So, Robin Hood’s got an approach to medical bills.

Dan: Hey, I don’t have to tell you: navigating the American healthcare system— especially the financial side— can feel like getting trapped in a medieval torture device. 

So it pretty much fits that the people who work at Renaissance Fairs have come up with a workaround.

This is An Arm and a Leg, a podcast about the cost of health care. I’m Dan Weissmann.

If you heard our first episode, you know that one of the things that pushed me to do this show is that, the minute I started talking to people about the idea of a show like this, they started telling me some surprising stories. 

This is one of those— and it’s my favorite. 

My oldest friend, we grew up together— has been performing at Renaissance fairs for more than 20 years. When I told him about this project, he was like, “Oh, yeah, there’s this thing we have… “

I did a short version of this story  with NPR’s Planet Money team a few months ago..

And in this episode, we’ll get a little deeper, because there’s more to the story. 

The Ren Fair people are doing two big things. One, they’re pooling money to help each other out. 

And two, they’re making medical bills disappear— more than two million bucks over the last few years. 

This time, we’ll be hearing more about that second part: We’ll meet the person who makes it happen, and she’s going to teach us a few of her tricks. 

All right, here we go.

About 35 miles east of Austin Texas, I’m standing in a kind of open-air pub at the Sherwood Forest Fair. Most people here are dressed like extras from ” Game of Thrones.” 

Elf: Have you gotten the chance to speak with Robin Hood yet?  ROBIN! Come forward.

Robin Hood does that thing they all do at Renaissance Fairs where they pretend to be amazed by modern technology, like my microphone.

Robin:  That’s a very strange device you have there, sir.

Dan: A lot of people say that here. 

Robin: That’s interesting. I can imagine.

Dan: Another new-fangled invention they don’t all have: health insurance.  

You don’t make a lot of money dressing up in tights. And everybody’s a contractor. Ren Fairs are a gig economy— health insurance not included.

And even those who buy insurance, they spend a bunch of every year chasing gigs from state to state, and their insurance coverage doesn’t follow them.  

Y’know, It’s all fun and games… until someone gets run through with a jousting lance.

There’s a lot that can go wrong back in the middle ages. Danielle DuPont performs as a Washing Well Wench, dragging spectators into her show.

Dani: Do you want to see him do something dangerous?

Audience: Yeah!

Dani: DISGUSTING?

Audience: Yeah!

Dani: Me too. 

Other: Yeah!

Dan: Years ago, she fell off a stage and twisted her ankle. Good news: By the time she got back from the ER… her fellow performers had passed the jangly hat… and raised like two thousand dollars for her. 

She was touched. But later, she found out that not everyone got the same kind of generosity. There was another family whose daughter got sick— and no one had stepped up to help them.

Dani: And it was not fair. It wasn’t fair that I was—  because I was popular, I was 22, I was cute, I had a stage show—  People came up with money for me. And yet this artisan family didn’t get any money and had to leave, was not fair.

Dan:So, the Rennies, as call themselves, took their informal spirit of charity and made it official. They call it Rescu Foundation. A way to raise   money and get it to whoever needs it the most at renaissance fairs around the country. 

The fundraisers turned out to be the easy part. Rennies have a ton of imagination and they came up with a clever way to use it. Carol Black is one of Rescu’s founders. She says they would pick up worthless items at a thrift store… and then auction them off with a story.  

Carol Black: We auctioned off a broken wooden dish strainer as the Gutenberg paper Dryer, and it went for $150, because of the story. 

Dan: But making sure that money went where it was needed most? To Rennies around the country? That was harder.

In order to make it work they had to embrace a concept that practically defines modernity: Bureaucracy.

Carol says they started, like any good health-care organization, with…..  PAPERWORK!  

Carol Black: Which is really hard for people— especially in this type of industry. 

Dan: Rennies who need help paying for health care have to fill out a form. Prove they’ve worked at a fair. As an elf or a juggler or a minstrel or a big, burly dude who sells turkey legs. Doesn’t matter.  

There’s a committee that reviews everything.  

Carol: We average probably about 4,500 minutes a month in conference calls.

Dan: Carrier pigeons? They’ve gotten expensive. 

Those who get approved can get a little money and more importantly, they can get help navigating the health care system. 

 Kaelyn Globig used to sell belly dancing outfits. Now she works as Rescu’s “case manager.”  

Kaelyn Globig: There are roads to take when you’re uninsured. It’s just that people don’t know how to do it and they won’t really tell you. 

Dan: Kaelyn walks Rennies through the process of advocating for themselves. She teaches them the magic words to slay the health care dragon: application, charity care, financial aid. 

Lots of hospitals are non-profits, and they’re actually required to show that they, you know, do some good works, like discounts for poor people. Sometimes they call it charity care, sometimes financial aid.  

