Business News <\/p>\n
Note: \u201cAn Arm and a Leg\u201d uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.<\/em><\/p>\n Hey there\u2013<\/strong><\/p>\n I have to start with a big THANK YOU to everybody who supports this show. It\u2019s January, we wrapped up our big fund-raising campaign at New Year\u2019s, and more than <\/strong>six hundred of you came through for us. We hit all our targets, including our stretch goal. It\u2019s huge.<\/strong><\/p>\n I\u2019ll have a LOT of people to thank at the end of this episode, and I want to think about how to celebrate. Thanks to you, this year is off to an amazing start.<\/strong><\/p>\n And for this first episode of 2023, I\u2019m going back to a story we first put out more than three years ago, in 2019.<\/strong><\/p>\n Because: this story changed my whole conception of what this show can aim to do.<\/strong><\/p>\n When I meet people today and tell them about An Arm and a Leg fo<\/strong>r the first time, this is the story I tell them about.<\/strong><\/p>\n Because this is a story about legal rights I never suspected we had\u2013 and how we can sometimes use them to fight back.<\/strong><\/p>\n I learned a lot of other stuff while reporting this story \u2014 about surprise bills, and the role of private equity. It was early days for the show.<\/strong><\/p>\n We\u2019re leaving out those parts out this time\u2013 we\u2019ve gone deeper on them in other episodes, and some of the underlying facts have changed.<\/strong><\/p>\n Some things have gone out of date in good ways, thanks to the federal No Surprises Act, which took effect last year.<\/strong><\/p>\n But the part about fighting back? Standing up for our legal rights? That holds up. And it\u2019s ready for some follow-up.<\/strong><\/p>\n OK, here it is:<\/strong><\/p>\n Dan:<\/strong> Miriam visited a fertility clinic a couple years ago in Washington and DC where she lives, and she got some tests done. She was lucky. Her insurance actually covered fertility stuff, so she got the bill and her share was like 30 bucks. She paid it. Then this other envelope arrives from someplace she never heard of.<\/p>\n Not the fertility clinic or anyplace else she\u2019s ever been, and it\u2019s hot pink. She thinks it looks fake. It says it\u2019s a bill and they want 35 bucks for some lab work<\/p>\n and perhaps unwisely, Miriam ignores it.<\/p>\n Okay. Uh, definitely unwisely and there are a couple of follow ups also in hot pink envelopes. And on the one hand, Miriam looks more closely and they are connected to her visit to the fertility clinic on the other. The follow ups say this other thing. They say, Hey, pay up now, or This thing\u2019s going up, way up, up to about 1300 bucks from 35, which<\/p>\n Miriam:<\/strong> was so outrageous that I thought, this is definitely bullshit.<\/p>\n Bullshit. . Sorry, can I say that?<\/p>\n Dan:<\/strong> Yes, absolutely. Yeah. So Miriam does a dumb thing and ignores it and a follow up, and then in September she gets a note from a collections agency. They want that $1,300. And can they freaking do that? Can some lab send you a bill for 35 bucks outta nowhere and then be like, Hey, better pay now while we\u2019re in a good mood.<\/p>\n Otherwise it\u2019s gonna be $1,300. Is that even legal?<\/p>\n This is An Arm and a Leg, a show about why health care costs so freaking much, and what we can maybe do about it. I\u2019m Dan Weissmann. I\u2019m a reporter, and I like a challenge. So our job on this show is to take one of the most enraging, terrifying, depressing parts of American life, and bring you something entertaining, empowering and useful.<\/strong><\/p>\n And what\u2019s more useful than knowing what our rights are?<\/strong><\/p>\n Because as consumers. No idea. I mean, I get a bill from the electric company. Well, for one thing, it\u2019s not a surprise. I\u2019ve been running the lights and it\u2019s the same rates as last month, and everybody\u2019s paying basically the same rates as me, like whatever I owe this, but a hot pink envelope from some ancillary lab.<\/p>\n And then a follow-up saying they\u2019re gonna take you for 1300, you\u2019d. Well, maybe they can freaking do that.<\/p>\n I mean, how would you even know? Who would you even ask? Well, now you can ask me and I\u2019ll go find out. This whole thing happened to Miriam a couple years ago. She ended up settling with the collections agency for like $217, which was a sixth of what they were asking for, but it was also six times that original $35 charge.<\/p>\n It still bugs her. Like was that even legal? What happened there? It is so messed up. So she wrote to me and I was. I really want to figure this out.<\/p>\n \u00a0When I talked to Miriam, she actually had a theory about what I might find.