James Cornell is a woodworker. He makes furniture. I have reclaimed wood like boards, mold houses. Sells it on Etsy. He does pretty well. He's got a big shop of his own. Business grows every year, but he can't afford health insurance. Thing story happened a few years ago, so that day I was making picture frames. I was ripping boards on the table, saw and May the last rip turned off the table saw. And for whatever reason, just looked away from the blade for a minute as I reached my hand in to grab the off cut and put my hand in the still spinning blade. So fortunately for me, since the power was off,

once the blade hit the bone, it pretty much kind of stopped the blade. So it didn't go all the way through the finger. But I was a pretty, pretty, gnarly, pretty gnarly situation. You were here by yourself? Yeah, Yeah, here with myself. So I screamed for about 10 seconds. I didn't feel anything just but knew what happened and then ran to a shop neighbor, leaving just like a trail of blood on the way over to him. They got me bandaged up and took me over to the urgent care because I know going to an emergency room is going to be just an obscene amount of money. But the doc in urgent care looks at Jim's finger and says,

I knew I'm not the guy for this. He was like, They're probably gonna have to amputate it. You're going to have to go to an emergency room. Jim and his friend get back in the car. That was a pretty rough drive. The pain was so excruciating that I couldn't even talk If I want to screen, I couldn't even scream. It was just I don't know which was worse, the pain or or the fear of what is this going to cost me? But there are a couple of nice surprises waiting for him first. He's not gonna lose. Doctor came in and take a look at everything. Correct a couple jokes and he was like, All right, I think we can set you back up.

Took him an hour and 1/2 to put in 10 stitches for him to kind of find enough skin to reattach, and it works that surprise Number one and then Jim stops at the desk on his way out to sign some paperwork. And the person behind the counter tells me if you give us $350 if you pay through under $50 today, we'll take 60% off your bill. 60 60%. So that's why I'm thinking again, this could be 8 $9000. I'm like, Yeah, here's here's my credit card. This is an arm and a leg show about the cost of health care. Dan. Wait, Jim, By the way, Listener.

He sent the story in just after the show launched last fall, and full disclosure. He supports the show on Patriots and Jim Situation worked out. Ended up paying about 1500 bucks. It's a lot, but it's a lot less than he expected. His fingers. Okay, and he sees a big question in this story. Is this a normal thing? If I walked into any hospital, is this something that they offer? Or did I luck out and just happened to walk into one that offers this 60% off program? This is a super good question. I don't think there's any way to know for sure to find out what kind of discounts on what kind of prices are out there but hospitals getting creative. That is definitely a thing.

They've got to do it. A couple months ago, I sat in on a webinar about the patient financial crisis by a woman named Sarah Geneti. She connected some dots. Start with, she says. Half of people with employer based insurance have a deductible of at least 1000 bucks. That's the amount you pay out of pocket before insurance pays anything.

And we know that 70% of Americans have less than $1000 savings at any

given time. So before our insurance kicks in, 70% of us have a problem.

And over half of Americans say that receiving a large medical bill can be almost traumatic. Is receiving a very severe diagnosis in and of it, though.

Oh, and here's the thing I didn't tell you about Sarah Geneti. She's the revenue director for a hospital. So our patient financial crisis it's her patient financial crisis, because when hospital bills are so high, we can't pay them, the hospital doesn't get paid. So Sarah's here telling other hospital administrators one way her hospital is dealing with this patient financial crisis. Her hospital has brought in a company called Care Payment, like car payment with a silent E in the middle to collect money from patients and care Payment makes paying for surgery. Kind of like financing a car. No money down. Everybody qualifies. Easy payments. Zero interest. This is from a promo clip the company posted to YouTube. I was very happy to find out from care payment that we were gonna be able to do monthly payments.

This is an upgrade from the usual medical billing approach. Bad cop. Pay up now in full, or we send you to collections and wrecked your credit, which most of us are pretty familiar with. Sarah Geneti says the good cop approach is working for her hospital. They now collect twice as much money from patients as before, and that is after care payment takes its cut. So all those bills we can't afford their good news for care payment like tha company commissions surveys and puts out a press release to say so. Here's one from 2018 new care payment research shows Americans can't afford their medical bills. Awesome, right? I talked with Laura Aylward. She's a marketing executive at care payment she gets that went bad times for people mean good times to your company. It means things are a little messed

up. You know, it's the incentives are misaligned in many respects. And you could even argue, like, Why do you even hear Plum? Why why do you even have to exist? Why do you use a company have to exist? Like what? What is that? What's the point? We shouldn't it be better. And yes, maybe so, but But the reason that a company like ours will always exist is Americans do want to pay their bills.

