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 For information regarding your data privacy, visit acast.com/privacy

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 For information regarding your data privacy, visit acast.com/privacy

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 For information regarding your data privacy, visit acast.com/privacy

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! For information regarding your data privacy, visit acast.com/privacy

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. For information regarding your data privacy, visit acast.com/privacy

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.   For information regarding your data privacy, visit acast.com/privacy

Dr. Saul Weiner is a physician and researcher at Jesse Brown VA Medical Center and the University of Illinois at Chicago. (Photo: Roberta Dupuis-Devlin) Researcher Saul Weiner has been sending fake patients — actors, wired for sound — into real doctors’ offices, to learn about what actually happens, especially: How well doctors really listen to their patients. He’s tallied up what doctors miss (a lot), and how much it costs (ditto).  In today’s episode, we hear what actually happened in one of those “secret shopper” doctor visits — with the doctor and the actor who played his patient reading from the transcript of their visit, and then unpacking what went wrong. Also:  We are doing a listener survey! Please take a couple minutes to fill it out. You will be helping us out a TON:  https://armandalegshow.com/survey/ Thank you! For information regarding your data privacy, visit acast.com/privacy

That’s the rude awakening Eric Umansky got when he called the company that provided his CPAP machine — a device that helps him breathe at night. He got mad. And he got even, in a way: Eric is an editor at the non-profit newsroom ProPublica, and he tipped a colleague —Marshall Allen, who covers health care there. The two of them together, in this episode, are hilarious and enlightening. The story Marshall wrote opened up bigger issues about how insurance companies are collecting all kinds of data to use against us. And it included at least one example of how the “little guy” can fight back sometimes, and win. Extra fun: One of those examples features a 16 year-old Marshall Allen. Marshall Allen, age 16, in his 1988 yearbook photo. (Photo courtesy Marshall Allen.) Note: Eric curses a couple of times. We left it in. For information regarding your data privacy, visit acast.com/pri...

The price of insulin is iconic — doubling, tripling, multiplying like crazy, for medicine Type 1 diabetics can’t live without. To understand it, we went back almost 100 years and dug up a story of sweaty Canadian researchers — swatting away flies and doing business with probable dog-nappers, on the way to a Nobel Prize… and a deal with corporate pharma. Charles Best and Frederick Banting on the roof of the University of Toronto medical building, petting a dog they probably picked up from some shady character on the street … and whom they would soon sacrifice in the name of science. (Photo courtesy University of Toronto.) We also found hopeful signs out there today, including the folks at the Open Insulin Project in Oakland, California, who are working on their own recipe for insulin, which they hope to share as widely as possible.

As we started working on season two of this podcast, there was one topic that seemed like we just had to look at: insulin. … and I wondered:  There are stories about insulin prices everywhere.  Would we really have something to add? Something that wasn’t just more of the same? (Enraging, terrifying, depressing.) Turns out: OH YES WE DO. And some of it is… hopeful. We are holding it back a week, so you can take a break for the holiday, come back fresh, and be ready for something epic.  See you then. (If you’re new here, welcome! All our episodes so far are on our home page, or wherever you get podcasts.  You can sign up for our newsletter , share a story, or check us out on Facebook and Twitter @armandalegshow.) For information regarding your data privacy, visit acast.com/privacy

I filled a prescription recently, and the drugstore said they wanted more than 700 bucks… for an old-line generic drug. My insurance ended up knocking that down, but it was WEIRD.  And it meant a big homework assignment for me. Luckily, I got help. Both from some experts, and from the classic Christmas movie It’s a Wonderful Life (source of the pictures above and below, of course). I mean, what I actually learned was not a hundred percent cheerful. We get these unpredictable prices thanks to companies that — surprise! — make a big profit from driving prices up.  (They’re called “pharmacy benefit managers” — PBM for short.) Theoretically, they work for insurance companies and employers who pay the premiums, and they’re supposed to keep drug prices down. Economist Geoffrey Joyce used to think they did OK at that, but he’s changed his mind. One thing that turned him around: They got sued in several states, saying, ‘Hey, you should be acting in the best interest of your clients.’ And they’ve won in court saying, ‘No, we have no obligation to do what’s best for our clients. We do what’s best for us.’ So, not all sunshine.  But: Feeling a little smarter about the whole thing? It’s a victory. Also kinda fun. For information regarding your data privacy, visit acast.com/privacy