<\/strong><\/p>\n Miriam:<\/strong> It might just be illegal to have such a, a big jump from, um, what the original copay was to what it ended up being after I was late.<\/p>\n Dan:<\/strong> <\/strong>Yeah! I was off\u2013 ready to test that theory out.<\/strong><\/p>\n So, I made some calls. And I FOUND OUT SOME STUFF.<\/strong><\/p>\n It took a minute. I started out calling national legal experts and policy nerds, and they were like, \u201cI don\u2019t really know. The law is complicated, it varies from state to state, blah blah blah\u201d<\/strong><\/p>\n So then I started calling folks who help consumers challenge wild medical bills \u2014 like, for a fee, that\u2019s how they make a living. One of them was Braden Pan, his company\u2019s called Resolve Medical bills.<\/strong><\/p>\n \u00a0I described Miriam\u2019s story to him, the pink envelo<\/strong>pe, the fine print that was like\u2026.<\/strong><\/p>\n \u2026is for a charge of $1,287 for which you get a great discount and will take $35 from you if you pay by date.<\/p>\n Wow. . Okay.<\/p>\n It\u2019s like he was kind of impressed by how brazen this was.<\/strong><\/p>\n And even though he didn\u2019t know the answer, he had some smart thoughts about what questions to start asking.<\/strong><\/p>\n Braeden Pan:<\/strong> I\u2019m gonna tell you right now that I\u2019m not a lawyer. Yeah. Um, now I can tell you that the, the idea of what hospitals or clinics can charge for services that hasn\u2019t been settled.<\/p>\n Dan:<\/strong> In other words, he thought you\u2019d need a lawyer if you wanted to fight it, and you don\u2019t know how it\u2019s gonna come out.<\/p>\n Braeden Pan:<\/strong> What might actually be going on with this company is they know this, they know that there\u2019s confusion out there about this, uh, that you need a lawyer to actually figure it out, whether or. Someone can can do this and for a thousand bucks it\u2019s not worth it to hire a lawyer to tell you because they\u2019re gonna charge you 1200 bucks just to tell you whether or not they can do this<\/p>\n Dan:<\/strong> Right, right.<\/p>\n So himself, Braden Pan wasn\u2019t so sure they were good answers here, but he pointed me to a couple of other people and they actually had some very hopeful answers. Some serious self-defense tools. You might wanna grab a pen. We\u2019ll have that right after.<\/p>\n This season of an Arm and a Leg is a co-production of Public Road Productions and Kaiser Health News.<\/p>\n That\u2019s a nonprofit newsroom that covers healthcare in America. Kaiser Health News is not affiliated with the giant healthcare provider, Kaiser Permanente. We\u2019ll have a little more on Kaiser Health News at the end of this episode.<\/p>\n Sir, here\u2019s where we meet the folks who are going to give us our big strong weapons for fighting off totally unreasonable bills.<\/strong><\/p>\n Lisa Berry Blackstock:<\/strong> My name is Lisa Berry Blackstock, and I have been a patient advocate since 1990.<\/p>\n Dan:<\/strong> That\u2019s like almost 30 years. And I asked her, is there anything you can do in a situation like this when you\u2019re getting hit up for 1300 bucks for some stupid lab test? And she was like, well, You could take \u2019em to small claims court and you don\u2019t have to be a lawyer to do that.<\/p>\n I was like, wait, you\u2019ve done this?<\/p>\n Lisa Berry Blackstock:<\/strong> Oh, I, I\u2019ve lost count. I can\u2019t tell you how many times I\u2019ve done it and in how many different, uh, counties.<\/p>\n Dan:<\/strong> Huh? So it works.<\/p>\n Lisa Berry Blackstock:<\/strong> Oh, it works. It\u2019s worked for me.<\/p>\n Dan:<\/strong> She says it works every single time. And here\u2019s something I learned in this conversation that I absolutely had not known.<\/p>\n When you go to court, it does not have to be to make somebody else give you. You can go to court and say, judge, this lab says I owe them 1300 bucks, but I have researched it and 35 bucks is fair. I\u2019m offering them 35. Would you please order them to take 35?<\/p>\n It takes a plan to do this and it takes work.<\/p>\n Lisa Berry Blackstock:<\/strong> You have to demonstrate in writing that you have made a good faith effort to resolve this to your best ability and that you\u2019ve been unable to, and that\u2019s why you\u2019re asking the court to intervene.<\/p>\n Dan:<\/strong> And so you\u2019re asking the court basically to approve. A settlement offer that you\u2019re making. Correct?<\/p>\n Lisa Berry Blackstock:<\/strong> Correct.<\/p>\n Dan:<\/strong> That\u2019s what Lisa Berry Blackstock says she does. There\u2019s some serious homework involved. If you grabbed a pen earlier, here\u2019s where you start taking notes first. Lisa says, you call whoever\u2019s sending the bill and make them give you the billing codes for everything on the bill.