And when we owe a hospital, most of us definitely cannot pay the whole thing in one go, So care payment is doing great. Ah, press release says. It's business recently went up 50% in a year. And then there are hospitals getting creative on their own. That's in just a minute on an arm and a leg right after the break. An arm and a leg is a co production of Public Road Productions and Kaiser Health News, a nonprofit newsroom covering health care in America. It's an editorially independent part of the Kaiser Family Foundation. It is not affiliated with the giant health care provider Kaiser Permanente. They share an ancestor. It's a fun story. You can read all about it at arm and leg. Show dot com slash so problem. Hospital bills that are too high for people to pay means people don't pay their bills.

Hospitals lose money, so some of them are getting creative. For instance, a pair of hospitals in eastern Ohio offered a special recently, Bring us a bill from last year. You can pay it off at 50 cents on the dollar. I talked with Jose Guevara, the revenue director for the two hospitals. They're owned by the same chain. They share administrators and stuff He started last year, and things

were looking bad. People were just paying their bills. And I said, How do I reach out this community? Because when I got here, the first thing that was told to me was, You know where a poor community are. People don't pay their bills. And I said, Oh, you know, you really don't realize I come from a state That's number two is the poorest state of the nation. Albuquerque, New Mexico. You know, and people pay their bills and when we give them discounts and we work with them and so

forth. So a little while after he arrived, he got the OK for a one month experiment, 50% off on old bills. They just put up some fliers in the hospital to see what would happen.

And that worked out really good. Our collections for that month was almost 1.2 1,000,000 donors for

the whole month on what is it usually

so? Usually runs about maybe 600,000. We almost

doubled it. So you gave people at this kind of 50% but you took in twice

as much money. Yes, yes,

yes, that was last fall. They liked all that money. So they ran a special again in February and March of this year, and this time they pushed it harder. They have Facebook and Twitter got local media to write about it. Suddenly, Jose's team is getting calls from all over the country.

People were calling me. They were going like, Hey, you know, my mother said that she owes Bill. I mean, I'm in Columbus, Ohio. Can I pay that bill for her by, Of course, I mean, you know, we have digging money from Atlanta, Georgia, you know? Nashville, Tennessee. Columbus, Ohio

The hospital's ended up extending the special offer through Tax Day to get people's refund checks. This time they tripled their usual take. So this raises kind of an obvious question. And so how How can you? How can you afford to give 50% off? There's an obvious answer. 50% of something is better than 100% of nothing. It's even better when people are calling you to pay it instead of you having to spend time and money chasing them, to maybe pay it. But Jose gave me a second answer to

Well, you know, people have asked that question. This is the thing, you know. The entrance way used to get paid 60%. Most of our cares, you know, like Medicaid 44% s 0 50% is affordable to us.

He's saying that carriers insurance companies pay them 60%. Medicaid pays 44% so 50%. It's in the range of what the hospital expects to get. What it routinely accept from the big players will pay most of the bills, which raises a whole nother question. If you can afford a big discount like, why did you set the price so high in the first place? Wherever you look, the prices don't seem real. Jose is happy to get 50% partly because otherwise he's likely to get nothing. James Cornell in that emergency room gets a 60% discount, mostly for the same reason Sara Geneti is happy to give care payment a fat cut because her hospital still gets more money this way, way. In all these cases, the hospital are looking at losing money because they've set their prices. So far, it seems like it's not working for anybody except maybe for care payment in the next few episodes of an arm and a leg wouldn't get right into this.

How did we end up with the prices we've got? We'll start with one procedure. A brain emery and four wildly different price tax from $1000.26,000 dollars, two of them from the same hospital, the same patient on the same day. That's next time on Armin Elek. Till then, take care yourself. This is an arm and a leg show about the cost of health care this'll leak Stories came from listeners, not just James Cornell. I found out about Sara Geneti and Jose Guevara after following a tip from a listener works as a health care Thank you and keep that stuff coming arm and a leg show dot com slash contact. This episode was produced by me. Dan Weissman, our editor is Whitney. Henry Lester are consulting managing producer is Daisy Rosario. Our music by Dave Winer and Blue Dot Sessions.

Adam Ramada is our audio or intern is Daniel Fernandez. An arm and a Leg is a co production of Public Road Productions and Kaiser Health Nonprofit newsroom covering health care in America. It's an editorially independent party, the Kaiser Family Foundation. It's not affiliated with the giant health care provider Kaiser Permanente. They share an ancestor. It's a fun story. You can hear it at the end of this season's first episode, or check it out at arm and leg. Show dot com slash Keizer. Van Weber is the national editor for Broadcast, and Tanya English is senior editor for broadcast innovation at Kaiser Health News. They're the editorial liaisons for this show and two of the world's nicest humans and Diane joined an arm and a leg as a patron supporter. Justice Season one ended. So Diane is the first of more than 100 people I am about to think right now because anybody who pledges two bucks a month or more gets a shout out right here and now. Are you ready?

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Let me know if you got yours wrong. I'll redo it. Okay. Okay. Dan Weissmann out of here. This is season two. So glad you're with us.