An Arm and a Leg

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.

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.

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.

For months now, you’ve been sharing stories with us about facility fees, those sneaky fees that keep showing up on your medical bills. Facility fees are kind of like a cover charge for visiting a health care facility, usually one owned by a hospital. And many of you have been blindsided by them. Some of you have been going to the same place for years, only to one day get a brand new charge, seemingly out of nowhere. Many of you only found out about a facility fee after the fact, while some of you managed to avoid one by going somewhere else. Pretty much all of you were vexed, confused, and wanted answers. Next week, we’ll start unpacking these stories, starting with one that’s particularly epic. Stay tuned! In the meantime, got a story or tip you want to share? Send your stories and questions. Or call 724 ARM-N-LEG.And of course we’d love for you to support this show.

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.

We take our first look at Medicaid— the big, federally-funded health insurance program for folks with lower incomes— for two reasons: First, it’s a huge part of our health-care system. Medicaid covers a quarter of all Americans, and four in ten children. Second, it’s timely: In the last year, more than 20 million people have lost Medicaid — even though there’s evidence to suggest a lot of those people probably still qualify. More than two-thirds have been dropped for “procedural reasons” — basically, missing paperwork.Of folks who’ve been dropped, 70 percent have ended up either uninsured, or — in most cases — back on Medicaid. This is all because of a process called “the unwinding” of COVID-emergency protections that kept folks from getting dropped at all for a few years. It’s been messy.We’ve been hearing the stories of folks who got dropped, and their fights to get re-enrolled.  In this episode, we hear about two families in Tennessee who lost coverage they were entitled to — including one family who lost their coverage after their mail got sent to a horse pasture — with help from KFF Health News reporter Brett Kelman. 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.

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.

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.