, we will review how the last few months look.  


I am still enjoying the blog and hoping to start producing more practical healthcare content soon. I have been trying to get used to writing again since I probably haven’t written anything but boring corporate emails since about 2006. It is important to get the healthcare content accurate and useful while keeping it somewhat entertaining around here. Not an easy task, but it turns out I actually enjoy writing and like my new hobby.

We started the month doing a full analysis of an NPR article that suggested a patient in Wisconsin was charged almost $5,000 for Nitrous Oxide. I was very proud of my title “Midwife Crisis and $5,000 Nitrous” and fully expected my article to go viral. This just goes to show how ‘green’ I am to the blogging world. Unfortunately, the NPR article fell a little short in using the situation to fully educate healthcare consumers on how healthcare pricing works. Evidently, NPR has been doing this “Bill Of The Month” series for just over a year. I read some of the articles from the past few months and several of them do a really good job identifying breakdowns in the healthcare system. Although the Nitrous Oxide article brought up a lot of good points, it just didn’t get the full Max OOP seal of approval. Since I really want to come from a place of collaboration, I did reach out to the author to share my expertise in the field with an offer to collaborate, but I haven’t heard back. I even shared it with a few local reporters in Wisconsin. I noticed a few people in Minnesota and Wisconsin took a peak at my post, so maybe we did get to educate someone after all. We need to tackle this problem together as Max OOP doesn’t have all of the answers; just most of them. 

Unfortunately, NPR released another “Bill Of The Month” article on June 17th that didn’t get my full seal of approval either. It was about a $94,000 bill a patient got for neuromonitoring during back surgery back in late 2017. The article made a lot of good points about consents and out-of-network providers working within a hospital that is in-network. This is extremely confusing for patients since they think they are doing everything right, but have no reasonable way to know that someone working within the hospital walls is not in their network. But once again, there are a few holes in the analysis. 

The title of the article said this bill was a “real back-breaker”. Cute. Actually sounds like something Max OOP would come up with. The only problem I have with this article is there wasn’t even a bill yet. In this case, the article is cherry-picking an Explanation Of Benefits (EOB) summary that suggests the patient would owe $94,000 for the neuromonitoring that occurred during the back surgery. If you recall, the Explanation Of Benefits is what I wanted to see in the $5,000 nitrous case. I will need to look back at this series and if NPR ever took the time to educate readers on the difference between an EOB and an actual medical bill.  The article goes on to say this particular patient is worried about getting a bill in the mail for this service.

“Every time I go out and I collect the mail, I’m wondering, ‘Is this the day it’s going to show up and we’re going to have to deal with this?’ ” she says.

A Year After Spinal Surgery, A $94,031 Bill Feels Like A Backbreaker

Sitting around waiting for the bill to come should not be acceptable behavior for Max Out of Pocket readers. We engage, learn, and push back when things don’t make sense. The EOB was dated 11/14/2018 and the last time I checked the calendar we were sitting solidly in June 2019. Consumers need to proactively push back and understand the healthcare system if we ever want to fix it. Waiting around to get screwed by this system does not fit the bill. No pun intended. Nowhere in the article does it suggest the patient actively tried to deal with this issue directly with the company (TRAXX). It does say the company (TRAXX) didn’t respond to NPR when they were requested to comment about the charge, but that doesn’t surprise me considering HIPPA regulations. Based on the quote above, I am making an assumption here that these attempts were made by NPR since the article didn’t clarify. It is pretty doubtful the real price for these services was $94,000, but more likely a clerical error that occurred during the billing process. The entire surgery for the hospital stay was just north of $100,000 so it is not reasonable to think the separately billable neuromonitoring would come close to that. I actually think it is questionable if the company will ever try to collect this balance from the patient. Since it has been 6 months since the claim was processed by Blue Cross, it seems likely they don’t intend on actually billing the patient and maybe even identified the error through internal audit. Is it unfortunate the patient got this EOB? Yes. Is it unfortunate that this provider may have been out-of-network? Yes. But it wouldn’t hurt for the patient to follow up with two or three escalated phone calls to be sure she actually owes this. If the answer was yes – then we need to jump all over TRAXX and question them about their pricing, especially if we can establish the problem extends beyond our current sample size of approximately one patient receiving neuromonitoring.

There are also other things at play here like the untimely billing of the patient or potential financial aid through TRAXX. We can challenge untimely billing and even the out-of-network provider issue. It may take a little work, but it can be done. The biggest takeaway from the article is this, and this goes for any non-emergent service you receive from a provider;

Check with your insurer to determine if the neuromonitoring provider is within your network and to make sure the estimated charge will be covered.

A Year After Spinal Surgery, A $94,031 Bill Feels Like A Backbreaker

I am still a fan of the “Bill Of The Month” series. I know firsthand there are serious billing errors and issues out there that have direct impact on patients. There is a lot of good coming from this and I should probably back off some of the technicalities the articles are missing. But I also have concerns when I see something that just may be a clerical error used to depict a broken healthcare system. I am not sure how productive it is for me to troll these articles, which is why I didn’t dedicate a full post to this one. “Trolling” is new internet slang I picked up early in my questionable blogging career. Hopefully I am using it in the correct context. It may be more productive for me to just keep writing about the history of the FICA tax.

On with the staycation. Thanks for reading.


How was your June? Any summer plans?


3 Responses

  1. Ha- Adam and I always joke that golfing has got to be the worst sport ever for anyone pursuing FI. It can get so insanely expensive!

    Glad you sound like you’ve been having a nice summer so far. I am always curious reading about other health care systems. I work in a system that is both the insurance provider and the medical provider. This means that anything we order, we expect to pay for. It raises a whole other set of concerns from patients who state that we tend to under-order tests and procedures. However, when I order a test for my patient, I am saying “Hey, we are going to pay because you need this.” Anyway, I look forward to reading more about your expertise in this area!


    • Max OOP says:

      Hey Elise,

      My old health system managed their own insurance. It does put the system in an interesting position for managing their own healthcare costs and I could see the concerns of underordering tests. I actually don’t recall that coming up at all, but I could totally see it becoming something employees worry about. They also go into the local Medicare Advantage market and that turned into an absolute disaster (for other reasons).

      Thanks for stopping by.


  2. Dragon Gal says:

    Hey Max OOP, It’s okay to admit that you like flowers. : ) Your pictures are very nice.
    I like your reflection on NPR’s “Bill of the Month” series and how you deconstruct the article. Healthcare is such a mess, and you’re right we all need to be our own advocates when it comes to dealing with our insurance companies. I wish the system weren’t this complicated in general.

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