Dan Weissmann
Caitlyn Mai thought she did every thing proper. She known as forward to verify her insurer would cowl her cochlear implant surgical procedure. She thought every thing went in response to plan however she nonetheless obtained a invoice for the complete price of the surgical procedure: greater than $139,000.
What Caitlyn did subsequent is a reminder of why a beloved former visitor as soon as stated it’s best to “never pay the first bill.” This episode of “An Arm and a Leg” is an prolonged model of the July installment of the “Bill of the Month” sequence, created in partnership with NPR.
Dan Weissmann
Host and producer of “An Arm and a Leg.” Previously, Dan was a employees reporter for Marketplace and Chicago’s WBEZ. His work additionally seems on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.
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Emily Pisacreta
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Claire Davenport
Producer
Adam Raymonda
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Ellen Weiss
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Don’t Get ‘Bullied’ Into Paying What You Don’t Owe
Dan: Hey there —
One morning when she was in eighth grade, Caitlin Mai did what she at all times did when she awakened.
Caitlyn Mai: Music has at all times been an enormous a part of my life. And so I instantly put in my headphones and began placing on music as I used to be about to get away from bed and prepare. And I observed my earbud in my proper ear wasn’t working.
Dan: It was apparent, as a result of on this Beatles tune she’d cued up, Eleanor Rigby, the vocals are virtually all on the right-hand facet, and she or he couldn’t hear them.
Caitlyn: I used to be like, that’s form of bizarre. So I switched the earbuds and it labored high-quality. But then it was, the opposite one wasn’t working in my proper ear. And I used to be like, what?
Dan: Yeah, complicated. And then she tried getting away from bed.
Caitlyn: I used to be so dizzy. It was my first time experiencing vertigo, and it was so extreme, I couldn’t stroll throughout the room with out getting severely movement sick.
Dan: With that vertigo, Caitlin may barely stroll in any respect. She had no sense of steadiness — that really depends on a mechanism inside our ears. Later, docs discovered she had misplaced 87 % of her listening to on the suitable facet.
Caitlyn: They assume I simply had some kind of virus that settled in my ear, and it broken my ear. But I went to mattress fully wholesome the evening earlier than. Woke up, couldn’t hear out of my ear.
Dan: She needed to learn to stroll once more.
Caitlyn: I’ve to depend on my eyes. My mates nonetheless discover it hilarious if I shut my eyes, I fall over.
Dan: That was eighth grade. Caitlyn made it via highschool, in Tulsa the place she grew up with out loads of lodging.
Caitlyn: Cause in center faculty, early highschool, you don’t need to convey consideration to your incapacity. At least I actually didn’t need to on the time. I used to be tremendous anxious about that.
Dan: Catilyn’s 27 now, she works as a authorized assistant in Oklahoma City. Her husband’s a lawyer. And for the longest time, she couldn’t entry a software that helps restore listening to for many folks: Cochlear implants — small units that stimulate nerves contained in the ear.
The FDA didn’t approve them for only one ear till a few years in the past. Last yr, Caitlin obtained her insurance coverage to approve one for her. She had surgical procedure in December to insert the implant. And in January, an audiologist hooked up an exterior part to modify on Caitlin’s right-side listening to.
Caitlyn: She stated, okay, in some unspecified time in the future, you’re gonna begin listening to some beeps, simply say sure when you’ll be able to hear them. And my husband stated my face simply, out of nowhere, lit up, and I am going, sure! It was streaming on to my cochlear implant. And I positively began tearing up.
Dan: Then, two weeks later, Caitlin obtained an alert from the hospital on her cellphone.
Caitlyn: And I open it up, and I instantly began having a panic assault.
Dan: It was a invoice for 100 and thirty-nine thousand {dollars}. The full quantity for Caitlin’s surgical procedure.
Which, on condition that Caitlyn had gotten her insurance coverage firm’s OK for the process upfront, was a fairly large shock. NPR featured Caitlyn’s story not too long ago for a sequence they do with our buddies at KFF Health News.
