An Arm and a Leg

What if we had a decent, publicly-funded health system — available to everybody, with or without insurance? We’ve got one, says Dr. Ricardo Nuila. It’s where he works. And it could be a model for the whole country. Yes, really. That’s the pitch he makes in his new book, The People’s Hospital: Hope and Peril in American Medicine. It’s a love letter to Houston’s Ben Taub hospital, and an argument for bringing Ben Taub’s model — efficient, innovative, and cheap —to the rest of the country.And if that seems unlikely in today’s political climate, well: Ben Taub’s wild origin story was plenty unlikely too. That story takes us to the 1960’s, when Dutch novelist and playwright Jan de Hartog moved to Houston. He fell in love with the bustling, futuristic home of NASA and the Astrodome. But he also discovered the city’s dreadful underside: a neglected charity hospital where largely African-American patients are left to seek health care in unsanitary and unsafe — hellish — conditions. De Hartog and a group of Quaker volunteers waged a campaign to change that, and eventually found an unlikely ally who brought it over the finish line. The People's Hospital is a heck of a book. We might want to start a book group someday, just to talk about it. If you want to grab a copy, here’s a link. (Or: Audiobook, or ebook.)Here’s a transcript of the 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.

The ER visit was quick and uneventful. The bill was $1,300. Our listener decided to push back. He didn't win, but he learned a lot — and so did we. We had help, from an expert we met by visiting a Renaissance Fair — which we did in this very fun early episode. Kaelyn Globig, head of advocacy for the Rescu Foundation, is a medical-bill wizard, and no one has taught us more.In this story, she teaches us how to find out what Medicare pays for a given procedure — here’s the guide she shared with us — and how to use that information. We also got advice on dealing with debt collectors — when it makes sense to file a dispute — from April Kuenhoff, an attorney with the National Consumer Law Center. She shared resources too. Here are sample letters — templates you can edit:To tell a debt collector that you are disputing a charge. To demand verification of a debt they say you oweTo limit their legal right to harass you. Here’s a transcript of the 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.

“I sued a hospital in small claims court and lost — here’s what I learned.” That was the subject line for an email we got from listener Lauren Slemenda. She wrote: “I feel like I won” — and we knew we needed to talk with her.She wants to encourage more people to try taking providers to court over unfair bills. “If everybody that they screw stands up,” she says, “They can't afford to pay a lawyer to defend against all of those [cases].” It’s an interesting idea for sure — What if more people use small claims court to fight messed-up medical bills? Like, a lot more people? — and we’ll be exploring it in the coming months. Meanwhile, Lauren’s story has lessons for all of us. For instance, even though she lost her case, she doesn’t expect to pay a cent. Here’s a transcript of the episode. More helpful resourcesWant to try some of Lauren’s tactics? Looking up billing codes: The latest First Aid Kit newsletter is all about fact-checking medical bills and includes a section about examining billing codes. We'll go deeper on those codes in the next installment. Dealing with debt collectors: We discussed knowing your rights when dealing with debt collectors with a couple of experts in this very-fun episode.Lauren got her dealing-with-debt-collectors playbook from journalist and friend-of-the-show Marshall Allen. His book, Never Pay the First Bill, includes a template of a letter you can send to a debt collector, challenging them to document their claim.Exploring small claims court: We first got tipped off to this aggressive approach in a story we re-played recently: Can They Freaking Do That?!? ... and followed up with the story of Jeffrey Fox, who successfully used small claims court to force a big hospital to refund a $2,000 charge. David vs. Goliath.  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.

