Can They Freaking Do That?!? (2023 Update)

The “An Arm and a Leg” podcast is again. This season, host Dan Weissmann will inform tales about sufferers discovering inventive methods to battle again towards outrageous payments. 

This primary episode of Season 9 updates a narrative from 2019 a few listener who acquired 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 straight away.

This leap in value left her questioning: Can they freaking try this?!?

The reply: They will attempt. And so they typically get away with it. 

But when sufferers have the time and moxie, they will suggest a good value and even take suppliers to courtroom to power them to just accept the counter supply.

The original version of this story lined a few subjects the present has explored: Shock payments (for which new legal protections were enacted in 2022) and the way private equity has been expanding into health care and the way some doctors are trying to fight back.  

Word: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can comprise errors. Please use the transcript as a instrument however examine the corresponding audio earlier than quoting the podcast.

Hey there–

I’ve to begin with an enormous THANK YOU to all people who helps this present. It’s January, we wrapped up our large fund-raising marketing campaign at New Yr’s, and greater than 600 of you got here by way of for us. We hit all our targets, together with our stretch aim. It’s big.

I’ll have a LOT of individuals to thank on the finish of this episode, and I wish to take into consideration the right way to have a good time. Because of 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 complete conception of what this present can goal to do.

Once I meet folks as we speak 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 generally use them to battle again.

I discovered plenty of different stuff whereas reporting this story — about shock payments, and the function of personal fairness. It was early days for the present.

We’re leaving out these components 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, because of 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 acquired some assessments performed. She was fortunate. Her insurance coverage really lined fertility stuff, so she acquired 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 scorching pink. She thinks it seems faux. It says it’s a invoice they usually need 35 bucks for some lab work

and maybe unwisely, Miriam ignores it.

Okay. Uh, positively unwisely and there are a few observe ups additionally in scorching pink envelopes. And on the one hand, Miriam seems extra carefully and they’re related to her go to to the fertility clinic on the opposite. The observe ups say this different factor. They are saying, 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 assumed, 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 observe up, after which in September she will get a notice from a collections company. They need that $1,300. And may they freaking try 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 a superb 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 components of American life, and convey you one thing entertaining, empowering and helpful.

And what’s extra helpful than figuring out 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 working the lights and it’s the identical charges as final month, and all people’s paying mainly the identical charges as me, like no matter I owe this, however a scorching 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 try this.

I imply, how would you even know? Who would you even ask? Properly, now you possibly can ask me and I’ll go discover out. This complete 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 authentic $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 wish to determine this out.

 Once I talked to Miriam, she really had a idea about what I would discover.

Miriam: It’d simply be unlawful to have such a, an enormous leap 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 specialists and coverage nerds, they usually had been like, “I don’t actually know. The regulation is sophisticated, it varies from state to state, blah blah blah”

So then I began calling of us who assist customers problem wild medical payments — like, for a price, that’s how they make a residing. Certainly one of them was Braden Pan, his firm’s referred to as Resolve Medical payments.

 I described Miriam’s story to him, the pink envelope, the high-quality print that was like….

…is for a cost of $1,287 for which you get an amazing low cost and can take $35 from you in the event you pay by date.

Wow. . Okay.

It’s like he was sort of impressed by how brazen this was.

And despite the fact that he didn’t know the reply, he had some good ideas about what questions to begin asking.

Braeden Pan: I’m gonna let you know proper now that I’m not a lawyer. Yeah. Um, now I can let you know that the, the concept of what hospitals or clinics can cost for companies that hasn’t been settled.

Dan: In different phrases, he thought you’d want a lawyer in the event you wished to battle it, and also you don’t know the way it’s gonna come out.

Braeden Pan: What may really be occurring with this firm is that they know this, they know that there’s confusion on the market about this, uh, that you just want a lawyer to truly 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 let you know as a result of they’re gonna cost you 1200 bucks simply to let you know 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 they usually really 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 Highway Productions and Kaiser Well being Information.

That’s a nonprofit newsroom that covers healthcare in America. Kaiser Well being Information is just not affiliated with the enormous healthcare supplier, Kaiser Permanente. We’ll have a bit of 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 present us our large sturdy weapons for combating off completely unreasonable payments.

Lisa Berry Blackstock: My title is Lisa Berry Blackstock, and I’ve been a affected person advocate since 1990.

