Dan Weissmann
The “An Arm and a Leg” podcast is again. This season, host Dan Weissmann will inform tales about sufferers discovering artistic methods to combat again towards outrageous payments.
This primary episode of Season 9 updates a narrative from 2019 a few listener who received a $35 invoice from a medical testing lab she had by no means heard of. Quickly a follow-up invoice arrived demanding $1,300 if she didn’t pay instantly.
This bounce in value left her questioning: Can they freaking do this?!?
The reply: They can attempt. And so they usually get away with it.
But when sufferers have the time and moxie, they will suggest a good value and even take suppliers to court docket to drive them to simply accept the counter provide.
The unique model of this story coated a few subjects the present has explored: Shock payments (for which new authorized protections had been enacted in 2022) and the way non-public fairness has been increasing into well being care and the way some docs try to combat again.
The Host
Dan Weissmann
@danweissmann
Host and producer of “An Arm and a Leg.” Beforehand, Dan was a workers reporter for Market and Chicago’s WBEZ. His work additionally seems on All Issues Thought-about, Market, the BBC, 99 P.c Invisible, and Reveal, from the Heart for Investigative Reporting.
Credit
Emily Pisacreta
Producer
Marian Wang
Editor
Ann Heppermann
Editor
Adam Raymonda
Audio Wizard
Click on to open the transcript
Transcript: Can They Freaking Do that?! (2023 Version)
Notice: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can include errors. Please use the transcript as a software however verify the corresponding audio earlier than quoting the podcast.
Hey there–
I’ve to begin with a giant THANK YOU to everyone who helps this present. It’s January, we wrapped up our large fund-raising marketing campaign at New 12 months’s, and greater than 600 of you got here by means of for us. We hit all our targets, together with our stretch purpose. It’s large.
I’ll have a LOT of individuals to thank on the finish of this episode, and I need to take into consideration how you can have a good time. Due to you, this yr is off to a tremendous begin.
And for this primary episode of 2023, I’m going again to a narrative we first put out greater than three years in the past, in 2019.
As a result of: this story modified my entire conception of what this present can intention to do.
After I meet folks right this moment and inform them about An Arm and a Leg for the primary time, that is the story I inform them about.
As a result of it is a story about authorized rights I by no means suspected we had– and the way we will typically use them to combat again.
I discovered loads of different stuff whereas reporting this story — about shock payments, and the position of personal fairness. It was early days for the present.
We’re leaving out these elements out this time– we’ve gone deeper on them in different episodes, and among the underlying info have modified.
Some issues have gone old-fashioned in good methods, due to the federal No Surprises Act, which took impact final yr.
However the half about combating again? Standing up for our authorized rights? That holds up. And it’s prepared for some follow-up.
OK, right here it’s:
Dan: Miriam visited a fertility clinic a pair years in the past in Washington and DC the place she lives, and she or he received some assessments executed. She was fortunate. Her insurance coverage truly coated fertility stuff, so she received the invoice and her share was like 30 bucks. She paid it. Then this different envelope arrives from someplace she by no means heard of.
Not the fertility clinic or anyplace else she’s ever been, and it’s sizzling pink. She thinks it appears pretend. It says it’s a invoice and so they need 35 bucks for some lab work
and maybe unwisely, Miriam ignores it.
Okay. Uh, positively unwisely and there are a few comply with ups additionally in sizzling pink envelopes. And on the one hand, Miriam appears extra carefully and they’re linked to her go to to the fertility clinic on the opposite. The comply with ups say this different factor. They say, Hey, pay up now, or This factor’s going up, manner up, as much as about 1300 bucks from 35, which
Miriam: was so outrageous that I believed, that is positively bullshit.
Bullshit. . Sorry, can I say that?
Dan: Sure, completely. Yeah. So Miriam does a dumb factor and ignores it and a comply with up, after which in September she will get a word from a collections company. They need that $1,300. And may they freaking do this? Can some lab ship you a invoice for 35 bucks outta nowhere after which be like, Hey, higher pay now whereas we’re in temper.
In any other case it’s gonna be $1,300. Is that even authorized?
That is An Arm and a Leg, a present about why well being care prices so freaking a lot, and what we will possibly do about it. I’m Dan Weissmann. I’m a reporter, and I like a problem. So our job on this present is to take one of the vital enraging, terrifying, miserable elements of American life, and convey you one thing entertaining, empowering and helpful.