<\/p>\n itemized. Each one has a five digit code called a C P T Code, C P T. And honestly, this sounds like it could be the hardest part. You gotta get them to cough up this information. You have a right to it, but getting it, once you\u2019ve got that, you figure out what a fair price is in your area, and there are a couple of websites that actually can help you do this.<\/p>\n Lisa uses one from a group called Fair Health. The site is fair health consumer.org. You put in your zip code and that five digit medical billing code, they will tell you what the going rates are in your area.<\/p>\n And that\u2019s my basis of my offer. It\u2019s fair I, I mean, I have independently verified information.<\/p>\n Lisa Berry Blackstock:<\/strong> It\u2019s not a number that I\u2019ve made up and it\u2019s not like you\u2019re trying to rip people off .<\/p>\n Dan:<\/strong> Then you write to whoever\u2019s billing, you use certified mail. So you get a signed receipt, you can prove they got it, and you say, here\u2019s what I\u2019m offering. Here is how I determine this number. I want to hear from you by date X, that you will accept it.<\/p>\n Otherwise<\/p>\n Lisa Berry Blackstock:<\/strong> I will be filing in small claims, you know, against you, and you can expect to receive a notice.<\/p>\n Dan:<\/strong> And you\u2019re saying generally if they get that, they\u2019ll be like, okay, I\u2019ll take it. Is that right?<\/p>\n Lisa Berry Blackstock:<\/strong> Yes. I mean, general, they, they look, they don\u2019t understand anything with billing other than raking people over the coals because that\u2019s what. is generally allowed across the country.<\/p>\n Dan:<\/strong> She says a lot of the time just sending the letter is enough, but sometimes she actually has to file Now, once I\u2019ve filed Yeah. And they\u2019ve been served. Yeah. Oh, then they\u2019re, they\u2019re falling all over themselves to make it go away. Because look, they\u2019re used to sitting in an office sending out pieces of paper saying, send us 1300 bucks, or We\u2019ll ruin your.<\/p>\n and getting 1300 bucks, or maybe getting a phone call and allowing themselves to be talked down to 200 without leaving their desk, they gotta send somebody to court. That person who would go to court could make more money by just accepting this offer and moving on to the next sucker,<\/p>\n Especially because, according to Lisa Berry Blackstock, they\u2019d probably lose in court anyway.<\/strong><\/p>\n Now, this was cool, but I didn\u2019t just wanna take one person\u2019s word for it. I found somebody else who had actually tried this thing. Somebody with a pretty good credential.<\/p>\n Christopher Robertson:<\/strong> My name\u2019s Christopher Robertson. I\u2019m a professor and associate dean at the James E. Rogers College of Law<\/p>\n Dan:<\/strong> That was his job when we talked in 2019. Now he\u2019s a professor and associate Dean at the Boston University School of Law.<\/strong><\/strong><\/p>\n Anyway, I asked him, you can make these people accept a fair offer, and he\u2019s like,<\/strong><\/p>\n Christopher Robertson:<\/strong> Yeah. Duh. You know, basic contract law, you know, the stuff we teach to first year law students every day purports to just make this a non-pro. Of course you don\u2019t have to pay a number that the other side just invented, um, , you know, this is, this is shooting fish in a barrel from a, from a contract law perspective.<\/p>\n Dan:<\/strong> Whoa, baby. The deal is you see a doc anywhere. You sign something in the business, they call it consent to treat. It says, yeah, examine me, poke, prod, whatever, and it says, I\u2019m gonna give you my insurance info and whatever the insurance doesn\u2019t pay, I\u2019ll pay. The thing I\u2019m signing doesn\u2019t say how much I\u2019ll pay because nobody knows exactly what\u2019s gonna happen at the doctor\u2019s office or the er, wherever.<\/p>\n Anyway. I got a stomach ache. Maybe I ate something weird. Maybe I have an ulcer. So Robertson says, what I\u2019m signing is what lawyers call an open price contract. You know, normally a<\/p>\n Christopher Robertson:<\/strong> contract has a price in it, right? So if you want to go buy a car, your contract to buy the car has a price that\u2019s true of a washing machine or a, or a house.<\/p>\n But when there is no price in the contract, it\u2019s called an open price contract.<\/p>\n Dan:<\/strong>\u00a0 The courts do not treat an open price contract as a blank check.<\/p>\n Christopher Robertson:<\/strong> If the court is gonna be called upon to enforce the contract to force someone to pay something, then the court has to figure out, well, what, what amount should I force them to pay?