An Arm and a Leg

Hey, first: This is a GREAT time to support us — right now, every gift gets matched! Click here to support us.  Longtime listeners to this show know we’ve been talking about something called “charity care” for years. Federal law requires that all nonprofit hospitals have charity care policies – that is, financial assistance policies — to reduce or remove people’s medical bills. The problem: people don’t know about it, and hospitals don’t always make it easy to access. New research suggests that the scale of this problem is huge: hospitals are failing to provide more than 14 billion dollars worth of charity care to people who qualify for it. Instead, that money becomes medical debt.That research comes from the nonprofit Dollar For, an organization dedicated to helping people get charity care. We’ve been talking with Dollar For’s founder, Jared Walker, for years – following his team on their mission to crush medical debt, one charity care application at a time. Jared brings us up to speed on Dollar For’s latest research, their efforts to reach hospitals, and how new programs targeting medical debt in places like North Carolina may change things. That new program in North Carolina is estimated to wipe out $4 billion in medical debt. We look into how it took shape. Plus, we meet Clara, a listener who used her impressive research chops to get charity care from a hospital in New York. In the process, she crafted an expert charity care appeal letter, and shared a template with us. Use case: the hospital has denied you charity care after you applied, or offered you less than you need. Here’s the template. Of course, Dollar For has tons of resources, including a tool to help you quickly figure out if you qualify for help. And staff to help if you get stuck. Start here: https://dollarfor.org/help/Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.Of course we’d love for you to support this show. This month, every dollar you give gets matched dollar-for-dollar, by NewsMatch, from the Institute for Nonprofit News." Hosted on Acast. See acast.com/privacy for more information.

Several listeners sent us an article with the headline Make your health insurance cry, about a new AI tool to fight health insurance. We had to learn more. Meet Holden Karau: a Bay Area software engineer who says she’s “trying to make health insurance suck a little bit less.”So she’s created an AI tool to appeal insurance denials.Her project, Fight Health Insurance, is a labor of love (she’s not earning money from it) and fueled by hatred (of insurance companies). It draws on her tech expertise and on her years of experience fighting health insurance: for gender-affirming care, for rehab after getting hit by a car, and even for her dog, Professor Timbit. We talked with Holden about what it took to build the tool, how it works, and what she hopes comes next.Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.Of course we’d love for you to support this show. This month, every dollar you give gets matched dollar-for-dollar, by NewsMatch, from the Institute for Nonprofit News. Hosted on Acast. See acast.com/privacy for more information.

Something different: We talk with journalist Cara Anthony about topics that don’t always come up in conversations about the cost of health care. For the last four years, she’s been reporting on the public health effects of racism, violence, and intergenerational trauma in a small Missouri town.. The result: A new documentary and podcast series called Silence in Sikeston.   She sat down with us to talk about the value of breaking silences and the possibility for healing. Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.Of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

We're sharing an episode of “To See Each Other,” about a question that’s SUPER-relevant to this show:  How do we pay for long-term care, like nursing homes?  To See Each Other aims to complicate the narrative about small-town Americans. In this new season, host George Goehl heads to Lincoln County, Wisconsin — population, 28,000-and-some. And home to a publicly-run nursing home with a 5-star quality rating from the feds.  A conservative county board plans to sell the home to a private operator, but senior citizens aren’t having it. They show up to board meetings, march in the Labor Day parade, and fight with… their last breath.George goes deep into questions of aging in America, public versus private versions of long-term care, and the nuts and bolts of organizing. The show aims to put you in a fighting mood, and to think differently about aging. Hosted on Acast. See acast.com/privacy for more information.

An $88 “observation room” fee for a check-up didn’t sit right with Kari Greene, a listener from Oregon. When the price went up to $99 the next year, Kari complained to her benefits rep; they thought it was weird, too — but couldn’t do anything about it. In states like Connecticut and Indiana, legislators are trying to do something about fees like these – often called “facility fees.” In this episode, we go deep on Kari’s bill, one of dozens that listeners have shared with us over the past few months. And we talk with Christine Monahan, a researcher and attorney who knows more about facility fees — and state efforts to limit them — than any other expert in the country.Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.Of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

What happens when a hospital gets hit by a ransomware attack? We’re sharing an episode from a podcast called Click Here that takes us inside the aftermath of a cyber attack on a rural hospital in Oregon.  The story starts the minute the hospital’s IT director finds out they’ve been hacked, and follows him and his colleagues as they scramble to keep the place running while they try to get it back online. It’s a fascinating adventure, and it gives us a window into the growing problem of cyberattacks in health care – why places like hospitals have become such a major target for cyber-criminals and how the industry is dealing with it. Click Here is a bi-weekly tech news podcast from Recorded Future News, hosted by Dina Temple-Raston. We’ll be back with more episodes of An Arm and a Leg in a few weeks.Send your stories and questions. Or call 724 ARM-N-LEG.Of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

