How to fight like a bulldog (against bogus medical bills)

Dan-Track: In January, Bridget Callahan got a weird letter from a health care company she’d never heard of. It was confusing.

Bridget Callahan: it didn’t say what it was for it. it wasn’t really a bill.

Dan-Track: Just one page. Actually, just two short paragraphs saying her insurance company needed more information about… “the above-referenced claim.”

Above was her husband’s name, an account number, a “date of service” four months in the past, and an “account balance” of 12 thousand and some dollars. She is like, holy crap.

Bridget Callahan: $1,200 would be a huge hit. I mean, that’s, that’s a lot of money.

Dan-Track: It’s six months worth of house payments for her. She and her husband do NOT have it lying around.

The letter was dated December 31st, and it said to get in touch within five working days.

Bridget Callahan: And if you’ll notice the postmark, I didn’t get that until January 9th.

Dan: That’s a long time for that to take to arrive. Yeah. Right.

Bridget Callahan: Yeah. Especially when they say you need to contact us in five

Dan: within five days, right?

Dan-Track: I told you, holy crap.

Now, this story gets worse before it gets better. But it does get better. Because, one, Bridget is ON it. And two: Bridget didn’t know it at the time, but she had a guy. His name is Steve.

And Steve is going to teach us a thing or two.

This is An Arm and a Leg— a show about the cost of health care.

I’m Dan Weissmann. I’m a reporter, and I like a challenge.

So my job on this show is to take this terrifying, enraging and depressing piece of American life and give you something entertaining, empowering, and useful.

These days, I am leaning into that useful part. We’re in the middle of a pandemic, so we’re all that much closer to some kind of holy-crap situation.

This podcast is a school for financial self-defense. Now in session. I’m gonna introduce you here to an expert, Steve Benasso.

I met Steve because he sent a note to NPR for the “Bill of the Month” series they do with Kaiser Health News, which is also our co-producer for this show. (They’re not affiliated with Kaiser Permanente, more on that later.)

I got to tell part of Steve’s story on the radio

It went like this: Steve and his daughter Izzy were playing tennis last summer, when Izzy made a big reach for the ball. Here’s Izzy:

Izzy B: I pivoted really hard. And something didn’t feel great. And before I knew it, I couldn’t straighten out my legs.

Dan-Track: She bent over and said “Oh no.”

Steve Benasso: And I wasn’t terribly concerned at first, just because she’s been a competitive soccer player, all her life. I just expected her to bounce back

Dan-Track: But she didn’t. Iizzy says it wasn’t even the pain that had her shedding a tear. It was the thought that she might have a serious knee injury.

Izzy B: I’ve seen quite a few teammates tear ACL, and know what that recovery process was.

Dan-Track: An MRI brought good news. didn’t tear her ACL. It was her miniscis. Much faster recovery. She was in and out of surgery within a week.

Izzy headed back to college for her senior year. Steve watched the mail for bills.

Before the first one arrived, there was a letter from someone who said he was a surgical assistant.

Steve Benasso: it was very cordial and it basically was explaining that this was not a bill for services, that he had let our insurance carrier know that he was present during Izzy surgery.

Izzy B: Like they were just sneaking people in while I was unconscious. And then they could all write letters and say, Hey, we were there too.

Dan-Track: A month later. A follow-up from the same guy, with the same message. And to understand what Steve does next, there’s a couple things worth knowing about him. First:

Izzy B: Steve is the kind of person to check every receipt twice and argue over any discrepancies he finds.

Dan-Track: Izzy says her family’s gotten lots of free stuff as a result. Like when this supermarket manager sent over a basket of food and some gift cards after Steve complained about something.

Steve Benasso: that’s by far not the best one. My wife and I received a free ski trip to sun Valley

Izzy B: Oh, yes, that one was good.

Dan-Track: The OTHER thing about Steve is his job: He’s a human-resources director. And he encourages people where he works to come to him with questions about their medical bills. Anything looks fishy, he goes to battle for them.

Steve Benasso: I am a bulldog on this stuff. I do it every month.

Dan-Track: So, this weird letter, from a “surgical assistant”? Steve gets suspicious. Writes the guy right back to say:

I’m guessing you’re telling me this so that I’m not surprised to get a bill from you. And I’m ALSO guessing that you don’t take our insurance, which is why you’re trying to soften me up.