And what’s extra helpful than realizing what our rights are?
As a result of as customers. No thought. I imply, I get a invoice from the electrical firm. Properly, for one factor, it’s not a shock. I’ve been operating the lights and it’s the identical charges as final month, and everyone’s paying principally the identical charges as me, like no matter I owe this, however a sizzling pink envelope from some ancillary lab.
After which a follow-up saying they’re gonna take you for 1300, you’d. Properly, possibly they will freaking do this.
I imply, how would you even know? Who would you even ask? Properly, now you’ll be able to ask me and I’ll go discover out. This entire factor occurred to Miriam a pair years in the past. She ended up settling with the collections company for like $217, which was a sixth of what they had been asking for, nevertheless it was additionally six instances that unique $35 cost.
It nonetheless bugs her. Like was that even authorized? What occurred there? It’s so tousled. So she wrote to me and I used to be. I actually need to determine this out.
After I talked to Miriam, she truly had a idea about what I’d discover.
Miriam: It would simply be unlawful to have such a, a giant bounce from, um, what the unique copay was to what it ended up being after I used to be late.
Dan: Yeah! I used to be off– prepared to check that idea out.
So, I made some calls. And I FOUND OUT SOME STUFF.
It took a minute. I began out calling nationwide authorized consultants and coverage nerds, and so they had been like, “I don’t actually know. The regulation is difficult, it varies from state to state, blah blah blah”
So then I began calling people who assist customers problem wild medical payments — like, for a charge, that’s how they make a dwelling. One in all them was Braden Pan, his firm’s referred to as Resolve Medical payments.
I described Miriam’s story to him, the pink envelope, the wonderful print that was like….
…is for a cost of $1,287 for which you get an important low cost and can take $35 from you for those who pay by date.
Wow. . Okay.
It’s like he was sort of impressed by how brazen this was.
And although he didn’t know the reply, he had some good ideas about what questions to begin asking.
Braeden Pan: I’m gonna inform you proper now that I’m not a lawyer. Yeah. Um, now I can inform you that the, the concept of what hospitals or clinics can cost for providers that hasn’t been settled.
Dan: In different phrases, he thought you’d want a lawyer for those who wished to combat it, and also you don’t know the way it’s gonna come out.
Braeden Pan: What may truly be occurring with this firm is that they know this, they know that there’s confusion on the market about this, uh, that you simply want a lawyer to really determine it out, whether or not or. Somebody can can do that and for a thousand bucks it’s not price it to rent a lawyer to inform you as a result of they’re gonna cost you 1200 bucks simply to inform you whether or not or not they will do that
Dan: Proper, proper.
So himself, Braden Pan wasn’t so certain they had been good solutions right here, however he pointed me to a few different folks and so they truly had some very hopeful solutions. Some severe self-defense instruments. You may wanna seize a pen. We’ll have that proper after.
This season of an Arm and a Leg is a co-production of Public Street Productions and Kaiser Well being Information.
That’s a nonprofit newsroom that covers healthcare in America. Kaiser Well being Information just isn’t affiliated with the large healthcare supplier, Kaiser Permanente. We’ll have somewhat extra on Kaiser Well being Information on the finish of this episode.
Sir, right here’s the place we meet the parents who’re going to provide us our large robust weapons for combating off completely unreasonable payments.
Lisa Berry Blackstock: My identify is Lisa Berry Blackstock, and I’ve been a affected person advocate since 1990.
Dan: That’s like nearly 30 years. And I requested her, is there something you are able to do in a scenario like this if you’re getting hit up for 1300 bucks for some silly lab check? And he or she was like, properly, You possibly can take ’em to small claims court docket and also you don’t need to be a lawyer to try this.
I used to be like, wait, you’ve executed this?
Lisa Berry Blackstock: Oh, I, I’ve misplaced depend. I can’t inform you what number of instances I’ve executed it and in what number of totally different, uh, counties.
Dan: Huh? So it really works.
Lisa Berry Blackstock: Oh, it really works. It’s labored for me.
Dan: She says it really works each single time. And right here’s one thing I discovered on this dialog that I completely had not recognized.
