Former Facebook exec: ‘Zuckerberg is sitting on more data about what people want to do online than anyone else in the world’

Alex Stamos, Facebook's former chief security officer, said Zuckerberg is sitting on a whole lot of data about people's online decision making.


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Hope You’re Sitting Down: Hospital Charges $4,700 For A Fainting Spell

Listen to NPR’s All Things Considered tonight for our audio report on Bill of the Month. It’s scheduled to air at approximately 5:20 p.m. on your local public radio station.

Matt Gleason had skipped getting a flu shot for more than a decade.

But after suffering a nasty bout of the virus last winter, he decided to get vaccinated at his Charlotte, N.C., workplace in October. “It was super easy and free,” said Gleason, 39, a sales operations analyst.

That is, until Gleason fainted five minutes after getting the shot. Though he came to quickly and had a history of fainting, his colleague called 911. And when the paramedics sat him up, he began vomiting. That symptom worried him enough to agree to go to the hospital in an ambulance.

He spent the next eight hours at a nearby hospital — mostly in the emergency room waiting area. He had one consult with a doctor via teleconference as he was getting an electrocardiogram. He was feeling much better by the time he saw an in-person doctor, who ordered blood and urine tests and a chest-X-ray.

All the tests to rule out a heart attack or other serious condition were negative, and he was sent home at 10:30 p.m.

And then the bill came.

The Patient: Matt Gleason, who works for Flexential, an information technology firm in Charlotte. He is married with two children.

Total Bill: $ 4,692 for all the hospital care, including $ 2,961 for the ER admission fee, $ 400 for an EKG, $ 348 for a chest X-ray, $ 83 for a urinalysis and nearly $ 1,000 for various blood tests. Gleason’s insurer, Blue Cross and Blue Shield of North Carolina, negotiated discounts for the in-network hospital and reduced those costs to $ 3,711. Gleason is responsible for that entire amount because he had a $ 4,000 annual deductible. (The ambulance company and the ER doctor billed Gleason separately for their services, each about $ 1,300, but his out-of-pocket charge for each was $ 250 under his insurance.)

Matt Gleason questioned many of the charges he was billed after a trip to the ER and asked the health care provider for clarity. They sent him their chargemaster so he could investigate the charges himself.(Logan Cyrus for KHN)

Service Provider: Atrium Health Pineville (formerly called Carolinas HealthCare System-Pineville), a 235-bed nonprofit hospital in Charlotte and one of more than 40 hospitals owned by Atrium.

Medical Service: On Oct. 4, Gleason was taken by ambulance to Atrium Health Pineville emergency room to be evaluated after briefly passing out and vomiting following a flu shot. He was given several tests, mostly to check for a heart attack. 

What Gives: Fainting after getting the flu vaccine or other shots is a well-described phenomenon in the medical literature. But once 911 is summoned, you could be facing an ER work-up. And, in the U.S., that usually means big money.

The biggest part of Gleason’s bill — $ 2,961 — was the general ER fee. Atrium coded Gleason’s ER visit as a Level 5 — the second-highest and second-most expensive — on a 6-point scale. It is one step below the code for someone who has a gunshot wound or major injuries from a car accident. Gleason was told by the hospital that his admission was a Level 5 because he received at least three medical tests.

Gleason argued he should have paid a lower-level ER fee, considering his relatively mild symptoms and how he spent most of the eight hours in the ER waiting area.

The American Hospital Association, the American College of Emergency Physicians and other health groups devised criteria in 2000 to bring some uniformity to emergency room billing. The different levels reflect the varying amount of resources (equipment and supplies) the hospital uses for the particular ER level. Level 1 represents the lowest level of ER facility fees, while ER Level 6, or critical care, is the highest. Many hospitals have adopted the voluntary guidelines.

David McKenzie, reimbursement director at the American College of Emergency Physicians, said the guidelines were set up to help hospitals charge appropriately. Asked if hospitals have an incentive to perform extra tests to get patients to a higher-cost billing code, McKenzie said: “It’s not a perfect system. Hospitals have an incentive to do a CT exam, and taxi drivers have an incentive to take the long way home.”

The guidelines don’t determine the prices hospitals set for each ER level. Hospitals are free to set whatever prices they want as long as their system is consistent among patients, he said.

He said the multiple tests on Gleason suggest the hospital was worried he could be seriously ill. But he questioned why Gleason was told to stay in the ER waiting area for several hours if that was the case. It’s also not clear if Gleason’s history of fainting and overall good health were considered.

Blue Cross and Blue Shield of North Carolina said in a statement that the hospital “appears to have billed Gleason appropriately.” It noted the hospital reduced its costs by about $ 980 because of the insurer’s negotiated rates. But the insurer said it has no way to reduce the general ER admission fee.

