An Arm and a Leg An Arm and a Leg

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.
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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.

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We’re launching a brand new project and need your help!
We’re zooming in on charges that are becoming more and more common on your medical bills: facility fees. 
Facility fees are charges tacked onto your bill for visiting a doctor’s office or clinic related to a hospital or larger health care system… or even talking with a doctor who’s in one of those places on a telehealth visit. 
If you’ve ever seen a charge for a facility fee on your medical bill, we want to hear from you. 
... and if you haven't, we'd love your help spreading the word!
Consider sharing our posts on any of these networks:
Instagram | TikTok | Facebook | Ex-Twtitter | LinkedIn
We’ll be back with more new episodes in a few weeks. 
In the meantime, send your stories and questions. Or call 724 ARM-N-LEG.
And of course we’d love for you to support this show.

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

When a subsidiary of the giant UnitedHealth Group got hit by a cyberattack recently, a big chunk of the country’s doctors, pharmacists, hospitals and therapists just stopped getting paid. 
It’s been a huge disruption, with some providers wondering if they can keep their doors open.
But thanks to their huge size and reach, the situation may have had a silver lining — for United.
Which seems like a big problem, and got us wondering: What can we maybe do about it?
The answer turns out to be: Maybe more than we think, via antitrust enforcers at the Federal Trade Commission and the U.S. Department of Justice.
Strap in for a wild ride — and then maybe check out FTC Chair Lina Khan’s talk with Jon Stewart on The Daily Show. We include some short excerpts, but the whole thing is worth a watch.
Thanks to reporters Brittany Trang (STAT News) and Maureen Tkacik (The American Prospect) for guiding us through their reporting.
And to the novelist/journalist/activist Cory Doctorow, who has been writing about antitrust enforcement for years. Here are a couple of his columns about Lina Khan and what she and other antitrust enforcers are up to.
If you want a deeper dive on the new antitrust movement: It’s summed up in a terrific (and short) book by Tim Wu, a Columbia University law professor and former White House adviser: The Curse of Bigness: Antitrust in the New Gilded Age. 
And you may be able to get it for free! If your local library uses a system called Hoopla, you can borrow it as either an audiobook or an ebook.
Super-fun tangent: Cory Doctorow and Tim Wu went to elementary school together — and apparently played a lot of Dungeons and Dragons — when they were kids in Toronto. 
Here’s a transcript of this episode. 
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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Reporter Bob Herman from STAT News unpacks his blockbuster investigation about the country’s biggest health care company.   
Covering the American health care system means we tell some scary stories. But this episode is almost like a horror movie. 
It’s got some of Hollywood’s favorite tropes: Machines taking over. Monsters from separate franchises meeting face to face in a new movie, like Godzilla and King Kong, or Jason and Freddy. And a couple perceptive folks warning everyone, ”Hey, look, something really bad is happening!” 
Those folks are Bob and his STAT News colleague Casey Ross. The monsters are United HealthGroup — a “behemoth” as one expert called them in an episode from last year — and Medicare Advantage, which we looked at in our last episode. And the “machines” belong to United.
Bob describes what some of United’s own employees said about the result: “For some of us, it's creating this moral crisis. Like we know that we are having to listen to an algorithm to essentially kick someone out of a nursing home, even though we know that they can barely walk 20 feet.” 
Scary stuff. But Bob and Casey’s reporting has caught the eye of some powerful people in government, and right now, Medicare Advantage plans are on notice from the federal Centers for Medicare and Medicaid Services, the U.S. Senate is holding hearings, and the Department of Justice reportedly has an anti-trust investigation in the works. 
Here’s a transcript of this episode. 
Send your stories and questions. Or call 724 ARM-N-LEG.
And of course we’d love for you to support this show.

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

Health insurance sucks. Which leaves lots of us counting down the days until we turn 65 and can get on Medicare – the federal government’s health insurance program for seniors. 
But Medicare is a lot more complicated – and costs more money – than a lot of us realize. (Also, it involves insurance companies.) And:t There will be huge, complicated decisions to make when you turn 65, that can have huge consequences. 
The biggest, and most consequential: Choosing between original Medicare and Medicare Advantage – the privatized version sold by health insurance companies that’s advertised everywhere seniors look. 
Some folks who pick Medicare Advantage later regret it — but find there are no do-overs. 
We get the scoop from Reporter Sarah Jane Tribble, who’s been covering the story for KFF Health News and the Washington Post. 
And we get a preview: What do we all need to know before we hit 65 about the choices we’ll face? There are a lot of options, and a lot of price tags. Sarah Murdoch from the Medicare Right Center gives us an outline of those choices and their consequences — and supplies both tips and resources. 
The biggest: When it’s time for you -- or anyone you care about -- to make choices around Medicare, every state has a free source of unbiased advice and information: Here’s a link to find your State Health Insurance Assistance Program (or SHIP).
Here’s a transcript of this episode. 
Send your stories and questions. Or call 724 ARM-N-LEG.
And of course we’d love for you to support this show.

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