This week, we look at three MRIs with four different price tags, and an enormous range.   Liz Salmi and a view of her brain. (Photo: Kaiser Health News) The first two price tags come from listener Liz Salmi, who has been living with brain cancer for more than a decade. Liz gets MRI scans twice a year, to make sure the cancer isn’t growing.   A couple years ago, Liz changed insurance, changed providers… and got serious sticker-shock when she saw the bill for a scan: $1,600 — AFTER insurance. So when she needed a follow-up scan, she shopped around — and found an option that set her back less than 90 bucks. Which is great news, and useful — as far as it goes: As Liz points out, not everybody has six months to shop around. But Liz’s experience isn’t even the craziest MRI-price-tag story we look at this week. Stick around for that. Coming in to bat cleanup — to help us understand why these prices are so crazy, and so variable — is journalistic super-star, friend of the show, and my new colleague: Elisabeth Rosenthal, editor-in-chief of Kaiser Health News and author of An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. She breaks it down in an authoritative, funny, clear-as-glass way. (Reminder: Kaiser Health News — our co-producers for this season — is not affiliated with the health care provider Kaiser Permanente. It’s a great story, and we’ve got it for you right here.) This is the first of three episodes where we look at where health care prices come from. So this week it’s MRIs. Next up: Prescription drugs.   span...

Hospital bills are too high, and insurance doesn’t cover enough. Turns out, that’s a crisis for hospitals too: more and more of us aren’t paying those bills, because we can’t. So, they’re getting creative about collecting — and offering discounts. Which raises questions about why the bills are so high to begin with. Photo courtesy James Crannell We start with Chicago woodworker James Crannell, who — and there’s no non-scary way to say  this — stuck his finger in a table saw. Even more scary: He didn’t have insurance. “I don’t know which was worse. The pain in my hand, or the fear of: What is this going to cost me?” Spoiler alert: The emergency-room didn’t charge him full price. This episode kicks off a series where we start asking: How did prices get so high to begin with?   For information regarding your data privacy, visit acast.com/privacy

Caitlin and Corey Gaffer got a surprise letter from their insurance company — saying they were being dumped for non-payment. Except, as far as they knew, they were paid up. As it turned out, they’d made a couple of small mistakes, which they were eager to fix. But their insurer was definitely not interested. Caitlin and Corey spent fruitless weeks on the phone. And then, Caitlin’s pregnancy — more than six months along — ran into complications. They scrambled for months to get covered, while racking up about $30,000 in hospital bills. There’s a happy ending. Two, in fact. First, their baby was born healthy (and insured) in January. She’s in the episode too, and she’s adorable. Maggie, Corey, and Caitlin Gaffer, with Luna the dog. (Photo by Lauren Cutshall.) Second: In March their old insurer offered an apology — and offered to reinstate them. (This was the day after a reporter called to ask the insurer for their side of the story.) … but the whole journey was harrowing, and opens up questions about what kinds of safeguards consumers have — or should have — against getting dropped. Welcome to Season Two! This story — like a lot of this season — came straight from my inbox. A few days after the show launched, I got an email with the subject line “Pregnant woman and her husband in Minnesota need help.” We’ve got new friends! We’ve got co-producers for Season Two, Kaiser Health News. Three things to know: First: Kaiser Health News is not affiliated with the giant health care provider Kaiser Permanente. They share an ancestor — which is a fun story I’ve written all about here. Second: They ARE a great non-profit newsroom covering health care in America, an editorially independent project of the Kaiser Family Foundation. (There’s that name again. And again, here’s the story.) Third: Their editor-in-chief is one of the people who inspired this show. YEP. The whole story is worth reading. I am so pleased and proud to be working with these folks. Catch you next time. Till then, how about… Following us on Twitter or Facebook? Becoming a Patron? Sharing a story? For information regarding your data privacy, visit acast.com/privacy

Hey there! We’ve been working hard on season 2. We hope you enjoy this preview — there’s so much good (and frightening) stuff ahead. For information regarding your data privacy, visit acast.com/privacy

