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An Arm and a Leg

An Arm and a Leg

Author: An Arm and a Leg

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A show about the cost of health care that’s more entertaining, empowering, and occasionally useful than enraging, and terrifying and depressing. Reporter Dan Weissmann digs in to show how we got into this crazy mess and how we just might live through it.

38 Episodes
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We wrap up our COVID-19 popup season with stories from three folks with very different takes on what we've learned so far about what the pandemic is costing us: A doctor and advocate in Brooklyn looks back on the wave of black and brown patients that filled her clinic in March. A nurse-practitioner in Texas looks at how new tech is—and isn't—helping the older patients she cares for. And: One of the country's top insurance nerds says her first policy ideas to keep people from getting stuck with high bills for COVID tests ... were wrong. Get ready for the hug shortage, the new abnormal, and the $7,000 COVID test. And: Help guide the next steps for this show! Take five minutes for our listener survey. We so appreciate it. https://armandalegshow.com/survey/ Thanks to everyone who supports the show on Patreon. You can join 'em here: https://www.patreon.com/armandalegshow  See acast.com/privacy for privacy and opt-out information.
In early April, Katelyn was in a financial bind: Home sick with COVID, she hadn't been paid in weeks. And bills were due. "My landlord is kinda beating down my door right now," she said in a voicemail to our hotline. Weeks later, Katelyn got back in touch: She had made it through, thanks to a combination of playing hardball with one company and knowing how to play nice with others. Because of her job, she had an insider's understanding of the playing-nice process: Katelyn works in collections for a financial institution, so she knew how to ask for help. Even so, she didn't find the process easy. She came out of the ordeal with a heck of a story, and hard-won tips for all of us. In addition, here are a couple of resources mentioned in this story: * A collection of tips on dealing with medical bills and collection agencies, from one of our favorite teachers: TikTok mom Shaunna Burns. https://armandalegshow.com/medical-bill-tips-from-a-mom-who-knows-some-things * Hello Landlord is a free online tool that automatically generates letters you can send to your landlord, asserting your legal rights. (Right now, those rights may include some federal protections avainst evictions.) https://hellolandlord.org/ You can call and leave us a message too: (724) 267-6534 — that's 724 ARM N LEG Or share stories at https://armandalegshow.com/contact/ Thanks to everybody who supports our work! Join 'em here: https://www.patreon.com/armandalegshow  See acast.com/privacy for privacy and opt-out information.
A listener, who has worked in health insurance for decades, wrote in. "I have listened to all the episodes in this podcast, and there are times I come away feeling bad working for the insurance company." We talked. Along with angst, she shared advice we all can use.  See acast.com/privacy for privacy and opt-out information.
You've probably noticed: The U.S. economy is crashing. Something you may not have noticed, that may sound really weird: Almost half of that economic devastation comes from just one sector. And that sector? It's health care. If that sounds completely backwards, it is. Except in the world of how we pay for health care in this country. Because even though we as a society need health care workers like never before, to fight COVID... ... we-as-individuals are avoiding doctors' offices and hospitals for everything else, whenever we can. Just like we're avoiding going out to eat. And this country runs health care kind of like the restaurant industry: When people stop showing up for Sunday brunch— or for hip replacements, colonoscopies, etc. —the enterprise runs short of cash real fast. Even folks you'd think would be the most in-demand — ER docs fighting COVID—aren't immune. In this episode, we look at some of the extra weird details of this very-weird recession: how a couple pieces of it are working, and what they could mean. For our wallets. We draw in this story on stuff we covered in a Season 3 episode called "Can They Freaking DO That?!?" It's still fun and relevant, and you can catch it right here. https://armandalegshow.com/episode/can-they-freaking-do-that/ Thanks to everyone who supports this show on Patreon! Join 'em, and we'll shout you out at the end of an episode: https://www.patreon.com/armandalegshow  See acast.com/privacy for privacy and opt-out information.
Anna's insurance company said it would pay 100 percent for COVID-related testing. And then they left her to pay a giant bill. She got help, thanks to a viral tweet, but... her story exposes big loopholes in consumer protections. (We learn how not to fall in.) And: The way people responded to her tweet was generous, moving, and... complicated. Uncomfortable. Weird. Even with everybody doing their absolute best. (And, we should say, with as happy an ending as any of us get these days.) Anna's story gets right to the heart of some of the really weird ways that dealing with the cost of health care — ESPECIALLY in the world of COVID-19 and the Internet and everything else — just messes with our minds, and our relationships as humans. Thanks to Carmen Heredia Rodriguez, who reported the story of Anna's bill for Kaiser Health News and kindly let me piggyback on her hard work! You can read her version at.https://khn.org/news/bill-of-the-month-covid19-tests-are-free-except-when-theyre-not/. Send your stories our way: https://armandalegshow.com/contact/ And support our work: https://www.patreon.com/armandalegshow  See acast.com/privacy for privacy and opt-out information.
