Several listeners sent us an article with the headline Make your health insurance cry, about a new AI tool to fight health insurance. We had to learn more. 

Meet Holden Karau: a Bay Area software engineer who says she’s “trying to make health insurance suck a little bit less.”

So she’s created an AI tool to appeal insurance denials.

Her project, Fight Health Insurance, is a labor of love (she’s not earning money from it) and fueled by hatred (of insurance companies). 

It draws on her tech expertise and on her years of experience fighting health insurance: for gender-affirming care, for rehab after getting hit by a car, and even for her dog, Professor Timbit. 

We talked with Holden about what it took to build the tool, how it works, and what she hopes comes next.

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. This month, every dollar you give gets matched dollar-for-dollar, by NewsMatch, from the Institute for Nonprofit News.

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Something different: We talk with journalist Cara Anthony about topics that don’t always come up in conversations about the cost of health care. 

For the last four years, she’s been reporting on the public health effects of racism, violence, and intergenerational trauma in a small Missouri town.. The result: A new documentary and podcast series called Silence in Sikeston.   

She sat down with us to talk about the value of breaking silences and the possibility for healing. 

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.

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We're sharing an episode of “To See Each Other,” about a question that’s SUPER-relevant to this show:  How do we pay for long-term care, like nursing homes?  

To See Each Other aims to complicate the narrative about small-town Americans. In this new season, host George Goehl heads to Lincoln County, Wisconsin — population, 28,000-and-some. And home to a publicly-run nursing home with a 5-star quality rating from the feds.  

A conservative county board plans to sell the home to a private operator, but senior citizens aren’t having it. They show up to board meetings, march in the Labor Day parade, and fight with… their last breath.

George goes deep into questions of aging in America, public versus private versions of long-term care, and the nuts and bolts of organizing. The show aims to put you in a fighting mood, and to think differently about aging.

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An $88 “observation room” fee for a check-up didn’t sit right with Kari Greene, a listener from Oregon. When the price went up to $99 the next year, Kari complained to her benefits rep; they thought it was weird, too — but couldn’t do anything about it. 

In states like Connecticut and Indiana, legislators are trying to do something about fees like these – often called “facility fees.” 

In this episode, we go deep on Kari’s bill, one of dozens that listeners have shared with us over the past few months. 

And we talk with Christine Monahan, a researcher and attorney who knows more about facility fees — and state efforts to limit them — than any other expert in the country.

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.

Hosted on Acast. See acast.com/privacy for more information.

What happens when a hospital gets hit by a ransomware attack? We’re sharing an episode from a podcast called Click Here that takes us inside the aftermath of a cyber attack on a rural hospital in Oregon.  

The story starts the minute the hospital’s IT director finds out they’ve been hacked, and follows him and his colleagues as they scramble to keep the place running while they try to get it back online. 

It’s a fascinating adventure, and it gives us a window into the growing problem of cyberattacks in health care – why places like hospitals have become such a major target for cyber-criminals and how the industry is dealing with it. 

Click Here is a bi-weekly tech news podcast from Recorded Future News, hosted by Dina Temple-Raston. 

We’ll be back with more episodes of An Arm and a Leg in a few weeks.

Send your stories and questions. Or call 724 ARM-N-LEG.

Of course we’d love for you to support this show.

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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.

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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.

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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.

Hosted on Acast. See acast.com/privacy for more information.

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.

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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.

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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.

Hosted on Acast. See acast.com/privacy for more information.