Caitlyn Mai expected her share of a recent surgery bill to be about $2,000, with insurance covering the rest. Then she started getting alerts on her phone from the hospital that she owed $139,000 — the full cost of her surgery. But Caitlyn, a legal assistant in Oklahoma, instinctively knew a cardinal rule of the American healthcare system — “never pay the first bill.” It’s a lesson we first heard from the journalist Marshall Allen, whose 2021 book Never Pay the First Bill serves as a how-to guide for anyone facing down a potentially bogus medical bill, and whose passing earlier this year left a giant hole in the hearts of many. This episode is an extended version of a recent installment of the NPR and KFF Health News series Bill of the Month. Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.Of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

We’re starting a new investigation and need your help. We’re looking into something we’ve talked about a lot on this show: hospital financial assistance – also known as “charity care” — which most hospitals are legally required to offer. Something like 60 percent of people might qualify to have their hospital bills reduced or even forgiven through charity care — but of course nowhere close to 60 percent of people actually get that assistance. A lot of people just don’t know about it. (A survey our friends at Dollar For ran last year found that more than half of patients who might qualify for charity care had never even heard of it.)Which raises a question: How exactly are hospitals telling you and me about charity care — you know fulfilling their legal obligation to let us know we just might qualify to have our medical bill forgiven? This is where you come in: we want to see a LOT of bills from hospitals. If you got one any time in the last year would you please you share it with us here? Even if you weren’t worried about how you’d pay — we just want to see what your hospital was saying about your options (like payment plans vs charity care). We want to see what’s in bold type and what’s in fine print.And if you were at all worried about how to pay, we’d like to hear the story. Did anyone mention charity care to you? Or what? And how’s it going? We also need your help spreading the word to friends and family. Spread the word to your friends and family, share our form with them. Finally, if you’re looking for charity care support, or just to see if you might qualify, you can go to Dollar For’s website and use their screening tool to see if you’re eligible, and their team of amazing volunteers can take it from there. And you can find more information on charity care in our First Aid Kit newsletter.That’s all for now. Here's a transcript of this short episode. We’ll be back with more new episodes in a few weeks. In the meantime, you can send us other stories and questions. Or call 724 ARM-N-LEG.Of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

Georgann Boatright's local hospital told her she'd need to pay an $8,000 "operating room" charge for a test she was pretty darn sure wouldn't involve an operating room. So she went elsewhere, even though it meant driving to another state.Avoiding that charge required more than just a willingness to go — literally — way out of her way. Georgann Boatright has knowledge, skills, and grit that most of us don't — although we can maybe learn a thing or two from her.More and more, people are noticing sneaky new fees like the one Georgann spotted. They’re often called “facility fees,” and they’re kind of like a cover charge for walking through the door. Hospitals say these fees go toward overhead on facilities with lots of specialized equipment —places like emergency rooms. But these fees have been increasing in recent years — and becoming more common: As hospitals buy up doctor’s offices, patients are starting to see them tacked onto bills for routine trips to the doctor.We asked you to send us stories about facility fees. We heard from a ton of you and learned so much. We’ve got lots of stories to share. And we’re starting with this epic tale — which also involves the biggest facility fee charge we saw in all your submissions. Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.Of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

Folks who expected their health insurance to cover some out-of-network care have been getting stuck with enormous bills instead. Like one couple from Kansas City: Their insurance hung them out to dry for thousands of dollars, all while sending statements touting a “discount” the couple was supposedly getting. Turned out: A middleman was cutting their coverage — actually a middleman’s middleman — working with their insurance company. The couple’s insurer got the “discount,” and the middlemen got big fees. And of course this couple wasn’t alone. A recent New York Times investigation from reporter Chris Hamby documented and explained this Russian-nesting-dolls-of-middlemen scheme. Insurance companies (middleman #1) work with a with a company called MultiPlan (middleman #2), which slashes the amounts the insurance plans actually pay for care.To show how it all works — and what we can maybe do about it — we dive into the hidden mechanics of health insurance.  Here's a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.Of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

We’re launching a brand new project and need your help!We’re zooming in on charges that are becoming more and more common on your medical bills: facility fees. Facility fees are charges tacked onto your bill for visiting a doctor’s office or clinic related to a hospital or larger health care system… or even talking with a doctor who’s in one of those places on a telehealth visit. If you’ve ever seen a charge for a facility fee on your medical bill, we want to hear from you. ... and if you haven't, we'd love your help spreading the word!Consider sharing our posts on any of these networks:Instagram | TikTok | Facebook | Ex-Twtitter | LinkedInWe’ll be back with more new episodes in a few weeks. In the meantime, send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