Steve Benasso: And I want you to know that I have absolutely no intention of paying your bill. And, if you feel that you’re owed something for your services. I suggest you take it up with Izzy’s surgeon, and that you perhaps come to some sort of agreement on how to split the fee that he receives.

Dan-Track: Or— he closes— you can have the pleasure of arguing this with the insurance company yourself.

Dan-Track: That letter is hilarious. And it seems to have worked. Steve says he hasn’t heard from the guy since. No bill, no nothing.

So the NPR story was about that one incident. And by the end of my interview with Steve, I was like, “I’ve got a live one here.”

I said to him, you love disputing bills? And you take on medical bills all the time, for your job? Really every month?

He was like, yep. He says the last one was over a bill for more than 10 thousand bucks. The person getting the bill had done everything right, Steve says, but the insurance denied it. Steve took care of it. And…

Steve Benasso: I forced our insurance company to review every out of network claim for the last three years so that I could personally look at them and make sure that this hadn’t happened before.

Dan: You did. That’s very interesting.

Dan-Track: I was like: Oh, when can we talk again?

When we did, I asked Steve how he became the kind of a guy who picks over every bill.

Steve Benasso: that’s my dad. There’s no question.

Steve’s dad was an accountant, and not overpaying was part of his personality.

I remember him telling me as a kid, you know, looking at the bill at a restaurant and said, look, Round these numbers up and do a quick addition. And if it’s within three or $4 or $5, it’s probably right.

Dan-Track: And if it’s off by fifteen or twenty bucks… not right.

So not overpaying — and not being a pushover— became part of Steve’s personality too.

And then: About 15 years ago, he was running HR for a company in Austin, Texas, and he hired a health-insurance broker based on a very-appealing pitch.

Steve Benasso: It was, we have this person in our office who is dedicated to helping people figure out their bills when something doesn’t appear to be. Right.

Dan: And did they say to you like, and you’d be surprised how often this happened?

Steve Benasso: Oh, yeah, absolutely . And that wasn’t a surprise to me because I knew that something wasn’t necessarily right. I just didn’t have any idea what the steps look like to, you know, to get it corrected.

Dan: And this struck Steve as a bigger deal than fighting over his own tab in a restaurant. A lot of the people at his company worked in warehouses and lived paycheck to paycheck.

Steve Benasso: it was really hurtful, right. To see, to see people who were of modest means and an additional 50 or a hundred bucks, um, for something they didn’t know meant a big was a big deal.

Dan-Track: Steve signed his company up with this broker. And it worked. He says the woman at his insurance broker’s office— the fixer— turned the light on for him.

Steve Benasso: she’d be the first one to tell you now, you know, this is exactly how it. It works under your policy or no, this is incorrect and you’re being taken advantage of, or they’re making a mistake

Dan-Track: Steve took notes.

Steve Benasso: over time, I learned more and more to the point where I could look at someone’s bill and knew immediately that they either did owe the money or didn’t .

Dan-Track: So Steve became a fixer too. He moved on to other jobs, at other companies, and wherever he went…

Steve Benasso: it kind of became known that, you know, Steve really hates insurance companies and hates seeing people get taken advantage of. So if you bring this to him, you know, chances are he’ll, he’ll help you work something out.

Dan-Track: And lucky for Bridget Callahan— the woman with the holy-crap letter saying she owes twelve thousand bucks— Steve is the HR director where her husband works. And he is going to help work something out.

We’ll get to her story right after this.

This episode of An Arm and a Leg is a co-production with Kaiser Health News. That’s a non-profit news service covering health care in a America. Kaiser Health news is not affiliated with the big health care outfit Kaiser Permanente. We’ll have a little more information about Kaiser Health News at the end of this episode.

OK, Bridget’s got this holy-crap letter. Says she and her husband are about to be on the hook for twelve thousand forty-seven dollars and 26 cents, unless … it’s not even clear what. Some insurance mix-up?

The letter’s from a company she never heard of. Says there’s some kind of question about insurance. Wants a response by a date that’s already passed by the time the letter arrives. Oh, and it actually lists the wrong insurance company for her.

Bridget Callahan: I was very puzzled when I saw that.

Dan-Track: Yeah, that NEVER got cleared up.

And this letter doesn’t even say what the twelve thousand dollar charge was for.