<\/p>\n It can\u2019t be just what one side says later.<\/p>\n Dan:<\/strong> In other words, courts would. An open price contract like your agreement with a medical provider does not mean the other side just gets to bill you for whatever they want, and Miriam\u2019s case is special. It\u2019s got this other wrinkle, which is basically the lab said the price was 35 bucks, but if you\u2019re late, it\u2019s 1300.<\/p>\n That\u2019s why I was so interested in this case. And Robertson says, Miriam has the law on her side there too. He says, this involves something else. They teach first year law students<\/p>\n Christopher Robertson:<\/strong> literally on the very first day of contract law<\/p>\n Dan:<\/strong> When you breach a contract, courts don\u2019t treat that like a blank check either, and a late fee, it\u2019s like a penalty for breaching a contract. The contract says you pay on date X. Miriam breached her contract by not paying on time. But Chris Robertson says there\u2019s a limit to what that penalty can be, and it\u2019s gotta have some relationship to what the breach actually cost. The. .<\/p>\n Christopher Robertson:<\/strong> So that\u2019s a second reason. This strategy is completely legally frivolous to take a $35 charge and convert it into a thousand dollars plus.<\/p>\n Right. So yeah, they didn\u2019t get their $35 check in June when they wanted it. They might get it in July. Well, that doesn\u2019t cost them a thousand dollars. So the penalty can\u2019t be a thousand dollars . Even if they don\u2019t get it, it\u2019s now September and they haven\u2019t gotten it. It\u2019s still not costing him a thousand dollars.<\/p>\n Christopher Robertson: <\/strong>Exactly.<\/p>\n Dan:<\/strong> So he\u2019s like, yeah, line it up. Small claims court, that sort of thing can work. I can barely believe it\u2019s this easy.<\/p>\n I\u2019m like, wait, why don\u2019t we do this more often??<\/strong><\/p>\n Christopher Robertson:<\/strong> I mean, frankly, we shouldn\u2019t have to. We need a systematic solution to this. Uh, you know, we are all have day jobs, you know.<\/p>\n Frankly, a lot of people who are dealing with medical bills surprise, surprise, are sick, right? Yeah. Um, so , they\u2019re busy trying to get well, uh, you know, they\u2019re trying to fight their own battles and so, you know, waging their own legal battle is, is, is a huge distraction and requires a level of attention to detail that not everyone has or should be expected to have.<\/p>\n So that\u2019s why I really need more systematic solutions.<\/p>\n Dan:<\/strong> So Miriam might have had some options, but small claims court, it\u2019s not exactly a blanket solution, especially cuz there\u2019s also the problem of scale. I mean, it\u2019s one thing if you\u2019ve got a lab hawking you for a thousand bucks. What if you\u2019ve got a whole system of hospitals trying to rake untold numbers of patients over the coals for crazy amounts? Then you\u2019re not in small claims court anymore. Christopher Robertson has been there, like he\u2019s gotten involved in lawsuits trying to stop hospitals from doing that sort of thing, and he. It is not pretty.<\/p>\n Christopher Robertson:<\/strong> It\u2019s, it\u2019s the utter, utter breakdown of law. I mean, when we tried to challenge these practices by hospitals, um, we bumped up into courts insisting that for every single charge, we affirmatively prove that the amount they made up is unreasonable. But proving that. Requires, you know, experts and accounting and economics, you could spend tens of thousands of dollars litigating every single one of these thousand dollars charges. And so that\u2019s why you really do need either class action or a more affirmative, you know, regulatory system to police this, this bad behavior.<\/p>\n Dan:<\/strong>But in an individual situation like Miriam\u2019s, where she\u2019s actually healthy, she\u2019s only got one charge to fight off. You can fight back. Get your evidence together, find out the itemized billing codes, and use a website like Fair health consumer.org to figure out what a reasonable price would be. Make an offer, put it in writing. Send it certified mail. Give \u2019em a deadline to accept your offer or else tell \u2019em you\u2019ll file in small claims court. . And if that doesn\u2019t make \u2019em play ball, actually do it. I ran all this down from Miriam and she was like,<\/p>\n Miriam:<\/strong> I wish I had known. That\u2019s my main thing. I wish I had known that I had these other options. I would\u2019ve totally gotten a letter, like if, even if I needed to notarize a letter, get it sent certified mail. I I\u2019m gonna take you to a small claims court. Okay. Maybe I\u2019ll, I\u2019ll give you 50 bucks. That\u2019s my, that\u2019s my offer. Yeah. I wish I had done that.