Dan: That’s like virtually 30 years. And I requested her, is there something you are able to do in a state of affairs like this once you’re getting hit up for 1300 bucks for some silly lab check? And he or she was like, properly, You can take ’em to small claims courtroom and also you don’t must be a lawyer to try this.

I used to be like, wait, you’ve performed this?

Lisa Berry Blackstock: Oh, I, I’ve misplaced depend. I can’t let you know what number of instances I’ve performed it and in what number of completely 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 identified.

While you go to courtroom, it doesn’t must be to make someone else offer you. You may go to courtroom and say, choose, this lab says I owe them 1300 bucks, however I’ve researched it and 35 bucks is honest. 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: It’s important to display in writing that you’ve got made a superb religion effort to resolve this to your finest potential and that you just’ve been unable to, and that’s why you’re asking the courtroom to intervene.

Dan: And so that you’re asking the courtroom mainly to approve. A settlement supply that you just’re making. Right?

Lisa Berry Blackstock: Right.

Dan: That’s what Lisa Berry Blackstock says she does. There’s some severe homework concerned. In the event 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 all the things 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 might be the toughest half. You gotta get them to cough up this data. You’ve got a proper to it, however getting it, when you’ve acquired that, you determine what a good value is in your space, and there are a few web sites that really might help you do that.

Lisa makes use of one from a gaggle referred to as Truthful Well being. The location is honest well being You set in your zip code and that 5 digit medical billing code, they are going to let you know what the going charges are in your space.

And that’s my foundation of my supply. It’s honest 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 definitely write to whoever’s billing, you employ licensed mail. So that you get a signed receipt, you possibly can show they acquired it, and also you say, right here’s what I’m providing. Right here is how I decide this quantity. I wish 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 understand, towards you, and you’ll count on to obtain a discover.

Dan: And also you’re saying usually 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, basic, they, they appear, they don’t perceive something with billing apart from raking folks over the coals as a result of that’s what. is usually allowed throughout the nation.

Dan: She says plenty of the time simply sending the letter is sufficient, however generally she really 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 smash your.

and getting 1300 bucks, or possibly getting a telephone name and permitting themselves to be talked right down to 200 with out leaving their desk, they gotta ship someone to courtroom. That one who would go to courtroom might earn more money by simply accepting this supply and shifting on to the subsequent sucker,

Particularly as a result of, in accordance with Lisa Berry Blackstock, they’d most likely lose in courtroom anyway.

Now, this was cool, however I didn’t simply wanna take one individual’s phrase for it. I discovered someone else who had really tried this factor. Any individual with a fairly good credential.

Christopher Robertson: My title’s Christopher Robertson. I’m a professor and affiliate dean on the James E. Rogers Faculty of Regulation

Dan: That was his job after we talked in 2019. Now he’s a professor and affiliate Dean on the Boston College College of Regulation.

Anyway, I requested him, you can also make these folks settle for a good supply, and he’s like,

Christopher Robertson: Yeah. Duh. You recognize, fundamental contract regulation, you understand, the stuff we train to first yr regulation college students on daily basis purports to simply make this a non-pro. After all you don’t must pay a quantity that the opposite facet simply invented, um, , you understand, 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 wherever. You signal one thing within the enterprise, they name it consent to deal with. It says, yeah, study me, poke, prod, no matter, and it says, I’m gonna offer you my insurance coverage data 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 one is aware of precisely what’s gonna occur on the physician’s workplace or the er, wherever.

Anyway. I acquired a abdomen ache. Perhaps I ate one thing bizarre. Perhaps I’ve an ulcer. So Robertson says, what I’m signing is what attorneys 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 examine.

Christopher Robertson: If the courtroom is gonna be referred to as upon to implement the contract to power somebody to pay one thing, then the courtroom has to determine, properly, what, what quantity ought to I power them to pay?

It may possibly’t be simply what one facet says later.

Dan: In different phrases, courts would. An open value contract like your settlement with a medical supplier doesn’t imply the opposite facet simply will get to invoice you for no matter they need, and Miriam’s case is particular. It’s acquired this different wrinkle, which is mainly the lab stated the worth was 35 bucks, however in the event you’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 facet there too. He says, this includes one thing else. They train first yr regulation college students

Christopher Robertson: actually on the very first day of contract regulation

Dan: While you breach a contract, courts don’t deal with that like a clean examine both, and a late price, 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 will be, and it’s gotta have some relationship to what the breach really value. The. .

