An Arm and a Leg – Détails, épisodes et analyse

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.

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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.

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.

Hosted on Acast. See acast.com/privacy for more information.

Hosted on Acast. See acast.com/privacy for more 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.”

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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

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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

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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

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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

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