Once you go to court docket, it doesn’t need to be to make any person else offer you. You possibly can go to court docket and say, decide, this lab says I owe them 1300 bucks, however I’ve researched it and 35 bucks is truthful. I’m providing them 35. Would you please get them organized to take 35?
It takes a plan to do that and it takes work.
Lisa Berry Blackstock: You need to show in writing that you’ve got made religion effort to resolve this to your greatest capability and that you simply’ve been unable to, and that’s why you’re asking the court docket to intervene.
Dan: And so that you’re asking the court docket principally to approve. A settlement provide that you simply’re making. Appropriate?
Lisa Berry Blackstock: Appropriate.
Dan: That’s what Lisa Berry Blackstock says she does. There’s some severe homework concerned. Should you grabbed a pen earlier, right here’s the place you begin taking notes first. Lisa says, you name whoever’s sending the invoice and make them provide the billing codes for every thing on the invoice.
itemized. Every one has a 5 digit code referred to as a C P T Code, C P T. And actually, this sounds prefer it could possibly be the toughest half. You gotta get them to cough up this data. You may have a proper to it, however getting it, when you’ve received that, you determine what a good value is in your space, and there are a few web sites that truly can assist you do that.
Lisa makes use of one from a gaggle referred to as Truthful Well being. The positioning is truthful well being client.org. You place in your zip code and that 5 digit medical billing code, they may inform you what the going charges are in your space.
And that’s my foundation of my provide. It’s truthful I, I imply, I’ve independently verified data.
Lisa Berry Blackstock: It’s not a quantity that I’ve made up and it’s not such as you’re attempting to tear folks off .
Dan: Then you definately write to whoever’s billing, you employ licensed mail. So that you get a signed receipt, you’ll be able to show they received it, and also you say, right here’s what I’m providing. Right here is how I decide this quantity. I need to hear from you by date X, that you’ll settle for it.
In any other case
Lisa Berry Blackstock: I will probably be submitting in small claims, you recognize, towards you, and you may anticipate to obtain a discover.
Dan: And also you’re saying typically in the event that they get that, they’ll be like, okay, I’ll take it. Is that proper?
Lisa Berry Blackstock: Sure. I imply, common, they, they give the impression of being, they don’t perceive something with billing aside from raking folks over the coals as a result of that’s what. is usually allowed throughout the nation.
Dan: She says loads of the time simply sending the letter is sufficient, however typically she truly has to file Now, as soon as I’ve filed Yeah. And so they’ve been served. Yeah. Oh, then they’re, they’re falling throughout themselves to make it go away. As a result of look, they’re used to sitting in an workplace sending out items of paper saying, ship us 1300 bucks, or We’ll damage your.
and getting 1300 bucks, or possibly getting a cellphone name and permitting themselves to be talked right down to 200 with out leaving their desk, they gotta ship any person to court docket. That one that would go to court docket might earn more money by simply accepting this provide and transferring on to the subsequent sucker,
Particularly as a result of, in keeping with Lisa Berry Blackstock, they’d most likely lose in court docket anyway.
Now, this was cool, however I didn’t simply wanna take one individual’s phrase for it. I discovered any person else who had truly tried this factor. Someone with a reasonably good credential.
Christopher Robertson: My identify’s Christopher Robertson. I’m a professor and affiliate dean on the James E. Rogers School of Legislation
Dan: That was his job after we talked in 2019. Now he’s a professor and affiliate Dean on the Boston College Faculty of Legislation.
Anyway, I requested him, you can also make these folks settle for a good provide, and he’s like,
Christopher Robertson: Yeah. Duh. You recognize, fundamental contract regulation, you recognize, the stuff we educate to first yr regulation college students day by day purports to only make this a non-pro. After all you don’t need to pay a quantity that the opposite aspect simply invented, um, , you recognize, that is, that is capturing fish in a barrel from a, from a contract regulation perspective.
Dan: Whoa, child. The deal is you see a doc anyplace. You signal one thing within the enterprise, they name it consent to deal with. It says, yeah, look at me, poke, prod, no matter, and it says, I’m gonna offer you my insurance coverage information and regardless of the insurance coverage doesn’t pay, I’ll pay. The factor I’m signing doesn’t say how a lot I’ll pay as a result of no person is aware of precisely what’s gonna occur on the physician’s workplace or the er, wherever.