We’re kicking off the year with a throwback. We revisit a 2019 episode that opened up new possibilities for fighting back against outrageous medical bills — a theme we’ll spend a lot more time exploring this yearA listener named Miriam 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 the kind of  question that comes up a LOT with medical billing: Can some random lab hit you up for money — and then threaten you with a late fee of more than $1,000??We went to find out.The answer: They can try. And a lot of the time, they’ll get away with it. But we found experts who explain how, sometimes, we can fight back— by threatening to take them to court.If you’ve got the time and the moxie, these experts say you’re on solid legal ground, and you really can make the other side accept a fair offer.We’ll come back to this idea next time. Meanwhile, here’s a 2020 episode with the story of a guy who took his local hospital to court, and won.The original version of this story, from 2019, found us learning about a couple topics we went on to explored in more depth later:  Surprise bills — which we got new legal protections from in 2022— and the role of private equity in health care, both how it’s been expanding, and how some doctors are trying to fight back.  Here's a transcript of this episode. Send your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEGAnd of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

The Arm and a Leg editorial team gathered to talk about the moments from 2022 that we’ll never forget — including when work collided with real life. We’re so lucky we get to do this work, and we couldn’t do it without our community. From sending us your stories and questions, to supporting the show financially, our listeners and subscribers are what this show runs on. Thank you. If you want to help us take on 2023, now is a great time to contribute. This month, every dollar you donate is DOUBLED, thanks to NewsMatch and the Institute for Nonprofit News. Holy cow, what a deal. Here, go for it.Here’s a transcript of this episode. Send your stories and questions or call 724 ARM-N-LEG. Hosted on Acast. See acast.com/privacy for more information.

When a car hit Susan and knocked out a bunch of teeth, her health insurance was supposed to pay for her oral surgery, and she knew it. So why has she had to chase them for 18 months and counting? Getting insurance to pay for anything dental is usually hard, but this had us asking ourselves… is it usually this hard? We connected Susan with law professor Jacqueline Fox — who, when she was practicing law, fought insurers on behalf of patients. And who says Susan has “done everything right.”We’ve started to wonder whether Susan’s troubles could be related to broader accusations against her insurer, Ambetter, the largest provider of plans on the Obamacare marketplace.  Here’s a transcript of this episode.We’d love for you to support this show.Now is a great time to do it. This month, every dollar you donate is DOUBLED, thanks to NewsMatch and the Institute for Nonprofit News.Holy cow, what a deal. Here, go for it.Send your stories and questions or call 724 ARM-N-LEG. Hosted on Acast. See acast.com/privacy for more information.

A couple months ago, we started getting messages from listeners telling us: you gotta watch this video. It’s a thirty minute YouTube video from a creator named Brian David Gilbert, and it’s probably the best video about health insurance we’ve ever seen. Brian David Gilbert is best known for his highly-detailed, hilarious videos for Polygon, a media company about video games. But when he left that job to strike out on his own, he needed new health insurance. We talked with him about how that experience turned into one of the most difficult videos he’s ever made — and this is a guy whose old job had him tracing things like Zelda storylines across decades-long franchises. You can watch the full video here. Other delightful BDG creations discussed in this episode:The two-minute video that launched his career.His 15-minute dive into the Legend of ZeldaA cooking demo: “Welcome to my weird ice creams.” Yum.Special thanks to Wil Williams, Sarah Ballema, Josh Rubino, and Bea Bosco for adding their voices to this episode!AND: We’d love for you to support this show. Now is a great time to do it. This month, every dollar you donate is DOUBLED, thanks to NewsMatch and the Institute for Nonprofit News. Holy cow, what a deal. Here, go for it. Hosted on Acast. See acast.com/privacy for more information.

Since the Supreme Court overturned Roe v. Wade, abortion has been banned in more than a dozen states. As you choose your insurance plan for next year, you might be wondering: How does that affect my insurance plan? We learned two big things.  First: There’s no one answer (and few answers are settled yet). A lot depends on where you live, and where you work. But second: For lots of people, for a long time, insurance has rarely been a help in accessing abortion. Most people pay cash. And lots of people can’t afford to.But there are organizations who have been tackling this issue for decades — abortion funds. We’re big fans of when regular people find a way to help each other survive this messed-up, profit-driven health care system — and abortion funds are a huge example of that kind of effort. There’s a lot we can learn from them. We talk with Oriaku Njoko, executive director of the National Network of Abortion Funds, and Tyler Barbarin, a board member with the New Orleans Abortion Fund, to learn from their experience. Here's a transcript of this episode. We’d love for you to support this show. Now is a great time to do it. This month, every dollar you donate is DOUBLED, thanks to NewsMatch and the Institute for Nonprofit News. Holy cow, what a deal. Here, go for it. Hosted on Acast. See acast.com/privacy for more information.

