Why I Built GougeStop (and MedCarePrecheck.com)

I was billed 550% more than Medicare pays for the same lab work — and no one could give me a straight answer about why. Here’s how it started.

It began with a couple of my own bills. Medicare denied a few tests, paid for the rest, and I got billed for what was left. On one, Medicare paid $76 for five of seven items — and then I was billed $173 for just the other two. It wasn’t a huge amount, but it felt wrong. I could see Medicare was paying a small fraction of what the provider charged on the covered items. What I couldn’t find out was what Medicare would have paid on the two I was being billed for in full.

So I started asking questions. The provider couldn’t — or wouldn’t — give me a copy of the ABN, the Advance Beneficiary Notice you’re supposed to sign, with a box checked, agreeing to pay if Medicare won’t. Every rep I spoke to, on both sides, acted like they had no idea what Medicare actually pays for these tests.

I’d never appealed a Medicare decision before, so I put it off and missed the 120-day window — a mistake I’d love to spare you. I eventually filed the appeal and wrote the provider that, since their claim rests entirely on an ABN I’d never seen, I wouldn’t pay until they produced a signed copy.

Here’s the frustrating part: those rates aren’t a secret. Medicare publishes them. They’re just buried in a lookup tool most patients can’t find or make sense of. Once I realized the data was out there but out of reach, I built GougeStop to put it in anyone’s hands in seconds.

When I ran my own bill through it, I had the answer in about a minute — roughly $27 versus the $173 I was charged, a 550% markup over the Medicare rate. It’s a lot easier to make the case that something’s unfair when you can see it in black and white.

That gap matters. Many patients are on fixed incomes and can’t absorb a surprise bill, and the markup over Medicare’s rate often isn’t anywhere close to reasonable. Putting it in plain numbers — for patients, and for the legislators who can do something about it — is the whole point.

One problem, two tools

What started as one app became two, because the problem has two sides:

• MedCarePrecheck is the prevention side — upload your doctor’s order before the lab visit and we’ll catch coverage problems while there’s still time to fix them with your doctor. (Our affiliate site.)
• GougeStop is the recovery side — if a bill has already arrived, GougeStop walks you through the appeal, the negotiation, and the pricing data you need to push back.

Same mission, two entry points. Use whichever one matches where you are in the process.

That’s why GougeStop and MedCarePrecheck exist.