Many Black Americans look to their religious leaders for guidance on a wide range of issues — not just spiritual ones.

This article was published on Monday, March 1, 2021 in Kaiser Health News.

By Anna Almendrala

In the hospital with COVID-19 in December, Lavina Wafer tired of the tubes in her nose and wondered impatiently why she couldn't be discharged. A phone call with her pastor helped her understand that the tube was piping in lifesaving oxygen, which had to be slowly tapered to protect her.

Now that Wafer, 70, is well and back home in Richmond, California, she's looking to her pastor for advice about the COVID vaccines. Though she doubts they're as wonderful as the government claims, she plans to get vaccinated anyway — because of his example.

"He said he's not going to push us to take it. It's our choice," Wafer said, referring to a recent online sermon that praised the vaccines as God-given science with the power to save. "But he wanted us to know he's going to take it as soon as he can."

Helping people accept the COVID vaccines is a public health goal, but it's also a spiritual one, said Henry Washington, the 53-year-old pastor of The Garden of Peace Ministries, which Wafer attends.

Clergy must ensure that people "understand they have an active part in their own salvation, and the salvation of others," said Washington. "I have tried to suggest that taking the vaccine, social distancing and protecting themselves in their household is something that God requires us to do as good stewards."

Many Black Americans look to their religious leaders for guidance on a wide range of issues — not just spiritual ones. Their credibility is especially crucial on matters of health, as the medical establishment works to overcome a legacy of experimentation and bias that makes some Black people distrustful of public health messages.

Now that the vaccines are being distributed, public health advocates say churches are key to reaching Black citizens, especially older generations more vulnerable to severe COVID disease. They have been hospitalized for COVID and died at a disproportionate rate throughout the pandemic, and initial data on who is getting COVID shots shows that Black people lag far behind other racial groups.

Black churches have also suffered during the pandemic. African American pastors were most likely to say they had had to delete positions or cut staff pay or benefits to survive, and 60% said their congregations hadn't gathered in person the previous month, as opposed to 9% of white pastors, according to a survey published in October by Lifeway Research, which specializes in data on Christian groups.

Washington's 75-member church is in Richmond, which has the highest number of COVID deaths in Contra Costa County, outside of deaths in long-term care facilities. The very diverse city, across the bay from San Francisco, also has one of the lowest rates of vaccination.

Offerings to Washington's church plunged 50% in 2020 due to job loss among congregants, but he's weathered the pandemic with a small-business loan and a second job as a general contractor remodeling bathrooms and kitchens.

To combat misinformation, he's been meeting virtually with about 30 other Black pastors once a month in calls organized by the One Accord Project, a nonprofit that organizes Black churches in the San Francisco Bay Area around nonpartisan issues like voter registration and low-income housing. Throughout the pandemic, the calls have focused on connecting pastors with public health officials and epidemiologists to make sure they have the most up-to-date information to pass on to their members, said founder Sabrina Saunders.

The African American church is an anchor for the community, Saunders said. "People get a lot of emotional support, people get resources, and their pastor isn't just looked upon as a spiritual leader, but something more."

And guidance is needed.

The share of Black people who say they have been vaccinated or want to be vaccinated as soon as possible is 35%, while 43% say they want to "wait and see" the shots' effects on others, according to a KFF survey. Eight percent say they'll get the shot only if required, while 14% say they definitely won't be vaccinated. Among whites, the first two figures are 53% and 26%, respectively; for Hispanics, 42% and 37%. (KHN is an editorially independent program of KFF.)

Among the "wait and see" group, 35% say they would seek information about the shots from a religious leader, compared with 28% of Hispanics and 14% of white people.

Grassroots outreach to Black churches happens in every public health emergency, but the pandemic has hastened the pace of collaboration with public health officials, said Dr. Leon McDougle, assistant dean for diversity and cultural affairs at the Ohio State University College of Medicine. The last time he saw such a broad coalition across Black churches, medical associations, schools and political groups was during the HIV/AIDS epidemic in the 1980s.

"This is at an entirely different level, though, because we've had almost half a million die in a year," McDougle said of the COVID pandemic.

Historically, no other institution in African American communities has rivaled the church in terms of its reach and the trust it enjoys, said Dr. Paris Butler, a plastic and reconstructive surgeon at the University of Pennsylvania Health System. Last month, he and a colleague spoke to leaders from 21 churches in Philadelphia to answer basic questions about how the vaccine was produced and tested.