Now, of all the people to get a letter like this, Bridget is pretty well-equipped. For one, she’s got time. Since she and her husband moved east to be close to their daughter and their young grandkids, Bridget hasn’t had a full-time job.

And two, she’s organized.

I’ve got the hand-written notes she took. Top of page one: January 9, 2020. Received letter… in big writing TWELVE THOUSAND two exclamation marks.

By the end of that day, she’s figured out, this was for a… stress test. This is a heart thing, they put you on a treadmill and see how you do.

Bridget Callahan: I was like, that can’t be right. $12,000.

Dan-Track: I mean, she barely remembered her husband going in for this thing. She thinks he’d had a funny EKG reading ahead of getting knee surgery, and the doc was like, Go get a stress test. Seemed routine.

Oh, and by the way, I’ve looked this up on a couple of websites: 12 thousand dollars is a LOT of money for a stress test. 70 bucks, a hundred and fifty is more normal for the test. Toss in up to three thousand if the hospital is adding in a lot of charges. Bridget didn’t know that.

She only knew: Twelve thousand dollars is a lot of money. Six months of house payments.

So the next day, she’s ON it. Calls the company that sent the weird letter, calls the insurance company, calls the company AGAIN. GOES to the hospital. Her notes say, “Spoke to a woman with a ‘supervisor” badge.’ Gets some paperwork, calls the insurance company again.

That’s a full day, and here’s what she learns: Her insurance is denying the claim because the hospital is out of network. Not covered.

Which seems nuts all around, because,

One. When her husband came in for the procedure, they checked his insurance card, right? They ALWAYS do that. So, you know, while they’re doing that…

Bridget Callahan: Why don’t they say this insurance isn’t going to work at our facility.

Dan-Track: I know, right? Bridget was pissed. That’s why she went to the hospital, saw the woman with the supervisor badge.

That woman gave Bridget paperwork, and you know what it was?

It was a pre-approval form FROM BRIDGET’S INSURANCE COMPANY. It said, “Yep, we approve you getting THIS procedure, from THIS doc, at THIS place.”

Bridget Callahan: And I was going well, this is ridiculous. If you get a letter from your insurance company saying this procedure is approved and it has the name of a facility on it…

Dan-Track: Then Bridget’s like, this kinda makes me think I’m covered here. In fact, it makes me think I’m ONLY covered if I go here. It says, this place. It’s nuts. End of the day, she makes sure the insurance company and the company sending the weird letter BOTH have that form.

A few days later, she’s back on the phone with everybody.

Bridget Callahan: And I mean, every phone call, it was just, it takes forever, you know, first you’re on hold to get. When you talk to the person there, they have to figure out, you know, what the thing is,

Dan-Track: One of her notes from this day includes, in parenthesis “34 minute call mostly on hold”

By the end of that day of calls, she’s got an address and a fax number for where to submit an appeal to her insurance.

She writes it all up. She even notes, in her appeal letter: Look: In one of these calls, somebody from your side said, “Hey, the pre-approval letter DOES have a couple of caveats, labeled ‘important reminders'”

And in her appeal, she’s like, Oh yeah? Let’s look at what those reminders say.

One reminder is: Your doc goes BEYOND what we’re approving, does other stuff? You may be on the hook. But that’s not the deal here.

The other is: Hey, you’ve actually gotta be enrolled in this plan, in good standing. Which. She. Is.

Sends it certified mail: TWO MONTHS LATER she hears back.

They’re like, nah. We’re denying your appeal.

And this is my favorite thing Bridget does. She doesn’t stop. She asks them, What’s the next step?

They refer her to a government agency, which actually refers her to the company her husband works for.

She gets a phone number, an address, and a couple of names. She calls, and gets a call back from somebody named Susie… who passes Bridget’s complaint on to Steve.

Steve Benasso: And my first reaction was the same as hers, which was, I don’t understand why they’re not paying for it either.

They approved everything in advance.

Dan: Steve gets things escalated. Which he can do, because he actually holds the purse strings: Steve is the guy who decides whether or not his company re-ups their contract with this insurance company next year. I tell him, yeah: You’re the paying customer. They’ve gotta take your call.

Steve Benasso: That’s exactly right. They would not have gone through this extra level of review had I not called.