And it helps to know how to ask for it.

Teaching people to this sort of thing turns out to be the Rescu Foundation’s real wizardy:      

In the past five years, Rescu says it has raised about half a million bucks to pay down medical bills— and it has gotten more than $2 million in price breaks. 

That 2 million bucks, that’s Kaelyn. 

We’ll get into how she does it, right after this.

OK: Here’s how Kaelyn became a medical-bill wizard. 

One day, years ago— when she was a Rennie scooting around the country— she had some scary stomach pain. She ended up in the ER.

Kaelyn Globig: And they did a bunch of tests and the doctor came back and said, “This is a head-scratcher!”

Dan: OK, thanks, doc. Then, she got the bill: Five thousand bucks.

Kaelyn Globig: It scared me. I had actually called the hospital crying: “I can’t pay this bill.”

Dan: And that worked. They offered her a charity-care application and knocked the bill down to 700 bucks. Which was still a lot for her, so she asked Rescu for help. 

That’s how she first got involved. Now, she’s off the road, and most Rennies who come to Rescu for help end up talking with her. 

Lots of Rennies qualify for charity care— folks who live in tents, or camper vans, or trailers they lug around the country. My friend who turned me on to this story calls his tribe the Mobile Homeless. 

And a number of them can really use Kaelyn’s help with the process. 

Kaelyn Globig: A lot of people do need that, that instruction, on like how to make a phone call. Like, you know, step by step, like how do you take care of this,  

Dan: And actually, making these kinds of calls successfully— keeping your cool enough to be effective— that requires some pretty advanced adulting.

Kaelyn Globig: I just let them know, it’s important just to be very calm and gracious and grateful for anything that they do, even if it’s something that’s not gonna work for you. Thank you for looking into that. Thank you for your time. That way if you have to call them back, you don’t have a black mark on your name there. 

Dan: Kaelyn says even she finds it hard sometimes. And sometimes she has to push harder.

Like when she had a heart patient who urgently needed treatment, and the cardiologist’s office wouldn’t play ball, even just to schedule a consult.

Kaelyn Globig:  They won’t see him because he doesn’t have insurance. And I’m like, well, we’re going to pay for his, you know, his initial visit. He’s covered for this visit. And they said, but what if he has a heart attack in the office? Then we have to do all this medical stuff to him and he’s not going to be able to pay  for it. And I’m like, I said, the other choice is to send our patients out to the street to die. … So you and I need to figure this out. 

Dan: Ultimately, she was more stubborn than they were. The guy got his appointment. And he didn’t have a heart attack on the table. 

She’s got lots of tactics: Negotiating payment plans, writing hardship letters, and asking for something called a super-bill:

Kaelyn Globig: The super bill has all of the codes for each procedure that this person has had, as they’re going through their medical adventure

Dan: These are the codes that insurance plans use. Including Medicare. Which posts the rates it pays for each code online. 

Kaelyn Globig: And I look up those codes and I see how much Medicare will pay for those. And often it is, it’s less than half of what they’re actually charging you.  

Dan: So she’ll ask: How about we pay you the Medicare price? Sometimes it works. 

So, yeah. This is stuff you could actually do. Call. Be really, really nice. And ask for the super-bill. You might have to ask more than once. 

Kaelyn says she’ll get maybe a hundred new cases a year.

And she does all this PART-TIME— she’s only working for the Rennies’ self-help fund, the Rescu Foundation, twenty hours a week, and she earns the rest of her living as a real-estate agent.

Kaelyn Globig: You know, I love this job because I am so appalled at the way they try to work our medical system. I like to be on this side of it. The one that’s kind of fighting for the, you know, for the little guy

Dan: This would be hard to make work in another setting, or on a bigger scale. 

Because it’s not just that Kaelyn loves her job and is really great at it. It’s that she’s serving a tight-knit bunch of people, her people— Rennies are a tribe. 

I mean, I met two women at that fair in Austin, Texas who worked at a candle booth— a retail gig, just, in a tent. Their incomes were like 6 or 7 thousand a year. 

Mandy Wilson used to be a nurse:

Mandy Wilson: My life is hard. Anyone who was out here and does what we do can’t say their life is not hard, but the ones of us who are out here and who have been out here wouldn’t trade it for the world. Because day by day there will be somebody there to pick you up to make you get to the next day because two months down the road they may need you to pick them up. 

Dan: So. Not a setup most of us are ready for. But something to think about. 

And a nice place to visit.

Robin Hood: Are you having fun?

ME: Well, yeah! I’m talking to Robin Hood.

ROBIN: Excellent!…

Dan: And: I think there are more people like Kaelyn— people who know the ins and outs of this system, and are game to help others. 

We want more of their tricks— and somewhere down the line, we might like to get them on the show to take questions from people who need some advice.