"Being an African American myself, and growing up in a Baptist church, I understand the value of that trusted voice," Butler said. "If we don't reach out to them, we're making a mistake."

Leaders with massive social media followings, like Bishop T.D. Jakes, are also weighing in, publishing video conversations with experts including Dr. Anthony Fauci to inform followers about the vaccines.

Church attendance is waning among young Black adults, as it is for other races. But elders can set examples for younger people undecided about the vaccine, said Dr. Judith Green McKenzie, chief of the division of occupational medicine at the University of Pennsylvania's Perelman School of Medicine.

"When they see their grandma go, they may say, 'I'm going,'" she said. "Grandma got this two months ago and she's fine."

Encouraging vaccine trust is delicate work. The Black community has reason to be skeptical of the health system, said Eddie Anderson, the 31-year-old leader of McCarty Memorial Christian Church in Los Angeles. In one-on-one conversations, congregants tell him they fear being guinea pigs. The low vaccine supply also makes Anderson hesitate to recommend, from the pulpit, that members get the shot as soon as they're able. He fears frustration with difficult online sign-ups would further sap motivation.

"I want to do that when it's readily available," he said. "I want to preach it, and then within a weekend a family can actually go get the vaccine."

Despite the doubts and fears, Anderson said the majority of his 125-member congregation, about half of whom are senior citizens, want the vaccine, in order to be with loved ones again. One older member is desperately seeking a vaccine appointment so he can help his daughter, who is going through cancer treatments. But the online sign-up process is confusing and nearly impossible for his followers, Anderson said.

For now, he's focused on asking several vaccinated members to write down everything about their experience and share it on social media. He also plans to record them talking about their shots — and to show that many people of different races were in the same vaccine line — and will broadcast the videos during church announcements.

While he can't tell people what to do, Anderson hopes he can remove any potential spiritual barriers to the vaccine.

"My biggest fear is for someone to say, 'I didn't get vaccinated' or 'I didn't get a test' because it's against [their] faith, or because 'I don't see that in the Bible,'" he said. "Any of those arguments, I want to get those off the table."

Anna Almendrala: aalmendrala@kff.org, @annaalmendrala

Shifting to an age-based priority system has frustrated people with health conditions such as cancer or diabetes who thought they would be next in line.

This article was published on Monday, March 1, 2021 in Kaiser Health News.

By Phil Galewitz and Carmen Heredia Rodriguez

With COVID vaccines expected to remain scarce into early spring, Connecticut has scrapped its complicated plans to prioritize immunizations for people under 65 with certain chronic conditions and front-line workers. Instead, the state will primarily base eligibility on age.

Gov. Ned Lamont pointed to statistics showing the risk of death and hospitalization from COVID-19 rises significantly by age.

Yet, shifting to an age-based priority system — after health workers, nursing home patients and people 65 and up have been offered vaccines — has frustrated people with health conditions such as cancer or diabetes who thought they would be next in line. It also could exacerbate the difficulty in getting people in underserved communities and those in minority racial and ethnic groups vaccinated, health experts said.

While it's reasonable for states to want to vaccinate people in their 50s and 60s ahead of those in their teens and 20s, the experts added, there are no easy answers in deciding who should get vaccines first. Is a 40-year-old with diabetes at higher risk than a 64-year-old without serious health issues? How about an older person who works at home or a younger person whose job puts them at higher risk of infection?

Gini Fischer, 57, a portrait artist in Wilton, Connecticut, has mixed feeling about people her age being in line ahead of those with chronic illnesses. She also teaches water aerobics to seniors at her local YMCA and sees getting vaccinated as a way to protect others. So, she plans to make an appointment for the vaccine.

"I do think people with chronic illnesses are more vulnerable than I am," said Fischer, a breast cancer survivor. But given her teaching responsibilities, "I certainly don't want to be a risk to anyone in the class," she said. "I do believe the more people who get vaccinated the safer it will be for others who have not been vaccinated."

People 50 to 64 are nine times more likely to die of the virus than adults 30 to 39, according to the data from the Centers for Disease Control and Prevention.

"There's no magic bullet," said Claire Hannan, executive director of the Association of Immunization Managers, referring to the different priority lists.