When a subsidiary of the giant UnitedHealth Group got hit by a cyberattack recently, a big chunk of the country’s doctors, pharmacists, hospitals and therapists just stopped getting paid. It’s been a huge disruption, with some providers wondering if they can keep their doors open.But thanks to their huge size and reach, the situation may have had a silver lining — for United.Which seems like a big problem, and got us wondering: What can we maybe do about it?The answer turns out to be: Maybe more than we think, via antitrust enforcers at the Federal Trade Commission and the U.S. Department of Justice.Strap in for a wild ride — and then maybe check out FTC Chair Lina Khan’s talk with Jon Stewart on The Daily Show. We include some short excerpts, but the whole thing is worth a watch.Thanks to reporters Brittany Trang (STAT News) and Maureen Tkacik (The American Prospect) for guiding us through their reporting.And to the novelist/journalist/activist Cory Doctorow, who has been writing about antitrust enforcement for years. Here are a couple of his columns about Lina Khan and what she and other antitrust enforcers are up to.If you want a deeper dive on the new antitrust movement: It’s summed up in a terrific (and short) book by Tim Wu, a Columbia University law professor and former White House adviser: The Curse of Bigness: Antitrust in the New Gilded Age. And you may be able to get it for free! If your local library uses a system called Hoopla, you can borrow it as either an audiobook or an ebook.Super-fun tangent: Cory Doctorow and Tim Wu went to elementary school together — and apparently played a lot of Dungeons and Dragons — when they were kids in Toronto. Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

Reporter Bob Herman from STAT News unpacks his blockbuster investigation about the country’s biggest health care company.   Covering the American health care system means we tell some scary stories. But this episode is almost like a horror movie. It’s got some of Hollywood’s favorite tropes: Machines taking over. Monsters from separate franchises meeting face to face in a new movie, like Godzilla and King Kong, or Jason and Freddy. And a couple perceptive folks warning everyone, ”Hey, look, something really bad is happening!” Those folks are Bob and his STAT News colleague Casey Ross. The monsters are United HealthGroup — a “behemoth” as one expert called them in an episode from last year — and Medicare Advantage, which we looked at in our last episode. And the “machines” belong to United.Bob describes what some of United’s own employees said about the result: “For some of us, it's creating this moral crisis. Like we know that we are having to listen to an algorithm to essentially kick someone out of a nursing home, even though we know that they can barely walk 20 feet.” Scary stuff. But Bob and Casey’s reporting has caught the eye of some powerful people in government, and right now, Medicare Advantage plans are on notice from the federal Centers for Medicare and Medicaid Services, the U.S. Senate is holding hearings, and the Department of Justice reportedly has an anti-trust investigation in the works. Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

Health insurance sucks. Which leaves lots of us counting down the days until we turn 65 and can get on Medicare – the federal government’s health insurance program for seniors. But Medicare is a lot more complicated – and costs more money – than a lot of us realize. (Also, it involves insurance companies.) And:t There will be huge, complicated decisions to make when you turn 65, that can have huge consequences. The biggest, and most consequential: Choosing between original Medicare and Medicare Advantage – the privatized version sold by health insurance companies that’s advertised everywhere seniors look. Some folks who pick Medicare Advantage later regret it — but find there are no do-overs. We get the scoop from Reporter Sarah Jane Tribble, who’s been covering the story for KFF Health News and the Washington Post. And we get a preview: What do we all need to know before we hit 65 about the choices we’ll face? There are a lot of options, and a lot of price tags. Sarah Murdoch from the Medicare Right Center gives us an outline of those choices and their consequences — and supplies both tips and resources. The biggest: When it’s time for you -- or anyone you care about -- to make choices around Medicare, every state has a free source of unbiased advice and information: Here’s a link to find your State Health Insurance Assistance Program (or SHIP).Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

A listener wrote to us at the beginning of the year with a query, “I was just reading the news about the price of insulin going down to $35! Is that for everyone?”It turns out, there is a lot of good news about the so-called “poster child” for the high cost of prescription drugs. But to say it costs $35 now is an oversimplification – and diabetes activists don’t think this fight is over.Senior producer and self-proclaimed “insulin correspondent” Emily Pisacreta took a hard look at the recent developments. Plus, what does the explosion of drugs like Ozempic and Wegovy have to do with the price of insulin? We break it down. Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

Dealing with the American health care system as a patient means lots of tough moments – unexpected bills, meds not covered, insurance and hospitals making you go back and forth without a clear answer, endless hold times and phone trees… the list goes on. So listeners ask us all the time: How do I stay strong and fight for my rights without totally losing my s---? We’re bringing back one of our most useful episodes ever: How to keep your cool in a tough moment, according to a self defense expert. In late 2020, Dan hit up self defense expert Lauren Taylor to get strategies for standing up for yourself, and hear how she’s applied her approach in her own fight for health care coverage. Since then, she’s published a book! It’s called Get Empowered: A Practical Guide to Thrive, Heal, and Embrace Your Confidence in a Sexist World. Extra tip: At the moment, the site bookshop.org, which supports independent bookstores, has the best price.Here’s a transcript of this episode. Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