It’s open enrollment for 2023 health insurance for lots of folks — a time when you might find yourself asking: what good is health insurance anyway? One listener wrote to us about his son, a student with no income. Dad asks, If the son could get charity care (financial assistance) at his local hospital….  should he bother getting health insurance? The big picture question: If you’re broke, and can’t get insurance from work, what are your best options? The big picture answer:  It totally depends!  Do you live in a state that expanded Medicaid?What are the financial-assistance policies like at the hospitals around you?What kind of health care do you know you’re going to need?We had expert help here:   Karen Pollitz, a senior fellow at the Kaiser Family Foundation, and . Jared Walker, founder of Dollar For, and a super-expert on charity care.  If you want to go deeper:We did a three-part series on picking health insurance in our First Aid Kit newsletter. Start here. An episode from last year explored some more dos and don’ts for picking health insurance.In a 2018 episode, we talked with another listener — a “financial therapist” — who had her own deep questions about health insurance. We’d love for you to support this show. Now is a great time to do it. This month, every dollar you donate is DOUBLED, thanks to NewsMatch and the Institute for Nonprofit News. Holy cow, what a deal. Here, go for it.Here’s a transcript of this episode.Send your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEG Hosted on Acast. See acast.com/privacy for more information.

Hey there,You may have noticed, we've been keeping a slower pace for the last few months — publishing every three weeks instead of every two — since Dan recovered from COVID.And every-three-weeks is gonna stay our default for now. Putting out the show more often was wrecking Dan's health, and some important behind-the-scenes work just wasn't getting done. When we slowed down the podcast release schedule, we also suspended the First Aid Kit newsletter, which compiles our most-useful information for dealing with the out-of-control medical system. Starting today, First Aid Kit is back — publishing monthly instead of every-other-week. (We're telling you, Dan was pushing too hard before.)If you're already a subscriber, you should have a new issue in your inbox right now. If you're not a subscriber yet, why not sign up? Hosted on Acast. See acast.com/privacy for more information.

This year, the state of California put up $100 million to produce its own insulin, and sell it for cheap. How’s it going to work? (Is it going to work?)  The price of insulin could be the starkest example of our out-of-control health care system: More than 7 million Americans need it to survive, and some die because they can’t afford it— medicine that’s been around for 100 years, medicine its discoverers didn’t want to patent. We look at how California’s plan came to be, and what might stand in the state’s way. Further listening:How insulin got so horribly expensive was one of the first stories we covered on this show. Here’s that story-- a version we ran in 2021, including updates on what citizen-scientists, hackers, and activists are up to: https://armandalegshow.com/episode/revisiting-insulin/One of the biggest possible obstacles to California’s plan is the power of middleman companies called pharmacy benefit managers, or PBMs. We unpacked their role, their power, and the profits they make when drug prices are high, in this 2019 episode:  https://armandalegshow.com/episode/why-are-drug-prices-so-random-meet-mr-pbm/ … and here’s a deep dive on the devious, clever games among PBMs, pharma companies, and insurance companies — games where we, people who need medicine, always lose. https://armandalegshow.com/episode/swimming-with-sharks/ Also, we mention our recent coverage of the legal and lobbying power of the pharmaceutical industry. That’s in our last episode, here:  https://armandalegshow.com/episode/congress-fixed-a-piece-of-medicare/ Here’s a transcript of this episode.Send your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEGGet our newsletters here. And of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

Lots of seniors have to pay thousands of dollars for drugs—even tens of thousands—or do without life-saving medicine. That’s finally going to change. The new Inflation Reduction Act will set a $2,000 cap on out-of-pocket drug costs for seniors. (Yes, it’ll do a bunch of other stuff too.) It took a long time. Folks like researcher Stacie Dusetzina spent years building evidence about how Medicare prescription drug policy was failing people with cancer and other conditions. The pharmaceutical industry fought this change tooth and nail — for decades. Julie Rovner, Chief National Correspondent for Kaiser Health News, takes us on a journey back to the late 1980’s, when Congress learned the cost of messing with Big Pharma. TranscriptSend your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEGSupport us Hosted on Acast. See acast.com/privacy for more information.