NPR HOST: Time now for the most recent installment in our invoice of the month sequence, the place we dissect and clarify complicated or outrageous medical payments.
Dan: I interviewed Caitlyn for that story. And we’re bringing you an expanded model right here as a result of Caitlin’s state of affairs — effectively, it was a great story. And it made me interested in a pair issues.
It additionally jogged my memory of some good recommendation we’ve heard right here earlier than — and it jogged my memory of an necessary colleague and trainer. And the underside line to Caitlyn’s story? Stand up for your self. Don’t cave. Make the following name.
This is An Arm and a Leg — a present about why well being care prices so freaking a lot, and what we are able to 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 produce you one thing entertaining, empowering, and helpful.
To get her insurance coverage firm’s approval, Caitlyn had already spent loads of time — and some huge cash — within the months earlier than surgical procedure. For occasion …
Caitlyn: To show to insurance coverage {that a} listening to support wouldn’t work needed to be fitted for a listening to support after which do a pair hours of testing to show, yep, it doesn’t assist.
Dan: There have been evaluations with audiologists, together with her surgeon, and an MRI to verify there wasn’t an excessive amount of scar tissue for an implant to take.
Caitlyn: That took a very long time to get scheduled, get insurance coverage to approve, pay for, then get again for an additional appointment. I counted up at one level — it’s like round eight or ten appointments that I had earlier than the ultimate, okay, let’s schedule surgical procedure.
Dan: And — you caught that, proper? Where she talked about she needed to get her insurance coverage to approve paying for the MRI? Every one in every of these preliminary steps price cash, and she or he needed to wrangle together with her insurance coverage to get their OK.
But in fact even together with her insurance coverage saying sure, there have been nonetheless copays, and deductibles, and what’s known as co-insurance — the place you pay a share of any invoice from a hospital.
Which meant Caitlyn was chipping away at what’s known as her out-of-pocket most: The most she could possibly be on the hook for in a given calendar yr. The surgical procedure obtained scheduled for December — the identical calendar yr as all these assessments — and she or he checked to see what she might need to pay.
Caitlyn: I checked out my little portal for insurance coverage, I’m exhibiting what’s left on my out-of-pocket max for the yr is round 2,000, give or take, 200 {dollars}.
Dan: She known as the insurance coverage firm to substantiate that estimate. And then she cranked up her due diligence.
Caitlyn: I known as the hospital, and I requested for the names of the anesthesiologist, the radiologist. I requested for all the particulars of who’s probably going to be on my case. And then I rotated and I known as insurance coverage and I stated, I need to be certain all of those physicians are going to be in community on this date.
Dan: Caitlyn had achieved her homework. Probably greater than loads of us would have thought to do. I requested her: How’d you get so diligent? And first, like loads of people I’ve talked with, she stated: Having a serious well being problem as a child — shedding her listening to — gave her an early heads-up to be careful.
Caitlyn: Just a little bit was, uh, expertise of my mother coping with insurance coverage battles with me rising up. I bear in mind her working into points with that.
Can: And she’s obtained some specialists in her life now. Her brother and her sister in legislation work in well being care. One of her finest mates is a healthcare lawyer and had some suggestions.
Caitlyn: But actually, I feel loads of it’s I’ve anxiousness, and so I used to be simply actually paranoid.
Dan: The surgical procedure went nice. And a couple of weeks later, Caitlyn was within the audiologist’s workplace, getting that exterior part hooked up, and listening to on her proper facet for the primary time in 15 years. Caitlyn says all of it took some getting used to.
Caitlyn: I bear in mind these, like, first few days particularly, it wasn’t actually like I used to be listening to full sounds. It was form of simply totally different pitches. I wasn’t listening to the phrases and every thing, it was simply the breakdown of the totally different pitches. And additionally they have been simply a lot increased than they need to be.
Dan: So attention-grabbing. Radiolab could have already achieved this story — [but] I’m identical to, let’s discover out what that’s about.