Christopher Robertson: In order that’s a second cause. 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 examine in June once 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 they usually 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 courtroom, that kind of factor can work. I can barely consider it’s this simple.

I’m like, wait, why don’t we do that extra typically??

Christopher Robertson: I imply, frankly, we shouldn’t must. We want a scientific resolution to this. Uh, you understand, we’re all have day jobs, you understand.

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 understand, they’re attempting to battle their very own battles and so, you understand, waging their very own authorized battle is, is, is a large distraction and requires a degree of consideration to element that not everybody has or must 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 courtroom, it’s not precisely a blanket resolution, particularly cuz there’s additionally the issue of scale. I imply, it’s one factor in the event you’ve acquired a lab hawking you for a thousand bucks. What in the event you’ve acquired an entire system of hospitals attempting to rake untold numbers of sufferers over the coals for loopy quantities? Then you definitely’re not in small claims courtroom anymore. Christopher Robertson has been there, like he’s gotten concerned in lawsuits attempting to cease hospitals from doing that kind of factor, and he. It’s not 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 understand, specialists and accounting and economics, you may spend tens of 1000’s of {dollars} litigating each single certainly one of these thousand {dollars} prices. And in order that’s why you actually do want both class motion or a extra affirmative, you understand, regulatory system to police this, this unhealthy conduct.

Dan:However in a person state of affairs like Miriam’s, the place she’s really wholesome, she’s solely acquired one cost to battle off. You may battle again. Get your proof collectively, discover out the itemized billing codes, and use an internet site like Truthful well being to determine what an inexpensive value could be. Make a suggestion, put it in writing. Ship it licensed mail. Give ’em a deadline to just accept your supply or else inform ’em you’ll file in small claims courtroom. . And if that doesn’t make ’em play ball, really do it. I ran all this down from Miriam and she or he was like,

Miriam: I want I had identified. That’s my predominant factor. I want I had identified 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 courtroom. Okay. Perhaps I’ll, I’ll offer you 50 bucks. That’s my, that’s my supply. Yeah. I want I had performed that.

Dan: YEP! That’s the place we left issues, a bit of greater than three years in the past.

I imply, we’ve adopted up a bit of 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 a bit of of his readiness to battle. Right here’s how he describes conversations with their billing division.

Jeffrey Fox: One factor they all the time do is that they all the time attempt to make it look like 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 really owe you, what a courtroom would say, I owe you is what applies. I bear 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 maintain going?

Dan: Jeffrey didn’t receives a commission on that improvised coverage of his… however he did get a choose 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 almost sufficient.

Particularly since I acquired a notice from a listener named Lauren with the heading: “I sued a hospital in small claims courtroom and misplaced”

… which ended, “I really feel like I gained.” She wrote, “the hospital spent far more cash on lawyer’s charges than the full quantity of my invoice.” They despatched three attorneys to a preliminary listening to — and her invoice wasn’t even that prime.

We talked — we’ll have plenty 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 pondering , do I , like, simply put collectively a listing of suggestions and go away it on folks’s windshields which are parked exterior of the er. how do I assist different folks do that?

If all people 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 a couple of extra folks than have tried it to date…

We’ll choose up that concept subsequent time.

Until then, care for 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 seems like Marian’s parental go away from this present, developing any minute now, will probably be everlasting. 

Marian, I can’t consider 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 Classes.

Gabrielle Healy is our managing editor for viewers. She edits the First Assist Equipment Publication.

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 is just not 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 may 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.

Because of 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 just accept tax-exempt donations. You may study extra about Public Narrative at www dot public narrative dot org.

And because of all people who helps this present financially.

“An Arm and a Leg” is a co-production of KHN and Public Highway Productions.

To be in contact with “An Arm and a Leg,” subscribe to the newsletter. It’s also possible to observe the present on Facebook and Twitter. And in the event you’ve acquired tales to inform concerning the well being care system, the producers would love to hear from you.

To listen to all KHN podcasts, click here.

And subscribe to “An Arm and a Leg” on SpotifyApple PodcastsStitcherPocket Casts, or wherever you hearken to podcasts.


Leave a Reply

Your email address will not be published. Required fields are marked *