Anyway. I received a abdomen ache. Possibly I ate one thing bizarre. Possibly I’ve an ulcer. So Robertson says, what I’m signing is what legal professionals name an open value contract. You recognize, usually a
Christopher Robertson: contract has a value in it, proper? So if you wish to go purchase a automobile, your contract to purchase the automobile has a value that’s true of a washer or a, or a home.
However when there isn’t any value within the contract, it’s referred to as an open value contract.
Dan: The courts don’t deal with an open value contract as a clean verify.
Christopher Robertson: If the court docket is gonna be referred to as upon to implement the contract to drive somebody to pay one thing, then the court docket has to determine, properly, what, what quantity ought to I drive them to pay?
It will probably’t be simply what one aspect says later.
Dan: In different phrases, courts would. An open value contract like your settlement with a medical supplier doesn’t imply the opposite aspect simply will get to invoice you for no matter they need, and Miriam’s case is particular. It’s received this different wrinkle, which is principally the lab stated the value was 35 bucks, however for those who’re late, it’s 1300.
That’s why I used to be so on this case. And Robertson says, Miriam has the regulation on her aspect there too. He says, this entails one thing else. They educate first yr regulation college students
Christopher Robertson: actually on the very first day of contract regulation
Dan: Once you breach a contract, courts don’t deal with that like a clean verify both, and a late charge, it’s like a penalty for breaching a contract. The contract says you pay on date X. Miriam breached her contract by not paying on time. However Chris Robertson says there’s a restrict to what that penalty might be, and it’s gotta have some relationship to what the breach truly value. The. .
Christopher Robertson: In order that’s a second purpose. This technique is totally legally frivolous to take a $35 cost and convert it right into a thousand {dollars} plus.
Proper. So yeah, they didn’t get their $35 verify in June after they wished it. They may get it in July. Properly, that doesn’t value them a thousand {dollars}. So the penalty can’t be a thousand {dollars} . Even when they don’t get it, it’s now September and so they haven’t gotten it. It’s nonetheless not costing him a thousand {dollars}.
Christopher Robertson: Precisely.
Dan: So he’s like, yeah, line it up. Small claims court docket, that form of factor can work. I can barely imagine it’s this straightforward.
I’m like, wait, why don’t we do that extra usually??
Christopher Robertson: I imply, frankly, we shouldn’t need to. We’d like a scientific resolution to this. Uh, you recognize, we’re all have day jobs, you recognize.
Frankly, lots of people who’re coping with medical payments shock, shock, are sick, proper? Yeah. Um, so , they’re busy attempting to get properly, uh, you recognize, they’re attempting to combat their very own battles and so, you recognize, waging their very own authorized battle is, is, is a big distraction and requires a degree of consideration to element that not everybody has or needs to be anticipated to have.
In order that’s why I actually need extra systematic options.
Dan: So Miriam might need had some choices, however small claims court docket, it’s not precisely a blanket resolution, particularly cuz there’s additionally the issue of scale. I imply, it’s one factor for those who’ve received a lab hawking you for a thousand bucks. What for those who’ve received a complete system of hospitals attempting to rake untold numbers of sufferers over the coals for loopy quantities? Then you definately’re not in small claims court docket anymore. Christopher Robertson has been there, like he’s gotten concerned in lawsuits attempting to cease hospitals from doing that form of factor, and he. It isn’t fairly.
Christopher Robertson: It’s, it’s the utter, utter breakdown of regulation. I imply, after we tried to problem these practices by hospitals, um, we bumped up into courts insisting that for each single cost, we affirmatively show that the quantity they made up is unreasonable. However proving that. Requires, you recognize, consultants and accounting and economics, you might spend tens of 1000’s of {dollars} litigating each single one in all these thousand {dollars} expenses. And in order that’s why you actually do want both class motion or a extra affirmative, you recognize, regulatory system to police this, this dangerous conduct.
Dan:However in a person scenario like Miriam’s, the place she’s truly wholesome, she’s solely received one cost to combat off. You possibly can combat again. Get your proof collectively, discover out the itemized billing codes, and use a web site like Truthful well being client.org to determine what an affordable value could be. Make a suggestion, put it in writing. Ship it licensed mail. Give ’em a deadline to simply accept your provide or else inform ’em you’ll file in small claims court docket. . And if that doesn’t make ’em play ball, truly do it. I ran all this down from Miriam and she or he was like,
Miriam: I want I had recognized. That’s my foremost factor. I want I had recognized that I had these different choices. I’d’ve completely gotten a letter, like if, even when I wanted to notarize a letter, get it despatched licensed mail. I I’m gonna take you to a small claims court docket. Okay. Possibly I’ll, I’ll offer you 50 bucks. That’s my, that’s my provide. Yeah. I want I had executed that.