Caitlyn: I like Radiolab.
Dan: Me too! Anyway, two weeks after she begins getting used to her new listening to state of affairs, Caitlyn will get that alert on her cellphone.
Caitlyn: And it tells me I’ve a brand new bill. And I used to be like, oh, superior! I’m not confused in any respect, I did my due diligence. I do know it’s gonna be costly, however reasonably priced.
Dan: Except, proper: It’s 100 and thirty-nine thousand {dollars}! Six figures. The full quantity for her surgical procedure. You may bear in mind, Caitlyn stated she had a panic assault. That was literal: Heart palpitations, hyperventilating.
It took her 20 or half-hour to get calm sufficient to start out making calls. And she says her insurance coverage informed her they hadn’t paid as a result of the hospital had uncared for to ship one thing necessary.
Caitlyn: The itemized invoice. Which has all of the codes and every thing,
Dan: Caitlyn says she instantly requested the hospital, in writing to ship her insurance coverage the itemized invoice, and she or he says despatched a follow-up every week later. But her cellphone saved pinging with alerts about owing the hospital 100 and thirty-nine thousand {dollars}.
Caitlyn: The app so conveniently informed me that I may join month-to-month funds of 11,000 {dollars} a month, which is simply so absurd.
Dan: After two weeks, she requested her insurance coverage: Do you may have that itemized invoice but? They didn’t. So she known as the hospital once more.
Caitlyn: The lady I spoke with stated she was placing in a request to have it faxed to my insurance coverage and that may take two to a few weeks. And I stated, maintain on, it takes you two to a few weeks to fax a doc?
Dan: Answer: Apparently sure? And Caitlyn says even three weeks later, her insurance coverage firm nonetheless hadn’t gotten that itemized invoice the hospital promised to fax.
And all this time Caitlyn was nonetheless getting notices from the hospital billing division. And the most recent one stated, “past due.” She tried one thing new: So she known as the hospital and demanded they ship the itemized invoice on to her, instantly. Which they did.
Caitlyn: So I rotated and faxed it to my insurance coverage.
Dan: Yeah however, this didn’t finish issues, not but. Caitlyn says she obtained extra notices labeled late. She fought her method to a direct dialog with a supervisor.
Caitlyn: They saved saying,‘well, a supervisor’s not obtainable proper now.’ I stated, No, you’re discovering a supervisor. I don’t care in the event that they’re slicing their lunch quick. I’m speaking to a supervisor proper now. I don’t care if I sound like a Karen. It’s been an extended, lengthy yr already.
Dan: Eventually, Caitlyn obtained a supervisor on the road and obtained the supervisor to get permission from a supervisor to cease sending her payments whereas the hospital waited for insurance coverage to pay.
By this time, it was late March, virtually two months after that first invoice gave Caitlyn that panic assault. Also by this time, Caitlyn had despatched her invoice to the parents at NPR and KFF Health News for that Bill of the Month function they do.
Caitlyn: I used to be like, I simply have to vent. And so I submitted it simply to vent it out. Never anticipating anybody to succeed in out.
Dan: But they did. And on April ninth, Caitlyn obtained a name from a regional Patient Service Center supervisor.
Caitlyn: And she was tremendous good and tried to be actually apologetic, however by no means really accepting any blame. Or outright saying,‘we’re so sorry.’ Just stated, ‘I’m sorry in your frustration, that sounds terrible.’
Dan: She DID inform Caitlyn that the hospital had acquired cost from her insurance coverage. And that Caitlyn may count on a ultimate invoice inside every week. And that as a substitute of 100 thirty 9 thousand, it was gonna be one thousand, 9 hundred eighty-two {dollars} and twenty-five cents.
Caitlyn: I stated,‘yep, that actually matches what my insurance said,’ and she or he stated,‘oh, you know what was left on your out-of-pocket, most people don’t,’ and I stated,‘I’m very effectively versed in each greenback signal at this level on this total case.’