It’s often possible to negotiate medical bills. It sounds hard — and it can be — but what if we got it down to a science? Mapped out all the moves ahead of time? Jared Walker and his team at the nonprofit Dollar For are running a big experiment to see if they can do just that. And we got to visit the lab. The folks at Dollar For caught our attention — and lots of other people’s—when they went super-viral on TikTok with a 60-second recipe for crushing medical debt by accessing charity care, financial assistance that most US hospitals are legally required to offer. That was early 2021. Next, a group of whip-smart volunteers helped Dollar For develop a user-friendly system to help folks apply for that assistance. Dollar For also started holding open trainings on Zoom, teaching people the ins and outs of applying for charity care—and helping others to do so. They say their work to date has helped erase more than $18 million in medical debt. But lots of people who can’t afford their medical bills don’t qualify for charity care. So Dollar For is trying something new: what they’re calling a “negotiation lab” for gaming out the best way to negotiate with hospitals and debt collectors. We listen-in on one of Dollar For’s real-life negotiations with a debt collector and take notes. Here’s a transcript of the episode.Send your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEGAnd of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

Is it possible for a health care company to make enough people mad about their billing practices that it hurts their business? For one genetic testing company, maybe so. An Arm and a Leg listener Jessica got a test that’s become routine in early pregnancy: non-invasive prenatal testing. It was supposed to be $99. But then — after she took the test — that turned into $250. And when she asked questions, she was told it could go up to $800 if she didn’t pay up quick. , Jessica looked up the testing company, and found out that lots of people experienced what she called “the genetic testing bait-and-switch.”And she’s not the only one who noticed.When some guys on Wall Street, plus New York Times reporter Sarah Kliff, started hearing about those bills, the company found itself in some hot water. Here’s a transcript of the episode. Bonus reading:Sarah Kliff and Aatish Bhatia’s reporting on non-invasive prenatal testingA scorching report on Natera from Hindenburg ResearchAndrew Rice’s story on Hindenburg Research: "The Last Sane Man on Wall Street" Send your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEGAnd of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

Thomas Fisher is an emergency room doc in Chicago. His book, The Emergency, is an up-close chronicle of the COVID pandemic’s first year in his South Side ER. It also zooms out to tell the story of his journey as a doctor: How his upbringing on the South Side fueled his desire to become a doctor. And how the realities and inequities of American health care limited his ability to help. He details how the failures of the American health care system — and the racial inequities it perpetuates — leave health care workers with a profound sense of moral injury. “Over time, when you have this conflict between what you can do and what you're supposed to do—what you wish you could do, what you're trained to do—that creates a moral conundrum….It also leads a lot of people to leave the profession ” For a time, Fisher himself stepped away from practicing medicine. The journey took him to the executive suite but ultimately landed him back in the ER where he started.On the street outside the hospital where Fisher works, he sits down with host Dan Weissmann to discuss the book and his search for meaning in the daily sprint of life in the ER. Here’s a transcript of this episode. Subscribe to our newsletters.Send your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEGAnd of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

About a third of ER doctors now work for companies backed by private equity. A lot of those docs do not like the arrangement, which they say puts profits ahead of patients. Now, a group of ER docs are suing to kick one of those private-equity owned companies out of their hospital-- and all of California. They see it as the first step in a long, long fight. The suit cites California’s ban on the “corporate practice of medicine” — which is supposed to outlaw situations where non-doctors tell doctors what to do, for profit. Which raises a question: How did it get left to a group of doctors to get that law enforced? We break it down, with help from:Dr. Lisa Moreno, immediate past president of the American Academy of Emergency Medicine which filed the lawsuit.Law professor Erin Fuse Brown, who has written about private equity’s growing role in medicine.Legendary financial reporter Gretchen Morgenson, now at NBC News, who has been reporting on private equity’s role in medicine since 2020, and whose reporting tipped us off to this lawsuit. And while you're here, why not:Subscribe to our newsletterSend stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEGAnd of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