So if you know someone like that— or if you ARE someone like that— would you get in touch, please?  

Meanwhile… some of you HAVE been getting in touch with stories of your own. Here’s a couple. Bonus: They’re voice memos! 

First, Susan from Virginia sent this in:

Susan: I fought our health insurance and won. Something I never thought I’d have to do but we’re self employed and we bought insurance through the marketplace in 2016 at buckle down hard because we were in the adoption process for our son who had major medical needs. He was born without an esophagus in another country and he had never eaten a bite of food by mouth. So when I chose insurance for the 2017 year I a hundred percent based on our choice on which policy I thought would cover this necessary surgery that needed to be done at an out of state hospital, a very specific hospital in the US. 

It’s basically impossible to know if something will be covered until it happens— so that things can be preauthorized to give you an idea.But I can’t get a pre-authorization for something before I’ve even bought health insurance or before the child is even legally mine and in the US. We went into surgery day, even, not really knowing whether or not it would be covered, um, but we also knew that, even if it costs a million dollars, he needed the surgery so we would figure something out. 

It ended up being a 19 month process to get the surgery covered at the in network rate.

The day insurance called and said that they granted the appeal. It felt absolutely unreal. Remember, I’d been working on this for 19 months. 

 I’d been fighting for so long, and honestly I’d been lied to by representatives of my health insurance company, whether intentionally or unintentionally. I just been lied to so many times. I had a really hard time believing that it was really happening, that the fight was really over it. It was really covered. 

I’m always troubled when talking about health insurance because on one hand I think the financial side of the health industry is in general just totally out of control, but on the other hand, if it weren’t for insurance in the marketplace, our son may not have been able to have the surgery at all. 

Dan: Susan, thank you for sharing that story.

And, in response to our story last time about how hard it is to understand health insurance, we got this, from Nick, under the heading: I still don’t understand health insurance.

Nick: Greetings, Dan, I’m fascinated by health economics and in particular the US health economic system at so finding An Arm and a Leg both a joy to listen to, but also a quite upsetting and horrifying experience. I’m also finding that the more I listened, the more I don’t quite get how your system works. 

Now I should clarify. You may have guessed from the accent, I’m British and so I’m incredibly grateful for our amazing nhs. I’m also a massive conflict of interest and anesthetics and critical care doctor working in the NHS. 

I’m just wondering if there’s any chance you could do a basic primer in U.S. healthcare for those don’t really understand it, especially those abroad, but listening in. Like what are copays and deductibles? What are plans? Why can you only see certain doctors on certain plans? I mean, I don’t even know whether this means that if you have a heart attack, you can only see a cardiologist on certain plans or is it individual cardiologists? I’m desperately trying to keep up but could really do with a roadmap all of that and keep up the good work. Nick.

Dan: Nick, I suspect you’re not alone. Even a lot of us here struggle to figure out a lot of this. So, yes: We should do that. 

We’ve already slated our big stories for the rest of Season One— which ends December 18— but consider this on the list for stories we are looking at for season two, coming in 2019.

Other folks have been sending in stories too. We will share a few of those in our newsletter. 

YEP! We’ve got a newsletter. it’s free. Comes out once a week.

It’s got a little extra information on each episode— and when Season One ends in December, it’ll be a way for us to keep in touch. 

Especially so we can let you know more about season two, and when it’s coming. You can sign up at arm-and-a-leg-show, dot com, slash, newsletter.

Meanwhile :  Insurance companies seem to say that one of the big things they do is to keep prices down for customers: They’ve got negotiating power.   Actually, they’re not very good at that. That’s next time, on An Arm and a Leg.  Till then… take care of yourself.

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

This episode was produced by me, Dan Weissmann and edited by Whitney Henry-Lester. Our consulting producer is Daisy Rosario. Adam Raymonda is our audio wizard. Our music is by Dave Winer. 

Special thanks for this episode go to Bryant Urstadt and Robert Smith at Planet Money for commissioning this story the first time out, and for GREAT edits. 

Thanks to everyone who has sent in stories— that’s stories at arm-and-a-leg-show, dot com— 

Thanks to everyone who has rated and reviewed us on iTunes and Apple Podcasts— and everywhere else. I mean: Thank you so much. 

And thanks to our new Patreon supporters!  Pledge two bucks a month or more, and you get a shout out right here. This week, it’s thank you to:  Howard Heitner, Frank Robinson Safford, Lawrence Moss, Nadia Oehlsen, and Tom Karches

Special thanks for this story also go to Joshua Safford, Rebecca O’Keefe, Judith Mitsch, and the Rennies who lent me a tent to sleep in and introduced me around at Sherwood Forest Fair.

Woman: TELL THIS NICE MAN YOUR NAME.

Fae: I am…