Dan: Caitlyn says she obtained that invoice 4 days later and paid it instantly.
Caitlyn: And I saved the receipt of that, I’ve saved every thing. It feels prefer it’s resolved, however there’s a part of me that’s nonetheless ready for the opposite shoe to drop
Dan: So, Caitlyn’s story brings up a LOT. Of course, I liked the best way she saved combating, and in the end took management of the state of affairs. And I hated how she obtained trapped between these two large entities and the way a lot time and stress the entire thing price her.
Because, you understand, the hospital may’ve resolved this so rapidly by simply sending that itemized invoice to Caitlyn’s insurance coverage firm.
Caitlyn: And the hospital didn’t try this. They simply rotated and billed me. Which was a silly concept, for the reason that insurance coverage firm is extra more likely to have the cash. Not the authorized assistant in Oklahoma.
Dan: Caitlyn’s story raised a couple of questions, and introduced again loads of themes we’ve touched on earlier than. We dug in additionally discovered some new suggestions, and a few reminiscences I need to share. That’s coming proper up.
This episode of An Arm and a Leg is a co-production of Public Road Productions and KFF Health News, a nonprofit newsroom protecting healthcare in America. Their senior contributing editor, Elisabeth Rosenthal, reported Caitlyn’s story for KFF and NPR. She wrote a e book about U.S. healthcare. It’s known as “An American Sickness,” and it was an inspiration for this present.
One query we ask generally on this present once we see a invoice that’s so wildly ridiculous and unfair is: Can they freaking DO that?!? Like, is that even authorized?
Like on this occasion, can they simply preserve billing you whereas they’re apparently not even enjoying ball along with your insurance coverage? And: Do we’ve any authorized weapons to combat again with?
We requested a bunch of authorized specialists, and so they just about all stated: Yes, they in all probability can try this, and no, we in all probability don’t have any straightforward authorized weapons we are able to combat with. But then I talked with Berneta Haynes. She’s a senior lawyer with the National Consumer Law Center.
And she had some sensible ideas which can be super-worth sharing. She used to work for a nonprofit known as Georgia Watch — that’s a state-level client safety group. They operated a hotline folks may name for assist.
Berneta Haynes: Consumers and sufferers would name us with all types of hospital billing points and medical debt points. And we’ve had these sorts of bizarre questions the place actually, there wasn’t a specific lever on the authorized stage to truly assist them. But in the event that they really feel like they’re experiencing what could possibly be thought of doubtlessly an unfair enterprise follow, it’s completely inside their proper to file a criticism inside their state A. G.’s workplace.
Dan: The A.G. The state lawyer normal. Whoever’s doing you flawed, you’ll be able to file a criticism.
Berneta: Whether or not there’s any actual hook that your AG may use to carry them accountable is at all times a query that’s up within the air. But even simply the act of submitting a criticism could be very more likely to get that entity, that firm, to behave accurately.
Dan: Basically, go up the chain. Whether to a authorities watchdog, or within the group that’s bugging you. We’ve heard this earlier than, however I liked the specifics that Berneta Haynes shared with me about her personal experiences.
Berneta: I’ll inform you, one of many mechanisms my husband and I’ve needed to make the most of repeatedly, not in a hospital context, however in varied different service contexts is to succeed in out or threaten to succeed in out to the CEO or president. And it will get outcomes each time. It will get outcomes each time!
Dan: Oh, and right here’s the professional tip.
Berneta: My husband has repeatedly, when he’s needed to do it, arrange a LinkedIn premium account simply to seek out the CEO and message them straight.
Dan: Ooh, that’s good!
Berneta: That has been the best way we’ve gotten decision on all types of points associated to insurance coverage firms not eager to do proper by us. And so forth.
Dan: So that was enjoyable. Now, I do need to speak a bit of bit about what Caitlyn did, and what allowed her to do it. Caitlyn figures she made at the least a dozen cellphone calls. And she says she’s fortunate — privileged — to have a job the place she may try this. Here’s the very first thing she says she did as soon as she obtained over that panic assault when the invoice arrived.