Ryan Gamlin spent a decade working on the financial side of health care, before going to medical school. Now, as an anesthesiologist in Los Angeles, he’s on the front lines fighting COVID-19, an experience he describes as “scary, in a way that I never expected to be scared, going to work.” He was scared one day last summer, too, when a California wildfire came within feet of the hospital where he was working.  And then a fleet of fire trucks showed up to protect the hospital. “City, county, park service, forest service, new trucks, old trucks, unmarked trucks.” “As I drove home later that day through the protective ring of equipment, I realized the fundamental difference between public safety and health care. Public safety is built on latent capacity. We pay for people and equipment to stand idle, over-prepared for emergencies.” These days, he’s been thinking back to that experience. “We’ve left no latent capacity in health care,” he wrote in a Twitter thread.  “And some part of the tragedy that’s now unfolding in this country is because of that. Because we let health care become a business. And because businesses don’t keep a hundred extra fire trucks around, their crews trained and ready, just in case.” We talked with Ryan about his experiences for this week’s episode. With protective equipment in short supply, he said, "It felt like a fire, with no one to call." We ALSO hear some good news, about folks who are stepping up to help — tapping their own latent capacity. That includes people making "ear savers" for health-care workers. Turns out, if you wear a mask all day, the elastic rubs the heck out of the skin behind your ears. Some people are 3-D printing connectors that go around the back of the head. And some people are taking a more low-tech approach. Here's a picture of my friend and neighbor Liz Feldman is the medical director at a local clinic. She's modeling ear-savers that are basically fabric headbands, with buttons sewn in to hold the masks in place, made by a retired colleague from old t-shirts and scavenged buttons.  See acast.com/privacy for privacy and opt-out information.
Lots of people have insurance plans that only cover them with certain places —providers, certain hospitals. But: in a COVID pandemic surge, who knows if you'd end up one of those places? And if you end up someplace else... then what? That’s the question we got from a listener named Becky in Minnesota. She's got a Bronze plan — it only covers a limited "network" of providers— and she's got a $6,000+ deductible. With officials talking about converting sports arenas into makeshift hospitals, Becky says: "If you call an ambulance, you may not even go to a hospital, right? Let alone a hospital that is quote-unquote in your network." We put Becky's question to one of the country’s top health-insurance nerds: Sabrina Corlette, founder and co-director of Georgetown University’s Center on Health Insurance Reforms. Not all the answers were comforting. But they weren't all grim either. And Becky turns out to have some good advice for us all. And, per Sabrina Corlette's advice for anybody newly out of work — and suddenly without health insurance: Go apply for Medicaid. As promised in the episode, here's a map showing which states have expanded Medicaid so that pretty much anybody who suddenly has very little income is eligible: https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/ Please keep your questions and stories coming: https://armandalegshow.com/contact/ Or call (724) 276-6534 — that's (724) ARM N LEG And as always, we'd love you to join us by supporting the show on Patreon: https://www.patreon.com/armandalegshow  See acast.com/privacy for privacy and opt-out information.
We kick off SEASON-19, about the cost of COVID, with a dose of hope — a story about an unlikely chain of people coming together to speed PPE to a COVID hospital in Brooklyn. NYC is a couple weeks ahead of the rest of the country, we think, so there are lessons here we can all get ready to use. Especially this: Don't be afraid that what you have to offer isn't enough. Take the step in front of you, even if it's a little one. Here's a couple ways to start 1. You can donate to that effort to get PPE to that Brooklyn hospital here: https://www.gofundme.com/f/artcube-army-ppe-supplies 2. There are stories like this all over, big and small. And we want as many as we can find for SEASON-19. Tell us about the ones you know at https://armandalegshow.com/contact/ ... or leave a message on our hotline: (724) 276-6534. That's (724) ARM N LEG.  See acast.com/privacy for privacy and opt-out information.
We were not expecting to bring the next season out for another couple months, but... STUFF has been happening. Is happening. We're here with you. Bring us your stories and your QUESTIONS: We'll ask the smartest people we know to tell us all what they know. go to https://www.armandalegshow.com/contact OR call our **hotline**! Yep: (724) 276-6534 -- which spells 724 ARM N LEG.  See acast.com/privacy for privacy and opt-out information.
This bonus episode turns the tables: Ace reporter Sally Herships interviews Arm and a Leg host Dan Weissmann, about what he's learned so far, and what's ahead for the show. \They dig into the stories listeners are sharing -- the lessons people say they’re learning, and the lessons they’re sharing. And Dan previews the celebrations in store as the show hits a landmark: 500 Patreon supporters! If you haven't signed up already, there's still time to join us -- sign up by March 1 -- and earn some special rewards. https://www.patreon.com/armandalegshow  See acast.com/privacy for privacy and opt-out information.
Cathryn Jakobson Ramin, an investigative reporter with a bad back, spent years researching the $100-billion back-pain industry. She found that the most commonly-prescribed treatments, including surgery, frequently do not work — and often leave people a lot worse off. She also learned what does work. Whenever someone I know says their back is killing them, I send them a link to Ramin's 2017 book, Crooked: Outwitting the Back Pain Industry. In this episode, we hit the highlights of Ramin's findings.  See acast.com/privacy for privacy and opt-out information.
Christmas in July