“We work hard to negotiate discounts that reduce costs for our members, but costs are still far too high,” the insurer said. “This forces consumers to pay more out of pocket and drives up premiums.”

Gleason, in fighting his bill, actually got the hospital to send him its entire “chargemaster” price list for every code – a 250-page, double-sided document on paper. He was charged several hundred dollars more than the listed price for his Level 5 ER visit.

Gleason reviews the chargemaster he received from Atrium Health.(Logan Cyrus for KHN)

“In this specific example, the price of admission to the ER was more than $ 2,960. That was on top of more than $ 1,000 for the medical procedures actually performed. We won’t significantly bring down health care costs until we address the high prices like these,” BCBS-NC said in the statement.

John Hennessy, chief business development officer for WellRithms, a consulting firm that reviews bills for large employers, said the hospital charges are significantly higher than what Medicare pays in the Charlotte area, but those are the prices Gleason’s insurer has negotiated. “Seeing billed charges well in excess of what Medicare pays is nothing unusual,” Hennessy said.

He said the insurer likely agreed to the higher charges to make sure it had the large hospital system in its network. Atrium is the biggest health system in North Carolina.

He said the coding “makes sense” because it meets the guidelines — even if that meant a nearly $ 4,000 bill for Gleason.

“The hospital has every right to collect it, regardless if you or I think it’s a fair price,” he said.

Gleason says the $ 3,700 hospital bill won’t bankrupt his family, but “what it does is wipe out our savings.”(Logan Cyrus for KHN)

Resolution: After Gleason appealed, Atrium Health reviewed the bill but didn’t make any changes. “I understand you may be frustrated with the cost of your visit; however, based on these findings, we are not able to make any adjustments to your account,” Josh Crawford, nurse manager for the hospital’s emergency department, wrote to Gleason on Nov. 15.

Atrium Health, in a statement to KHN and NPR, defended its care and charges as “appropriate.”

“The symptoms Mr. Gleason presented with could have been any number of things — some of them fatal,” the hospital said.

“Atrium Health has set criteria which determines at what level an [emergency department] visit is charged. In Mr. Gleason’s case, there were several variables that made this a Level 5 visit, including arriving by ambulance and three or more different departmental diagnostic tests.”

Gleason said the $ 3,700 hospital bill won’t bankrupt his family. “What it does is wipe out our savings,” he added.

The Takeaway: Gleason, understandably, said he’s reluctant to get a flu shot in the future. But that’s not the best response. It’s important to know that fainting is a known reaction to shots and some people seem particularly prone. It’s best to sit or lie down when you get the vaccine, and wait five to 10 minutes before jumping up and returning to business.

Be aware: If you — or someone else — calls 911 for a health emergency, you are very likely to be taken to the hospital. You probably won’t have a choice of which one. And a hospital trip may not even be needed, so think before you call: “How do I feel?”

The medical professional who administered the shot might have suggested that calling 911 wasn’t a smart or needed response for a known side effect of a vaccine injection in a young person.

The emergency room is the most expensive place to seek care.

In hindsight, Gleason might have gone to an urgent care facility or called his primary care doctor, who could have evaluated him and run some tests at much lower prices, if needed.

But employers, hospitals and doctors regularly tell patients if they need immediate care to go to the ER, and hospitals often tout short waiting times in their ERs.

With high deductibles becoming more common, consumers need to be aware that a single trip to the hospital, especially an ER, could cost them thousands of dollars — even for symptoms that turn out to be nothing serious.

Alex Olgin of WFAE and Elisabeth Rosenthal of Kaiser Health News contributed to the audio version of this story.

Do you have an exorbitant or baffling medical bill? Join the KHN and NPR Bill-of-the-Month Club and tell us about your experience.

Kaiser Health News


Animal Lover? Pet Sitting Just Might Be the Paw-Fect Side Gig for You

Diana Sanchez grew up surrounded by animals. So much so, her parents used to joke that she grew up in a zoo, complete with six fish, four dogs, two cats and a dove. Whenever she visited an animal shelter, she tried to bring home a potential new pet.

When she left home in Plant City, Florida, to attend the University of Tampa, she could not take her pets with her because dorm life wasn’t an ideal fit for them. But by her senior year, she really missed being around animals. While hunting for a part-time job in 2016, she discovered an ad from Tampa Pet Sitters.

“At first I thought it was too good to be true. ‘I get to pet dogs, and I get paid for it?’” she says. Fast forward to today: Sanchez, 25, is still pet sitting part time when she’s not teaching elementary school students.

Pet sitting as a side hustle is on the rise, according to a Penny Hoarder analysis of U.S. Census Bureau microdata. In 2017, 135,584 people in the U.S. classified themselves as part-time nonfarm-animal caretakers. That’s up from 74,349 in 2007 — an 82.4% increase.