Caitlyn: I simply went to my boss’s workplace and I stated, I’m going to should make some cellphone calls. There’s an issue with my hospital invoice. She’s like, don’t fear about it. Do what you must.
Dan: And she had folks in her nook, just like the good friend who’s a healthcare lawyer. And authorized recommendation wasn’t the massive factor that good friend gave Caitlyn.
Caitlyn: Most of the time I used to be simply venting to her, and she or he was like,‘you need to keep pushing, like, keep going at them. Don’t allow them to win. Don’t roll over. Just preserve pushing. They needs to be paying.’
Dan: And at that time, I informed Caitlyn, she and her story have been actually reminding me of somebody.
Dan: There’s a reporter named Marshall Allen. He labored for ProfessionalPublica for a very long time. He wrote on healthcare, and he wrote on stuff like this. And finally he wrote a e book, giving recommendation to folks. And the title of the e book was, Never Pay the First Bill.
Caitlyn: Oh!
Dan: And I informed Caitlyn, Marshall was on my thoughts on the time as a result of when Caitlyn and I talked in May, Marshall had simply died, like lower than two weeks earlier than. And he was younger — 52. He had three youngsters.
Caitlyn: So unhappy.
Dan: Super, tremendous, tremendous unhappy.
Dan: And in fact the title of Marshall’s e book — Never Pay the First Bill — that’s precisely how Caitlyn performed issues. She wasn’t going to consider paying something till she obtained her questions answered. And it’s value remembering.
When we have been speaking with authorized specialists, one factor a couple of of them stated was: If you pay one thing that insurance coverage was presupposed to cowl, after which insurance coverage comes via, you’re presupposed to get a refund. But who needs to chase that?
Yeah. Don’t pay that first invoice till you’ve made certain that is cash you actually owe. So, this looks like a great time to memorialize Marshall Allen a bit of bit. He favored to check the healthcare system to a schoolyard bully. Here’s what he informed me when he was on this present in 2021 when his e book had simply come out.
Marshall Allen: What I feel we have to do is stand as much as the bully. We have to cease being afraid. We have to cease considering another person goes to stay up for us. And I wrote the e book to equip and empower folks to face as much as the bullies.
And I feel it’s tremendously empowering, but it surely’s arduous, and standing as much as a bully takes unimaginable braveness. It takes fortitude. It takes persistence. You may get beat up within the course of. There’s no assure of victory. It’s dangerous, proper? But if we don’t strive, we don’t have an opportunity.
Dan: Marshall was a Christian minister earlier than he grew to become a reporter. He wrote a considerate essay about how his work as an investigative reporter match together with his religion. The gist was: The Bible is fairly clear that dishonest folks and exploiting them is flawed.
And to me, it looks like there was a component of ministry– not simply evangelism — to what he did after his e book got here out. Here’s what he informed me in 2021:
Marshall: I’ve began taking calls, and I’m responding to emails that I get from folks and I’m saying,‘call me, let’s speak it via, let me assist you with this. Let’s work via this collectively.’ And now I’m serving to folks work via their payments, work via these conditions the place they’re being cheated. It’s tremendous satisfying and gratifying, so it’s my new passion.
Dan: He saved at it. He left ProfessionalPublica and took a job with the Office of the Inspector General on the federal division of Health and Human Services. And he revealed a publication — it was free, however he inspired folks to pay if they might, and he used the cash to rent medical-bill advocates to assist folks with particularly difficult instances.
And Marshall was humorous. I need to shut out this episode with a narrative he informed me the primary time we talked, in 2019. It’s form of an origin story.
Marshall: So after I was 16 years outdated, um, I labored for this dinner theater in Golden, Colorado, the place I grew up. One day I present up for work, and so they’ve closed down the enterprise. They owed me like three weeks of pay.