Under Connecticut's new plan, the state on Monday will be the first to start vaccinating everyone age 55 to 64 and up. Later this spring, the state plans to vaccine younger adults. The only exception will be educators and child care providers, who also can also get vaccinated starting Monday.

Last month, Nebraska Gov. Pete Ricketts also indicated the state would adopt a plan to move away from prioritizing vaccinating people with chronic illnesses. But Friday he said Nebraska would issue plans in March to give certain people, such as those on dialysis and those who have compromised immune systems, priority when the state finishes vaccinating those 65 and older.

Rhode Island is the only other state with an age-based plan, and the state estimates it will begin vaccinating people younger than 65 by age group starting in mid-March. But between vaccinating the group of residents who are 60 to 64 years old and those with ages ranging from 50 to 59, Rhode Island also will offer vaccines to people with certain chronic illnesses. The state expects to start vaccinating those in the 16-to-39 age group in June.

"I am really happy to be able to get it," said Cathy Wilcox, 59, of Stamford, Connecticut, who made an appointment for Monday. Wilcox, who wears a KN95 mask when working the front desk at an indoor tennis facility, expected she wouldn't be eligible until April or later but is excited because she has been worried about her risk of getting COVID-19. "What worries me about COVID is you can have no symptoms but be a carrier and be fine or you can die or everything in between," she said.

More than 40 states adopted plans to prioritize adults with certain chronic conditions, a strategy that generally uses the "honor system" for people to self-attest they have conditions ranging from a smoking history to asthma, according to KFF. (KHN is an editorially independent program of KFF.)

"There is no obvious right or wrong way to do it," said Dr. Amesh Adalja, an infectious diseases expert with the Johns Hopkins Center for Health Security in Baltimore. He said the goal of the vaccine program — at least initially — is to protect the most vulnerable so they don't overwhelm hospital capacity. But it is difficult to determine who is most at risk.

A simpler age-based system could speed vaccination efforts that some say have been complicated in states with COVID priority phases with numerous tiers based on job and health status, Adalja said. "There is a clear argument to make it as simple and seamless as possible," he added.

The big advantage of giving vaccines out by age is it could reduce people from gaming the system (or lying that they have a health condition) since vaccinators can easily check a person's age identification, said Dr. Richard Zimmerman, a University of Pittsburgh professor who works with its Center for Vaccine Research.

"It may stop some people from skipping the line," he said.

States and the District of Columbia defend their systems that give early access to people with chronic illnesses, saying they are following CDC recommendations.

After it finishes vaccinating seniors, Maryland will include all adults 16 to 64 who are front-line workers and adults with certain health conditions. A spokesperson for the Maryland Health Department said vaccines should be in large-enough supply in a few months so there won't be a need to prioritize by age.

Washington, D.C., has a similar strategy. "Age is not a good metric for disease severity nor disease progression," the city's health department said in a statement when asked why it plans to eventually give people ages 18 to 64 equal access to the vaccine.

Age also doesn't not necessarily reflect overall risk, said Dr. Ana Núñez, an internist and vice -dean for diversity, equity and inclusion at the University of Minnesota School of Medicine. Housing, employment and other social determinants can raise a healthy person's chance of getting the virus.

Indeed, experts said these factors help explain why people from Black, Hispanic and Native American backgrounds are dying at disproportionately high rates.

Distributing by age without targeting the most affected populations also gives preference to white residents, she said, because they outnumber racial and ethnic minority groups in many states.

"If you just do age," Núñez said, "who are you preferentially immunizing?"

Michelle Cantu, who oversees infectious disease and immunization programs at the National Association of County and City Health Officials, said it's important for jurisdictions to use data to determine who and how they immunize.

Multiple locations with large minority populations have contacted her in the past month about how an age-based system doesn't work for them, she said. "I think there are a lot of critical considerations that states and local health departments have to consider," she said.

Figuring out the best priority order for vaccines will be a short-term issue, as the number of vaccine doses is expected to rise exponentially by late April. But the question of vaccine hesitancy may then become a greater challenge, said. Dr. Sonja Rasmussen, a professor in the departments of pediatrics and epidemiology at the University of Florida.

"I have a concern we will soon get to a point where we have more vaccine than people who want to get it."