Christmas in July

2019-12-2627:536

How one family's tragedy became, decades later, a $1 million gift to their neighbors. This story has everything: Laughter. Tears. Family. Community. Generosity. Softball. AND: Punk rock. John Oliver. A taco bar.  See acast.com/privacy for privacy and opt-out information.
They say the problem with relying on journalists to embarrass providers into caving on crazy bills is, there aren’t enough journalists to go around. Fair. But sometimes journalists can scale up. In Memphis, reporter Wendi Thomas found that the city’s biggest hospital routinely sued its patients over unpaid bills, despite making tidy profits.  The hospital even sued its own badly-paid employees — a fact Thomas said was immediately visible just by visiting the court house. “You saw them, there, in their scrubs,” she said. “I could see their [hospital] badge clipped to the front of their uniforms.” The injustices were stark. “The defendants are just outmatched,” Thomas said. “They don't have the resources of a billion dollar hospital with its own collection agency and attorneys.” Thomas did such a good job making a stink about it that after a couple of months, the hospital dropped more than 6,500 lawsuits, and erased the debts. “Shame is a powerful motivator,” said Thomas. “It just is. And the hospital didn't look good, so they had to address it.”  See acast.com/privacy for privacy and opt-out information.
A woman got a bill from a medical testing lab she’s never heard of, for $35. Then, a follow-up bill said if she didn’t pay up right away, that price was going up — WAY up: to $1,287. Which raises a question that comes up a LOT with medical billing: Can they freaking DO that?!? Can some random lab hit you up for money — and then threaten you with a late fee of more than $1,000?? On this episode, we go find out. This was fun. We'll do it again. Next time you want to know, Can They Freaking DO That?!? ... get in touch. Also: We get into a whole story in this episode about "surprise billing" — and as we were publishing this episode, news was breaking. We've got an update at https://www.patreon.com/armandalegshow  See acast.com/privacy for privacy and opt-out information.
Sarah Macsalka has seen the stories about how expensive an emergency room visit can be, even for a minor complaint. So when her seven year-old son Cameron gashed his knee on a weekend morning in June, the ER was NOT where her family headed first. In fact, Macsalka did just about everything she could to avoid paying a big, fat bill to get Cameron’s knee stitched up — and ultimately failed. For instance, she took Cameron first to a local urgent-care clinic, but was told they didn't have anesthetic. So it was off to the ER. Before signing anything, Sarah asked what it might cost and pressed hard — but got only squishy answers. She ended up liable for $3,000 in charges. If only she had known. “I would've said thank you very much. And walked out and gone back to our lovely urgent care and been like, 'Cameron, bite on this stick.'” Her adventures make an entertaining parable, and they raise a big question: In a health care system where consumers are told to "shop" for the best deal, why is it so hard for us to get the information we need? On this episode, we get some answers, thanks to a super-insider and straight shooter: Lisa Bielamowicz, a doctor who now runs Gist Healthcare, a consultancy firm where hospitals are the clients, gives us the dirt. We'd love it if you support this show on Patreon. https://www.patreon.com/armandalegshow  See acast.com/privacy for privacy and opt-out information.
Health Care: The Musical