The man had closed the place with out paying us and stated,‘there’s no cash. We shut down the enterprise. We can’t afford to pay you. You’re out of luck.’ Well, we have been all fairly indignant about that. We have been actually indignant as a result of they’d opened a sister dinner theater beneath the identical firm umbrella throughout city. And all of us knew that. And we have been like, effectively, in the event you can afford to maintain your different place open, you’ll be able to afford to pay us. And they stated,‘sorry, kids, you’re out of luck.’
Dan: Marshall goes residence, tells his mother what’s happening.
Marshall: And my mother tells me it’s best to sue him. I’m like, mother, what do you imply? I can barely drive. How can I sue the man? She goes,‘you should take him to small claims court.’ So lo and behold, I am going down, I fill out the paperwork.
It’s a couple of paragraphs. It’s straightforward to fill out the paperwork in small claims court docket. I fill out the paperwork and switch in like 10 bucks on the time or no matter it prices. It’s not that costly to file one in every of these instances. And I get a discover within the mail like six weeks later. And I’ve a court docket date, and I’m like equipped for this large Perry Mason second.
Dan: Perry Mason was a lawyer on this tremendous outdated TV present — courtroom drama. But this wasn’t a courtroom.
Marshall: It’s extra like a convention room and there’s some administrative listening to choose in there. And lo and behold, the proprietor of the corporate and his lawyer needed to present up in court docket there with me.
And I believed we’d have an enormous argument all the executive choose did is he learn my few paragraphs on the little factor I’d written up and he seems over on the proprietor and he goes,‘is what this kid saying true?’And the proprietor’s like, ‘well, yeah.’ And the choose is like,‘give this kid his money.’ And I used to be like, This is superb. You know what? Maybe the court docket system does really work now and again possibly now and again the little man can win.
Dan: Marshall and I each stayed interested by how folks can use the authorized system to get our rights. I realized lots from Marshall, and like lots of people, I simply liked his spirit. Marshall Allen, thanks. And right here’s the tip of my dialog with Caitlyn.
Dan: Marshall Allen would have been extraordinarily pleased with you.
Caitlyn: Yeah.
Dan: Caitlyn has the ultimate phrase right here.
Caitlyn: I obtained to the purpose the place I used to be like, it’s my combat. I’ve obtained gasoline within the fireplace. I’m, I’m going for it.
Dan: We’ll be again with a brand new episode in a couple of weeks. Till then, handle your self.
This episode of An Arm and a Leg was produced by me, Dan Weissmann, with assist from Emily Pisacreta and Claire Davenport — and edited by Ellen Weiss.
KFF senior contributing editor Elisabeth Rosenthal reported Caitlyn’s story for KFF and NPR. She was editor in chief there when she invited me to collaborate with KFF to make this present’s second season, and we’ve been colleagues ever since. I’ve by no means felt so fortunate or so grateful.
Special because of Christopher Robertson at Boston University’s School of Law, Wendy Epstein of the College of Law at DePaul University, Sabrina Corlette at Georgetown University’s Center on Health Insurance Reforms, and Elisabeth Benjamin from the Community Service Society of New York for pitching in with authorized experience right here.
Adam Raymonda is our audio wizard. Our music is by Dave Weiner and Blue Dot Sessions. Gabrielle Healy is our managing editor for viewers. Bea Bosco is our consulting director of operations. Sarah Ballama is our operations supervisor.
An Arm and a Leg is produced in partnership with KFF Health News. That’s a nationwide newsroom producing in-depth journalism about healthcare in America and a core program at KFF, an impartial supply of well being coverage analysis, polling, and journalism.
Zach Dyer is senior audio producer at KFF Health News. He’s editorial liaison to this present. And because of the Institute for Nonprofit News for serving as our fiscal sponsor. They permit us to just accept tax-exempt donations. You can study extra about INN at INN.org. Finally, thanks to all people who helps this present financially. You can take part any time at https://armandalegshow.com/support/. Thank you a lot for pitching in in the event you can — and, thanks for listening.
“An Arm and a Leg” is a co-production of KFF Health News and Public Road Productions.
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