Phil Galewitz: pgalewitz@kff.org, @philgalewitz

Carmen Heredia Rodriguez: CarmenH@kff.org, @ByCHRodriguez

There could hardly be a better time to beef up mental health coverage, as we approach the anniversary of a pandemic that's been tied to an increase in depression, anxiety, substance use and suicidal thoughts.

This article was published on Friday, February 26, 2021 in Kaiser Health News.

By Bernard J. Wolfson

Karen Bailey’s 20-year-old daughter has struggled with depression and anxiety for years. Since 2017, she’s been in three intensive group therapy programs and, each time, the family’s insurer cut her coverage short, says Bailey.

“At a certain point, they would send us a form letter saying: We have determined that she is all better, it’s no longer necessary, so we are not covering it anymore,” says Bailey, 59, who lives in Los Angeles. “And believe me, she was not all better. In one case, she was worse.”

In making coverage decisions about mental health and addiction treatment, insurers frequently use “their own kind of black box criteria, not knowable to enrollees and not consistent with standards of care,” says Julie Snyder, director of government affairs at the Steinberg Institute, a Sacramento-based mental health policy and advocacy group.

A California law that took effect Jan. 1, SB-855, should make it much harder for state-regulated commercial health plans to do so. It requires them to use nationally recognized clinical standards established by nonprofit associations of clinical specialists to determine which mental health and addiction treatments they’ll cover — and for how long.

This means, for example, that insurers will find it more difficult to limit a client to only a week of residential addiction treatment when 30 days is the clinical standard, or to treat only the most immediate physical symptoms of anorexia and not the underlying psychological drivers, says Snyder.

“It’s a very strong law, and it has the potential to really be a game changer,” says Karen Fessel, executive director and founder of the Mental Health and Autism Insurance Project, which supported the legislation.

There could hardly be a better time to beef up mental health coverage, as we approach the anniversary of a pandemic that’s been tied to an increase in depression, anxiety, substance use and suicidal thoughts.

Crucially, the new law, which updates and replaces California’s previous mental health parity statute, dramatically expands the number of conditions insurers must cover.

The state law in force until this year required coverage for only nine “severe” mental illnesses, including schizophrenia, bipolar disorder and major depressive disorder, and for “serious emotional disturbances” in children. SB-855 mandates coverage for conditions ranging from mild to severe.

Federal law already required broader coverage, but in vague terms that health plans have frequently circumvented with their restrictive definitions of what’s medically necessary, patient advocates say.

By expanding the range of conditions health plans are obliged to cover and holding them to stiffer standards on the type and amount of care they must pay for, the new law closes “loopholes you could drive a Mack truck through,” says state Sen. Scott Wiener (D-San Francisco), who authored the legislation.

For years, many health plans declined to cover mental health treatment until a patient was in crisis, Wiener says. The new law “makes sure people will be able to get care early while they still have a home, a family, a job.”

Another key aspect of the law is that it requires health plans to cover out-of-network providers at in-network costs if an enrollee is unable to find timely treatment a reasonable distance — generally, 15 miles or 30 minutes — from their home.

“That is something we run into all the time,” Bailey says. The family has spent $100,000 over the years on out-of-network mental health providers for their two kids, she says.

Opponents of the new law, including the California Association of Health Plans and the California Chamber of Commerce, have argued it will significantly increase health care costs, subject insurers to continuous litigation and — through its stringent definition of medical necessity — impede the ability of providers to decide what’s best for their patients.

Proponents say the medical necessity guidelines spelled out by the specialists’ associations allow providers wide discretion to decide the best treatment for each patient. An analysis conducted for state legislators by the California Health Benefits Review Program estimated that in the first year of the law’s implementation, premiums and enrollee cost sharing would rise a mere 0.002%.

The new law won’t help everybody: It applies only to state-regulated commercial health plans covering some 13 million Californians — about one-third of the state’s population. It excludes Medi-Cal, which insures another third of state residents, as well as federally regulated commercial plans, which cover nearly 6 million.

Because only a minuscule share of patients fight their health plans over denials of care, mental health advocates hope that diligent enforcement by the Department of Managed Health Care, which regulates plans covering the vast majority of commercially insured Californians, will discourage insurers from denying necessary care in the first place.

Rachel Arrezola, a spokesperson for the agency, which opposed provisions of the legislation last year, said it fully intends to ensure compliance and has begun to do so.