<\/p>\n Dan:<\/strong> YEP! That\u2019s where we left things, a little more than three years ago.<\/strong><\/p>\n I mean, we\u2019ve followed up a little here and there:<\/strong><\/p>\n We talked with a guy named Jeffrey Fox, who has made it\u2026 kind of a hobby to use small claims courts to stand up for his rights. So when UCLA overbilled him, he was ready.<\/strong><\/p>\n I mean, maybe we could all use a little of his readiness to fight. Here\u2019s how he describes conversations with their billing department.<\/strong><\/p>\n Jeffrey Fox:<\/strong> One thing they always do is they always try to make it seem like their policies apply to you. They\u2019re like, well, no, our policy is blah, blah, blah. I\u2019m like, I don\u2019t care. Contract law, the concepts of contract law and what I actually owe you, what a court would say, I owe you is what applies. I remember saying, okay. Well, my policy is you pay me a hundred dollars every time you say something stupid. So does that apply to you? If it does you only about 400 bucks already. Wanna keep going?<\/p>\n Dan:<\/strong> Jeffrey didn\u2019t get paid on that improvised policy of his\u2026 but he did get a judge to make UCLA give him a refund of more than two thousand dollars. That episode was called David vs Goliath, and we\u2019ll include a link to it wherever you\u2019re listening.<\/strong><\/p>\n So we\u2019ve come back to this approach to fighting back. But I\u2019ve been starting to think we haven\u2019t come back to it nearly enough.<\/strong><\/p>\n Especially since I got a note from a listener named Lauren with the heading: \u201cI sued a hospital in small claims court and lost\u201d<\/strong><\/p>\n \u2026 which ended, \u201cI feel like I won.\u201d She wrote, \u201cthe hospital spent <\/strong>way more money on lawyer\u2019s fees than the total amount of my bill.\u201d They sent three lawyers to a preliminary hearing \u2014 and her bill wasn\u2019t even that high.<\/strong><\/p>\n We talked \u2014 <\/strong>we\u2019ll have lots of details in our next episode \u2014 about what she had learned, and how she wanted to spread it around.<\/strong><\/p>\n Lauren:<\/strong> I walked out of that thinking , do I , like, just put together a list of tips and leave it on people\u2019s windshields that are parked outside of the er. how do I help other people do this?<\/p>\n If everybody that they screw stands up, they can\u2019t afford to pay a lawyer to defend against all of those.<\/p>\n Dan:<\/strong> I mean, it\u2019s an INTERESTING idea. Not for everybody. But maybe a few more people than have tried it so far\u2026<\/strong><\/p>\n We<\/strong>\u2019ll pick up that idea next time.<\/strong><\/p>\n Till then, take care of yourself.<\/strong><\/p>\n This episode of An Arm and a Leg was produced by me, Dan Weissmann, with help from Emily Pisacreta. Ann Heppermann edited the original story.\u00a0<\/p>\n Marian Wang edited this version\u2013 and it looks like Marian\u2019s parental leave from this show, coming up any minute now, will be permanent.\u00a0<\/p>\n Marian, I cannot believe how much I am going to miss working with you. It has been such an honor and such a joy.<\/p>\n Daisy Rosario is our consulting managing producer. Adam Raymonda is our audio wizard.\u00a0 Our music is by Dave Winer and Blue Dot Sessions.<\/p>\n Gabrielle Healy is our managing editor for audience. She edits the First Aid Kit Newsletter.<\/p>\n Bea Bosco is our consulting director of operations. Sarah Ballema is our operations manager.<\/p>\n This season of an arm and a leg is a co production with Kaiser health news. That\u2019s a nonprofit news service about healthcare in America, an editorially-independent program of the Kaiser family foundation.<\/p>\n KHN is not affiliated with Kaiser Permanente, the big healthcare outfit. They share an ancestor: The 20th century industrialist Henry J Kaiser. When he died, he left half his money to the foundation that later created Kaiser health news.<\/p>\n You can learn more about him and Kaiser health news at arm and a leg show dot com slash Kaiser.<\/p>\n Zach Dyer is senior audio producer and Tarena Lofton is audience engagement producer at KHN\u2013 they are editorial liaisons to this show.<\/p>\n Thanks to Public Narrative \u2014 That\u2019s a Chicago-based group that helps journalists and non-profits tell better stories\u2013 for serving as our fiscal sponsor, allowing us to accept tax-exempt donations. You can learn more about Public Narrative at www dot public narrative dot org.<\/p>\n And thanks to everybody who supports this show financially.<\/p>\n<\/p><\/div>\n