Real quick: Now's the best time to support this show! Thanks to a few super-star Arm and a Leg listener/donors, your donation is matched two for one right now. Here's the link to donate.Ok, now: We’ve got a mini-episode for you today, a four-minute coda to the epic story we brought you in December.It features a last tip for anyone who might want to ask a hospital about charity care — which, as we learned from these recent stories, is most of us.And it comes with my big thanks for being part of this show’s community this year. You’re our reason for being, and our best sources.  You’re also our biggest source of financial support, so I will ask one more time to pitch in now if you can.  Thank you so much! We'll catch you in 2024. Hosted on Acast. See acast.com/privacy for more information.

Hey! The BEST time to support this show with a donation just got even better. Right now, any gift you make, up to $1,000, will be matched TWO for ONE, thanks to a few super-generous Arm and a Leg fans who’ve pooled their dough. . It’s a great deal, and it will set us up to kick maximum butt in 2024. Here’s the link, go for it!And… are you ready for our most-ambitious story yet? We’ve been working on this investigation all year, with our partners at Scripps News and the Baltimore Banner. With those partners, we’ve dug up some surprising (and possibly uplifting) news about lawsuits in three states – Maryland, New York and Wisconsin — and what that news might mean for the rest of the country.  This is part two of a two-part series. In part one, we examined the phenomenon of hospitals suing patients in bulk – sometimes hundred or thousands at a time – over unpaid bills. We learned that in many cases, those patients are struggling financially, and that the lawsuits aren’t very lucrative for hospitals anyway. So why did they happen in the first place? As one former collections industry insider told us, those decisions are “philosophically based.” In this episode — before getting to those surprising/hopeful findings — we try to understand that “philosophy,” perhaps best described as: business-as-usual. We speak with a former hospital billing executive and a representative from the third-party collections industry. This series is produced in partnership with the McGraw Center for Business Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York.… and supported by the Fund for Investigative Journalism. Hosted on Acast. See acast.com/privacy for more information.

Hey, it’s the BEST time to support this show with a donation. Thanks to NewsMatch, any gift you make, up to $1,000, will be doubled. It’s a great deal, and it will set us up to kick maximum butt in 2024. Here’s the link, go for it!We’ve been working on this investigation all year, with our partners at Scripps News and the Baltimore Banner. For years, we’ve been hearing about hospitals suing patients over unpaid medical bills – sometimes even in bulk, by the hundreds or thousands at a time. Many of the patients getting sued are already facing financial hardship, or like one couple we interviewed, already in bankruptcy. Judgments against patients in these suits can be life changing. But according to experts, these lawsuits don’t recoup a ton of lost revenue for hospitals. So why do they happen? And what if hospitals stopped doing it completely? In this episode, we talk to a former sales rep for a medical-debt collections agency — who now steers hospitals away from efforts to collect money, via lawsuits or other means, from folks who just don’t have it.He tells hospitals: This is better for your bottom line. Stay tuned for part two, coming in two weeks. … and to preview some of what’s in it — plus a whole lot more excellent reporting — check out the Baltimore Banner’s story: Maryland hospitals stopped suing patients with unpaid bills. Will they start again?This series is produced in partnership with the McGraw Center for Business Journalism at the Craig Newmark Graduate School of Journalism at the City University of New York.… and supported by the Fund for Investigative Journalism.OOH: And don’t forget. It’s prime time to make a donation and support this show. Here’s a transcript of this episode. Hosted on Acast. See acast.com/privacy for more information.

Last fall, actor-writers Ellen Haun and Dru Johnston were hustling to get their health insurance sorted out for 2023. To qualify for insurance through the actor’s union, SAG-AFTRA, Ellen would have to book a little more work — doable, but not a sure bet. So they came up with a plan: crowdfund a bunch of money to make a short film, starring Ellen … called “Ellen Needs Insurance,” of course.It worked! And the movie, a 13-minute comedy, is terrific. Ellen and Dru sat down with us to go over how they made the whole thing happen, and how this year’s Hollywood strikes changed their perspectives. Here’s a transcript of this episode.ALSO: Hey, it’s the BEST time to support this show with a donation. Thanks to NewsMatch, any gift you make, up to $1,000, will be doubled. It’s a great deal, and it will set us up to kick maximum butt in 2024. Here’s the link, go for it! Hosted on Acast. See acast.com/privacy for more information.