But if your health plan still denies you the care you believe you need, fight it, patient advocates and health care attorneys say.

“You need to be vigilant, and you need to advocate for yourself and you need to appeal denials, and you need to do it in writing,” says Cari Schwartz, a Los Angeles lawyer who represents patients.

If you appeal a decision over the phone, take detailed notes, write down the time and day of the conversation and get the name of the person you spoke with, Schwartz says. Build a file of all communications and other information related to your case, she says.

And be persistent. “I think insurance companies bank on individuals giving up the fight,” Schwartz says.

If you need help, contact the Health Consumer Alliance (1-888-804-3536 or www.healthconsumer.org), which offers free advice and legal services.

If your mental health provider requested a certain type of treatment in 2020 that was denied by your health plan, ask the provider to resubmit it this year, because the changed legal landscape might work in your favor, says the Steinberg Institute’s Snyder.

With most commercial health plans, you have 180 days from the date you receive a denial to file an appeal. You must first appeal to your insurer. If it fails to respond after 30 days, or upholds its decision, you can take it to the agency that regulates your policy.

In most cases, that will be the Department of Managed Health Care (www.dmhc.ca.gov or 1-888-466-2219), which has a help center and allows you to file a complaint online. If your regulator is the California Department of Insurance, you can call its helpline at 1-800-927-4357 for advice, and file a complaint on its website (www.insurance.ca.gov).

Most Californians enrolled in commercial health plans are entitled to a review by independent medical experts if they are denied care because the insurer deems it unnecessary, or it’s experimental — or the insurer won’t reimburse them for emergency care.

The reviews, which can be requested through state regulators, are well worth the effort: About 60% of Independent Medical Reviews filed through the Department of Managed Health Care result in the patient getting the treatment that was initially denied, Arrezola says.

Be sure to open an archive on the managed care department’s website (https://wpso.dmhc.ca.gov/imr/), in which you can search past decisions for cases similar to yours. They can help you frame your arguments.

Ultimately, the utility of the new law depends on the will of regulators to enforce it and of consumers to avail themselves of it.

“With any luck, it means people won’t have to take out a $50,000 mortgage on their house to pay for their children’s opioid treatment,” says Snyder. “Unfortunately, that is all too common.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Northwell Health charged college student Divya Singh $50,282 for a psychiatric evaluation. Aetna reduced it to $17,066 and required Singh to pay $3,413.20. 

This article was published on Friday, February 26, 2021 in Kaiser Health News.

By Jordan Rau   

Despite a lifelong struggle with panic attacks, Divya Singh made a brave move across the world last fall from her home in Mumbai, India. She enrolled at Hofstra University in Hempstead, New York, to study physics and explore an interest in standup comedy in Manhattan.

Arriving in the midst of the COVID-19 pandemic and isolated in her dorm room, Singh's anxiety ballooned when her family had trouble coming up with the money for a $16,000 tuition installment. Hofstra warned her she would have to vacate the dorm after the term ended if she was not paid up. At one point, she ran into obstacles transferring money onto her campus meal card.

"I'm a literally broke college student that didn't have money for food," she recalled. "At that moment of panic, I didn't want to do anything or leave my bed."

In late October, she called the campus counseling center hotline and met with a psychologist. "All I wanted was someone to listen to me and validate the fact that I wasn't going crazy," she said.

Instead, when she mentioned suicidal thoughts, the psychologist insisted on a psychiatric evaluation. Singh was taken by ambulance to Long Island Jewish Medical Center in New Hyde Park, New York, and kept for a week on a psychiatric ward at nearby Zucker Hillside Hospital. Both are part of the Northwell Health system.

The experience — lots of time alone and a few therapy sessions — was of minimal benefit psychologically, she said. Singh emerged facing the same tuition debt as before.

And then another bill came.

What Gives: Singh had purchased her Aetna insurance plan through Hofstra, paying $1,107 for the fall term. Aetna markets the plan specifically for students. Under its terms, students can be on the hook for up to $7,350 of the costs of medical care during a year, according to plan documents. Singh's Northwell bill of around $3,413 is the plan's requirement that she pay for 20% of the costs of her hospital stay.

Although such coinsurance requirements are common in American health plans, they can be financially overwhelming for students with no income and families whose finances are already under the extreme stress of high tuition. Singh's Hofstra bill for the academic year, including room and board and ancillary fees, totaled $68,275.