Dan: YEP! That’s the place we left issues, somewhat greater than three years in the past.
I imply, we’ve adopted up somewhat right here and there:
We talked with a man named Jeffrey Fox, who has made it… sort of a passion to make use of small claims courts to face up for his rights. So when UCLA overbilled him, he was prepared.
I imply, possibly we might all use somewhat of his readiness to combat. Right here’s how he describes conversations with their billing division.
Jeffrey Fox: One factor they at all times do is that they at all times attempt to make it seem to be their insurance policies apply to you. They’re like, properly, no, our coverage is blah, blah, blah. I’m like, I don’t care. Contract regulation, the ideas of contract regulation and what I truly owe you, what a court docket would say, I owe you is what applies. I keep in mind saying, okay. Properly, my coverage is you pay me 100 {dollars} each time you say one thing silly. So does that apply to you? If it does you solely about 400 bucks already. Wanna hold going?
Dan: Jeffrey didn’t receives a commission on that improvised coverage of his… however he did get a decide to make UCLA give him a refund of greater than two thousand {dollars}. That episode was referred to as David vs Goliath, and we’ll embody a hyperlink to it wherever you’re listening.
So we’ve come again to this strategy to combating again. However I’ve been beginning to suppose we haven’t come again to it practically sufficient.
Particularly since I received a word from a listener named Lauren with the heading: “I sued a hospital in small claims court docket and misplaced”
… which ended, “I really feel like I gained.” She wrote, “the hospital spent far more cash on lawyer’s charges than the whole quantity of my invoice.” They despatched three legal professionals to a preliminary listening to — and her invoice wasn’t even that prime.
We talked — we’ll have a lot of particulars in our subsequent episode — about what she had discovered, and the way she wished to unfold it round.
Lauren: I walked out of that considering , do I , like, simply put collectively an inventory of suggestions and depart it on folks’s windshields which can be parked exterior of the er. how do I assist different folks do that?
If everyone that they screw stands up, they will’t afford to pay a lawyer to defend towards all of these.
Dan: I imply, it’s an INTERESTING thought. Not for everyone. However possibly just a few extra folks than have tried it thus far…
We’ll choose up that concept subsequent time.
Until then, deal with your self.
This episode of An Arm and a Leg was produced by me, Dan Weissmann, with assist from Emily Pisacreta. Ann Heppermann edited the unique story.
Marian Wang edited this model– and it appears like Marian’s parental depart from this present, arising any minute now, will probably be everlasting.
Marian, I can’t imagine how a lot I’m going to overlook working with you. It has been such an honor and such a pleasure.
Daisy Rosario is our consulting managing producer. Adam Raymonda is our audio wizard. Our music is by Dave Winer and Blue Dot Periods.
Gabrielle Healy is our managing editor for viewers. She edits the First Support Package E-newsletter.
Bea Bosco is our consulting director of operations. Sarah Ballema is our operations supervisor.
This season of an arm and a leg is a co manufacturing with Kaiser well being information. That’s a nonprofit information service about healthcare in America, an editorially-independent program of the Kaiser household basis.
KHN just isn’t affiliated with Kaiser Permanente, the large healthcare outfit. They share an ancestor: The twentieth century industrialist Henry J Kaiser. When he died, he left half his cash to the inspiration that later created Kaiser well being information.
You possibly can study extra about him and Kaiser well being information at arm and a leg present dot com slash Kaiser.
Zach Dyer is senior audio producer and Tarena Lofton is viewers engagement producer at KHN– they’re editorial liaisons to this present.
Due to Public Narrative — That’s a Chicago-based group that helps journalists and non-profits inform higher tales– for serving as our fiscal sponsor, permitting us to simply accept tax-exempt donations. You possibly can study extra about Public Narrative at www dot public narrative dot org.
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“An Arm and a Leg” is a co-production of KHN and Public Street Productions.
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