Dan: But he did, so they did. And here’s what they found. They looked at their OWN website and found… that it lists this provider as BEING IN NETWORK. Here’s what the insurance company told Steve:

Steve Benasso: They used to be in network, but we didn’t clean up our lists. They should have been taken off, but because they weren’t taken off, we’re going to approve it and pay it.

Dan: That’s twelve thousand bucks worth of good news to Bridget and her husband. Six months of house payments. She’s relieved.

Steve’s mad. He thinks the insurance company should be like.

Steve Benasso: Man, we really screwed up and we’re sorry, and that’s not acceptable . And therefore, this is what we’re going to do to make sure It doesn’t happen again, all those things. And they have never done that. Not once.

Dan: So, Steve demands that review of the last three years of denied claims for everybody in his company. They say OK.

And he wants the insurance company to put in new safeguards. Like changing the pre-approval form. They say nope.

Steve is still mad, but even he only has so much leverage. And only so many choices. There are only so many big insurance companies.

Steve Benasso: When I told our chief financial officer he said, do you really think anybody else is going to treat this any differently? And my answer to him was. I really don’t care. It’s still wrong.

So, Steve— who is a fighter by nature, and knows the ins and outs, and has enough clout that he got the insurance company to go back and fix Bridget’s case. And a bunch of other cases, month after month, year after year— Steve is mad. Steve is frustrated.

And this honestly sucks. Because of course, where does that leave the rest of us? Where does that leave those of us who don’t HAVE a Steve. We work for ourselves, or we work someplace where the head of HR is no Steve Benasso, on and on.

And I’m here to tell you, it is OK to be pissed about this. Steve is pissed. I am pissed. That is a hundred percent reasonable, and natural, and probably fucking healthy.

Here is what we can’t do: We can’t give up. This is a marathon.

And I’m not a marathon runner, but here’s what I understand: If you’re gonna run one, you gotta train, and you’ve gotta pace yourself.

Note to self: Consider booking an interview with somebody who helps people train for their first marathon

So: let’s take a minute here, grab a metaphorical cup of Gatorade, and see what we’ve learned.

First, a practical thing from Bridget’s story: Never let your guard down. Start playing defense FIRST chance you get.

In this instance? The doc’s office gets pre-approval from your insurance? VERIFY for yourself that the doc is on your insurance company’s list. And if you find it online, GRAB A SCREENSHOT.

My pals at Kaiser Health News tell me this kind of mistake, where insurance companies “forget” to scrub their lists? Happens all the time. So look ’em up, grab a screenshot, and email that sucker to yourself, so there’s a date stamp.

I know. It’s annoying. But not as annoying as what Bridget went through.

Second, here’s a piece of advice Steve gives people where he works: Once you understand the basics of how your insurance works— like, you know what your “deductible” is— when you get a bill? Trust yourself.

Steve Benasso: If you think something looks like it’s incorrect. There’s a good chance it is. Don’t doubt yourself just because you got this very official-looking bill in the mail

Dan: Third— and this is really a lesson from both Bridget and Steve, and it’s the big one: Don’t give up. I love how even when they denied her appeal, she was like, OK, what’s the next step? It turned out to be Steve.

We don’t all have a Steve, but Bridget would a hundred percent not have found hers if she hadn’t been such a trooper.

And one way to look at this is: You go into battle, BE PREPARED for it to be a long one.

For instance, here’s another piece of advice that Steve gives the people where he works:

Steve Benasso: When you get the answer no? Don’t accept that the first time. I tell people you’re, you’re going to get the answer. No, at least three times.

Dan: … and he tells them, so actually, don’t come to me until after the fourth phone call.

And even for those of us without a Steve, who have to be our own Steve: You might want to think of the first three phone calls as just reconnaissance. You’re listening, getting a sense of what the other side’s arguments are— and if they make any sense, if they seem to hang together, even if the conclusion sucks.

If they do— and this hurts me to say, but I’m doing this show because the system ACTUALLY sucks — maybe you figure out how to live with that conclusion. Maybe you move from arguing with your insurance company about whether they should pay to negotiating with the provider about whether they might accept less from you.

But don’t give up too easily.

Steve Benasso: You have to be willing to stand up for yourself. you have to be willing to tell people in authority sometimes, that you believe they’re wrong. And unless you’re willing to do that. it’s likely you’re going to continue to be treated that way. And the answer will always be no.