As a result, Singh found herself beset by a double whammy of bills from two of the costliest kinds of institutions in America — colleges and hospitals — both with prices that inexorably rise faster than inflation.

For hospitals, there is supposed to be a relief valve. The Internal Revenue Service requires all nonprofit hospitals to have a financial assistance policy that lowers or eliminates bills for people without the financial resources to pay them. Such financial assistance — commonly known as charity care — is a condition for hospitals to maintain their tax-exempt status, shielding them from having to pay property taxes on often expansive campuses.

Northwell's financial assistance policy limits the hospital from charging more than $150 for individuals who earn $12,880 a year or less. It offers discounts on a sliding scale for individuals earning up to $64,400 a year, although people with savings or other "available assets" above $10,000 might get less or not qualify.

The IRS requires hospitals to "widely publicize" the availability of financial assistance, inform all patients about how they can obtain it and include "a conspicuous written notice" on billing statements.

While the bill Northwell sent Singh includes a reference to "financial difficulties" and a phone number to call, it did not explicitly state that the hospital might reduce or waive the bill. Instead, the letter obliquely said "we can assist you in making budget payment arrangements" — a phrase that conjures installment payments rather than debt relief.

Resolution: In a written statement, Northwell said that although "all eligible patients are offered generous financial payment options … it is not required that providers list the options on the bill." Northwell stated: "If a patient calls the number provided and expresses financial hardship, the patient is assisted with a financial need application." However, Northwell lamented, "unfortunately, many patients do not call."

Indeed, a KHN investigation in 2019 found that, nationwide, 45% of nonprofit hospital organizations were routinely sending medical bills to patients whose incomes were low enough to qualify for charity care. Those bills, which totaled $2.7 billion, were most likely an undercount since they included only the debt hospitals had given up trying to collect.

Singh said the worker who took down her insurance information during her hospital stay never explained that Northwell might reduce her portion of the charge. She said she didn't realize that was a possibility from the language in the bill they sent.

Northwell said in a statement that after KHN contacted it about Singh's case, Northwell dispatched a caseworker to contact her. Singh said the caseworker helped Singh enroll in Medicaid, the state-federal health insurance program for low-income people. Foreign students are not generally eligible for Medicaid, but in New York they can get coverage for emergency services. With the addition of Medicaid's coverage, Singh should end up paying nothing if the stay is retroactively approved, Northwell said.

At the same time the caseworker was helping Singh, Singh received a "final reminder" letter from Northwell about her bill. That letter also mentioned Northwell's financial assistance, but only within the context of people who completely lack health insurance.

"Send payment or contact us within 21 days to avoid further collection activity," the letter said.

The Takeaway: Despite stricter requirements from the Affordable Care Act and the IRS to make nonprofit hospitals proactively educate patients about the various forms of financial relief they offer, the onus still remains on patients. If you have trouble paying a bill, call the hospital and ask for a copy of its financial assistance policy and the application to request your bill be discounted or excused.

Be aware that hospitals generally require proof of your financial circumstances such as pay stubs or unemployment checks. Even if you have health insurance that covers much of your medical bill, you may still be eligible to have your bill lowered or get on a government insurance program like Medicaid.

You can also find documentation online: All nonprofit hospitals are required to post financial assistance policies on their websites. They must provide summaries written in plain language and versions translated into foreign languages spoken by significant portions of their communities. Be aware that financial assistance is distinct from paying your full debt off in installments, which is what hospitals sometimes first propose.

Although the IRS rules don't govern for-profit hospitals, many of those also offer concessions for people with proven financial hardship. The criteria and generosity of charity care vary among hospitals, but many give breaks to families with middle-class incomes: Northwell's policy, for instance, extends to families of four earning $132,500 a year.

Singh's family has paid off her fall tuition and half of her spring tuition so far. She still owes $16,565.

Singh said the back and forth over her hospital bill continues to cause anxiety. "The treatment I got in the hospital, after I've gotten out, it hasn't helped," she said. "I have nightmares about that place." The biggest benefit of her week there, she said, was bonding with the other patients "because they were also miserable with the way they were being treated."

Dan Weissmann, host of the "An Arm and a Leg" podcast, contributed the audio portrait that aired on NPR's "Morning Edition."

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

Jordan Rau: jrau@kff.org, @JordanRau