Credit reporting bureaus announced in April that they would start taking most medical debt off of people’s credit reports. At first, we weren’t sure that would be such a huge deal. After all, the medical debt would still exist, people would still get harassed by debt collectors, or even sued over it. But it turns out, there’s a bunch of reasons why these changes could be life-changing, and we want to give credit (the good kind) where it’s due. The changes include:Paid-off medical debt disappears from credit reports on July 1, 2022Debts under $500 (even if you haven’t paid them) come off reports in March 2023Medical bills under $500 that you received after March 1, 2022 should will never be counted on your credit reportNo medical bills – of any size– will appear on your credit report until they’re at least a year old, starting July 1, 2022Plus, some an end to some games debt collectors can play with your credit score. Here’s a transcript of this episode.Subscribe to our newsletter, First Aid Kit.Send your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEGAnd of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.

A new golden age is dawning, and it starts where the sun don’t shine.A listener got a pricey quote for her colonoscopy, but the medical practice behind it seems like “the only game in town.” We scope it out and learn the surprising reason why: Investors have decided your butt is a goldmine. Private equity investors have made their way into many areas of our lives. Now, they’re at the gastroenterologist’s —and lots of other medical specialists, too. We learned why these doctors are selling their practices to private equity, and what it could mean for your health care and your bills. Correction notice: The original version of this story mis-identified the organization where Claire McAndrew worked when we spoke to her in 2019. Whoops. We've updated the audio file, so it's correct now.Here's a transcript for this episode.As always, we'd love you to:Subscribe to our newsletter, First Aid KitShare your stories and questions, either on our site or call 724 ARM-N-LEGPitch in to support this show financially. Hosted on Acast. See acast.com/privacy for more information.

Dan’s COVID has hung on there for a while, kept him SUPER tired. Yoinks. Back in a couple weeks!Meanwhile, as always, we'd love for you to:Get in touch to share a story or your thoughts. Subscribe to First Aid Kit, our newsletter about how to survive the health-care systemSupport us: Your donations are this show's biggest source of income. Hosted on Acast. See acast.com/privacy for more information.

Hey there — I got COVID a little before we were scheduled to tape this week's episode. Whoops! I'm fine now, but kinda tired. Just to be on the safe side — some people stay tired for a while — let's give me two weeks before we come back with a full episode.Meanwhile, I'll share this: I think one reason I got better quick was, I was able to get anti-viral meds. (Paxlovid, in my case.) And I mention this because: There's a new variant going around, BA.2, which looks like it's going to bring on a new wave; we don't know how big it'll be yet, but the New York Times had some good tips recently for how to be prepared. One was: Have a plan for getting antiviral treatment, in case you do get sick. Some docs don't like to prescribe them, and some folks shouldn't take them because of things like drug interactions. It's worth knowing your best options ahead of time.I'm here to co-sign that advice. The rest was good too. Here's the link: https://www.nytimes.com/2022/03/30/well/live/ba2-omicron-covid.htmlFinally: Even this two-minute sick note has a highly-entertaining moment, thanks to a listener who wrote a surprising response to a recent First Aid Kit newsletter... then recorded that note as a voice memo. So, I'll catch you in a couple weeks. Till then: Take care of yourself, for real. And as always:Our First Aid Kit newsletter collects the practical lessons I've learned about how to fight the awful cost of health care. You might want to subscribe.We love it when you send your stories and questions: https://armandalegshow.com/contact/ or call 724 ARM-N-LEGAnd of course we’d love for you to support this show. Hosted on Acast. See acast.com/privacy for more information.