Health Care: The Musical

2019-11-2723:325

It would sound a LOT like Explanation of Benefits, which is a musical revue that actually played in New York City in 2019. ... so it would feature a parody of "Bills, Bills, Bills" — the 1999 Destiny's Child hit —rewritten for the age of GoFundMe. And it would have smart, funny musical numbers tracing the long, sad history of the U.S. health care industry. Welcome to our musical episode! And thank you to the young NYC troupe Heck No Techno for creating Explanation of Benefits. Our episode isn't sung all the way through — it's more like the PBS documentary on Hamilton than an actual musical of its own. But that is still. Pretty. Darn. Cool.  AND: In keeping with our theme this season of self-defense against the cost of health care, Explanation of Benefits wraps with a set of short vignettes demonstrating ways patients can work to protect themselves from excessive charges. So we have included here an email-by-email breakdown of songwriter Emily Lowinger's successful battle to fight off a surprise medical bill. ... and we've set it off with music — timing and cues lovingly adjusted by our audio wizard, Adam — and it is a TREAT. Go enjoy. Have a great Thanksgiving! ... and speaking of thanks: I recently spent a weekend afternoon sending thank-you cards to folks who support this show on Patreon. I'd love it if you became one: https://www.patreon.com/armandalegshow  See acast.com/privacy for privacy and opt-out information.
Meredith Balogh has spent years learning to navigate the financial side of the health-care system. She’s a type-one diabetic, she’s never had a lot of money, and for years she didn’t have health insurance. It hasn’t been easy, but she’s become a master.  “There's only three things that you're fighting,” she says. “Problems with competence, problems with greed and problems with maliciousness. And luckily most things are incompetence.” She has saved herself and her family many thousands of dollars, and made a habit — even a hobby — out of helping others: Fellow diabetics, co-workers, and strangers on the Internet. She's a health-care ninja. And she happens to be my neighbor. Also in this episode: Our show's chief investor (and my spouse) applies some ninja-level negotiating skills to save our family more than $700 on a lost medical device. Around here, that's what we call romantic. Thanks to our supporters on Patreon! We'd love it if you became one: https://www.patreon.com/armandalegshow  See acast.com/privacy for privacy and opt-out information.
Mom vs. Texas

Mom vs. Texas

2019-11-1430:218

Stephanie Wittels Wachs has a daughter born hearing impaired, which is how she found out insurance didn't cover hearing aids for kids. Those start at $6,000 and only last a few years. Stephanie teamed up with a few other moms to change Texas law... and won. Stephanie is a terrific storyteller. She's the author of Everything Is Horrible and Wonderful, a memoir about grieving her brother, Harris Wittels, a writer for TV comedies like Parks and Recreation, who died of a heroin overdose. ... and she is the host of the new podcast Last Day, which uses her brother's story as a starting point for a deep and smart and very-human look at the opioid crisis. Highly recommend: https://www.lemonadamedia.com/show/last-day P.S. This podcast, An Arm and a Leg, is a finalist for a very-strange, very-approriate award: Best True Crime show of 2019. Because not all crimes are against the law. Let 'em know: Go vote for us right now — voting closes November 18: https://awards.discoverpods.com/finalists/ Also: We'd love it if you support this show on Patreon: https://www.patreon.com/armandalegshow Thanks!  See acast.com/privacy for privacy and opt-out information.
It’s going to be REALLY fun. Also, maybe useful. Catch you here soon! Also, here’s a little video preview. Wanna share it with folks? Be our guest! Here it is on Twitter, Facebook, Instagram, and Vimeo.  See acast.com/privacy for privacy and opt-out information.
For our Season 2 finale, time for some inspiration. For 30 years, James Gingerich has run a super-effective clinic in Indiana, delivering great results at low cost — to high-need, low-income patients. James Gingerich stands in front of shelves holding books that Maple City Health Care Center distributes to families with young children. He’s not a modest guy, and two of his brags stand out — as a study in contrasts. One is a quote from a board member that makes him sound like a big dreamer: “People think of us as a medical organization. We’re not. We are fundamentally a peace and justice organization that happens to be engaged in our community through medical care.” The other is the way he stands at his desk and nerds out on stats that show his clinic beating the pants off the competition, on preventive-care measures like screenings for cervical cancer, vaccination rates for two-year-olds, etc.. “OK, next: diabetes control,” he says. “Are you getting the idea here?” At the heart of it, he says, is listening to people’s stories. The rest he calls “housekeeping.” It’s not a fix for our whole broken system — you can’t just copy-and-paste what’s happening here — but it’s definitely pretty inspiring. There’s a bit more in this write-up I did for our pals at Kaiser Health News. But first!  How about taking our listener survey? It just takes a few minutes, and you’ll be helping us out a TON: https://armandalegshow.com/survey/ Thank you! You’ll be helping us get Season 3 made.    See acast.com/privacy for privacy and opt-out information.
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Comments (6)

Bella Quinn

so i love this podcast and have learned alot. so its pretty terrible what hospitals are doing to really sick patients. my theory if everyone stops paying insurance companies and stop paying hospitals all at the same time. maybe we could get health care that is standardized and that everyone can afford. like our justice system, we have the best healthcare system that money can buy. i really think everyone should consider my theory.

Apr 24th
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E Meany

interesting podcast. Informative. Quick question, why give a trigger warning about bleeped cuss words but explicitly describe dog testing and killing in the insulin episode? I would rather hear cuss words.

Jan 6th
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Simon Riley

what is the name of the tool they talk about from 12-13 min in?

Sep 13th
Reply (1)

Sheng h. davis

such a great show!!! why is this podcast not more popular?

Jan 9th
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