Remind yourself: these fights are long fights. And know that even for experienced fighters— even for Steve HIMSELF— this stuff takes time and effort. Steve says once he got involved with Bridget’s case, it still took three months to get things resolved.

And: Remember how Steve blew off the surgical assistant? It sounded so easy. He was like, “BUZZ OFF” and the guy did.

Yeah, but Steve DID HIS HOMEWORK first.

I’ve seen the bills from the surgery. I’ve seen the statement from the insurance company. And let me tell you: They were NOT easy to read. The insurance statement just labeled every line item— and there were dozens and dozens of them— as “surgery-related services.”

I asked Steve, how did you isolate the line item for that surgical assistant?

He said he spent hours going over all the charges.

I was like, WHAT? You have been reading insurance statements and medical bills for YEARS and YEARS. You’re not new to this. And it took YOU hours?

Steve’s like, Yeah. And it took weeks just to make sure I had all the paperwork together. Steve was like, there was real money on the line in this case— but…

Steve Benasso: Honestly, Dan, 80% of this, 90% of this is because I despise the medical system in this country. And I don’t differentiate whether it’s me or whether it’s somebody who works in my organization. I am going to get you: If you are mistreating somebody I’m going to get you.

Dan: So I say: LET’S DECIDE TO BE LIKE STEVE. Let’s engage. This is a righteous battle. For ourselves, for our family members, for each other. This is NOT an easy project. Guess what?

Neither is living through a pandemic, especially in this country.

These are the fights we’ve got.

Let’s keep going, together. So, do me a favor: Let me know, what is keeping YOU going, right now?

Not just in the fight against financial crap in health care — I’ll take those suggestions too— but what is KEEPING YOU GOING?

Let me know: Head over to arm and a leg show dot com, slash CONTACT. That’s arm and a leg show dot com, slash, CONTACT

Or call and leave a voice message: 724 276-6534— that’s 724 ARM N LEG.

724 ARM N LEG.

And of course if you’ve got stories for me, or questions, or just words about the show and what you want from us? I’ll take that too.

Because as much as anything else, YOU are keeping me going. That includes in a very practical way— lots of you are supporting the show on Patreon, and that makes a HUGE difference. It’s why I’m able to do this show— and this is a great time to join in on that.

But just by listening, and letting me know what you think, and what you could use, and how you are doing, you are keeping me going.

So thank you.

I’ll look forward to hearing from you— arm and a leg show dot com, slash contact. or 724 ARM N LEG.

I’ll share some of what I hear from you, next time.

And ALSO? Here’s something to look forward to. In the spirit of An Arm and a Leg as a school for financial self-defense: I’ve got Steve Benasso’s teacher. The woman from that insurance agency in Texas? The original fixer? The one who turned the light on for him?

I found her. She’s great. She fought insurance companies every day for 25 years. Her friends couldn’t believe it.

Barbara: They go, you love your job? You spend your whole day talking to an insurance company. Are you kidding me?

Remember how Steve said he was a real bulldog about medical bills?

Next time on An Arm and a Leg: Lessons from a Bulldog’s Trainer.

Till then? Take care of yourself.

This episode was produced by me, Dan Weissmann and edited by Marian Wang.

Daisy Rosario is our consulting managing producer, and Adam Raymonda is our audio wizard. Our music is by Dave Winer and Blue Dot Sessions.

This season of An Arm and a Leg is a co-production with Kaiser Health News— a non-profit news service about health care in America that’s an editorially-independent program of the Kaiser Family Foundation.

Kaiser Health News is NOT affiliated with Kaiser Permanente, the big health care provider— they share an ancestor. This guy Henry J. Kaiser— he had his hands in A LOT of different stuff. Concrete. Aluminum. Ship building. When he died, more than fifty years ago, he left half his money to the foundation that later created Kaiser Health News.

You can learn more about him and Kaiser Health News at armandalegshow.com/kaiser

Diane Webber is Senior Editor for Broadcast and Taunya English is Senior Editor for Broadcast Innovation at Kaiser Health News— they are editorial liaisons to this show.

Finally, thank you to some of our new backers on Patreon and some who increased their pledge. Pledge two bucks a month or more, and you get a shout-out right here.

Thanks this week to:

Sarah McClary, Cheryl Abramoff

Tikus Shio, Karen Vogel

Michelle Swanson, Meredith Kalman,

Sam Thompson, and Jon Ward.

Thank you SO much!