Bari Tessler is a little famous as a “financial therapist,” but even she gets rattled by the price of health care. Also: What my family is doing for health insurance next year. This is our Season One finale. Maybe you’d like to subscribe to our newsletter, so we can keep you posted as we prepare Season Two. Also this week: A taste from one of the most painfully-hilarious things to hit the Internet for a long time. Welcome to Our Modern Hospital, Where if You Want to Know a Price, You Can Go F*** Yourself, published by McSweeney’s. There’s a longer excerpt, and an interview with the author, Alex Baia — that’s on our Patreon.  Thanks to Alex for permission to record excerpts, and to ttsreader for dramatizing the text for us! Find Us Online Website: http://armandalegshow.comTwitter: http://twitter.com/armandalegshowInstagram: http://instagram.com/armandalegshowFacebook: http://facebook.com/armandalegshow Our Team: Host: Dan Weissman (www.danweissmann.com)Editor: Whitney Henry-Lester (thedarlingkiller.com)Consulting Producer: Daisy Rosario (@RunDMR)Audio Wizardy: Adam Raymonda (adamraymonda.com)Music: David Winer (wearefancymountain.com)Social Media Magic: Multitude Productions (http://multitude.productions) For information regarding your data privacy, visit acast.com/privacy

Emergency rooms often bill you a “cover charge” just for walking in the door, and it can be thousands of dollars. That’s in addition to the huge markup on everything that happens there: seven bucks for a band-aid. Twenty dollars for a couple of pills. Reporter Sarah Kliff has collected more than a thousand ER bills from her readers at Vox. She was an expert on health care before starting this project — she covered it for years at the Washington Post before moving to Vox — but even she found plenty of surprises. Find Us Online Website: http://armandalegshow.comTwitter: http://twitter.com/armandalegshowInstagram: http://instagram.com/armandalegshowFacebook: http://facebook.com/armandalegshow About Us Host: Dan Weissman (www.danweissmann.com)Editor: Whitney Henry-Lester (thedarlingkiller.com)Consulting Producer: Daisy Rosario (@RunDMR)Audio Wizardy: Adam Raymonda (adamraymonda.com)Music: David Winer (wearefancymountain.com)Social Media Magic: Multitude Productions (http://multitude.productions) Image adapted from a drawing posted to flickr by Wellness Corporate Solutions. For information regarding your data privacy, visit acast.com/privacy

Turns out, insurance companies allow — even encourage — crazy price-gouging by hospitals. For example, the leg brace Blake needed was available for $150 on Amazon. But thanks to his insurance, he paid more than $500. Investigative reporter Jenny Gold’s work helps us understand how that kind of thing happens. She compares health care to shopping for a gallon of milk. “We can look at the cost of a gallon of milk at lots of different stores and decide which one is the best,” she says.At the store, there’s maybe there’s a couple different brands, with the prices on the shelf. We pick the one we want, pay on the way out. “Now with healthcare,” she says, “the analogy would be, you go to the store for a gallon of milk. You have no idea what it costs. You don’t know what it costs at that store compared to other stores. You walk into a random store, pick out a gallon of milk, go through check-out. You still don’t know what it costs. You give them your credit card information and then a few weeks later you get a bill telling you how much they charged you.” Super-crazy. Jenny’s reporting shows how insurance companies help to keep those prices hidden, and keep them high. Jenny Gold works for Kaiser Health News — which, we should explain, is not part of Kaiser Permanente health care. It’s part of an independent foundation that basically runs on an endowment set up by Mr. Kaiser, more than 50 years ago.

The health-care system — especially the financial side — can feel like a Medieval torture device. So maybe it fits that workers from Renaissance fairs have come up with a work-around. In this episode I meet Robin Hood and a woman who has made more than $2 million in medical bills… disappear. Also, you’ve started sending us stories as voice memos. And they are awesome. Send more! stories@armandalegshow.com. Regular emails are nice too.  You’ve sent some powerful stories that way. We are listening. Also, you’ve shared tips, including this CBS News story about insurance companies refusing to pay ER bills.  Super-timely, since we’ve got a story about ER bills coming up in the next couple of weeks. You can find more information about the Rescu Foundation at the group’s website: rescufoundation.org (Photo from the Sherwood Forest Faire Facebook Page.) For information regarding your data privacy, visit acast.com/privacy

The answer involves a suburban housewife, a 1970s TV star, and a Las Vegas maker of popcorn and nacho cheese sauce. Also: Wall Street. Produced with our friends at 99 Percent Invisible. Many thanks to Abbey Meyers, Joshua Schein, and Nora Guthrie. Find Us Online Website: http://armandalegshow.com Twitter: http://twitter.com/armandalegshow Instagram: http://instagram.com/armandalegshow Facebook: http://facebook.com/armandalegshow About Us Host: Dan Weissman (www.danweissmann.com) Editor: Whitney Henry-Lester (thedarlingkiller.com) Consulting Producer: Daisy Rosario (@RunDMR) Social Media Magic: Multitude Productions (http://multitude.productions) For information regarding your data privacy, visit acast.com/privacy