Overall employment for all part-time workers increased only 16% in the same period.

So if you looking for a side hustle and have a love of four-legged furry friends, here’s what you need to know about being a pet sitter.

What Does a Pet Sitter Do?

Pet sitters provide owners peace of mind by watching over their animals while the clients are away. Jennifer Palhete, who works in Lakeland, Florida, about an hour from her home in Tampa, Florida, can’t let her three dogs out during the day. Knowing a pet sitter is going to be there to feed and let them out takes a huge burden off her shoulders.

“I never have to think about it, and the peace of mind that they offer is huge,” she says.

Some of the services offered by pet-sitting companies include midday walks and visits, in-home overnight watches and boarding at the sitter’s home.

For midday walks or in-home visits, a sitter will come to the client’s house to feed and let the pets out for a set period. The visit duration varies depending on the services provided by the company.

During in-home overnight visits, a sitter will stay at the client’s house to feed, walk, administer medication, play with and watch over the pets all night. “It’s very similar to an Airbnb experience, plus a pet to take care of,” Sanchez says.

People who opt for the in-home service do not want to board their pets in a kennel, she adds. All three of Palhete’s dogs were rescued, and one has special needs after suffering severe abuse. She knows putting them in a kennel would be detrimental to the progress they have made toward being comfortable around people.

“The fact that they can stay in their own house, have their own food and stay on the same schedule is such a huge help to me,” Palhete says.

Some services offer boarding where the owners drop their pets off at the sitter’s house instead of having the sitter stay in theirs. This option allows Lisa Peddicord, a part-time pet sitter and dog walker with Tails and Trails in St. Petersburg, Florida, to simultaneously care for the client’s and her own pets.

What’s the Work Schedule and Pay Like?

A woman trains a golden retriever puppy.

According to Sanchez and Peddicord, pet sitting is a flexible side job that works well for their respective schedules.

Sanchez says the demand for pet sitters usually increases during vacation times like spring break, the summer and holidays. This fits in perfectly with her day job as a teacher. Working seasonally, Sanchez says she’s able to make $ 200 to $ 300 in a weekend doing multiple overnight in-house watches or by doing one overnight with several midday visits.

Peddicord, who works in the evenings as a vet tech at an emergency animal hospital, is able to work 10 to 15 hours per week as a midday dog walker. Last year, between dog walking and boarding pets at least once a month, she was able to make just under $ 10,000.

“That’s the difference between going on vacation or buying your first house,” she says. “So it makes a big difference.”

What Makes a Good Pet Sitter?

A golden retriever puppy gets belly scratches from its pet sitter.

Both Sanchez and Peddicord offered some tips and advice to anyone considering becoming a pet sitter.

Build a Trusting Relationship With the Owners

Peddicord says not all pet owners are alike when it comes to trusting sitters. Some need more reassurance than others. To establish that rapport, she suggests meeting the owners with the pet for a “coffee date” or going to the owners’ home to have them demonstrate their routine.

Then during your visits, text the owners pictures of their pets with updates on what they did that day.  “I think that helps you build trust by filling them in on daily activities,” she says.

Be There On Time

Another way to establish trust is to be at the client’s house on time. Sanchez says most services offer a time window so the owner knows when to expect the sitter. For example, Sanchez may tell a pet owner she’ll be there between 4 p.m. and 6 p.m. If you have two or three appointments during that two-hour window, make sure you stay on schedule.

Have Patience

Sanchez says most of the time when you walk through the door, dogs are ready to play and the sitter has to be prepared for them to have a lot of energy. But some dogs require a little more work than others. She recalls working with a dog that was newly adopted from an animal shelter. The dog would vet Sanchez by cautiously sniffing her before exiting the crate. “Every single visit, he would do this thing before I even tried to put a leash on him,” she said. “I made sure he was comfortable.”

Learn About Different Pet Personalities

A woman takes photos of two whippet dogs and a poodle.

As Sanchez notices more people getting into the field, she encourages potential sitters to become familiar with animal behavior. She says you may know what works for your dog, but that may not work on other people’s dogs. “There are so many pets out there that want attention in different ways, so familiarize yourself with different animal behaviors. It will make your job so much easier.”

Don’t Have Experience? Volunteer

If you don’t have much experience with animals beyond your own pet, Sanchez recommends volunteering at an animal rescue or shelter. Also, if you have a friend who owns a pet, offer to pet sit if they go out of town. That way you can see how pets respond when their owners are not around.

She says, “The more patient and friendly people we can get into pet sitting, the better.”

Matt Reinstetle is a staff writer at The Penny Hoarder. He writes about side hustles and the gig economy. Follow him on Twitter @MattReinstetle.

This was originally published on The Penny Hoarder, which helps millions of readers worldwide earn and save money by sharing unique job opportunities, personal stories, freebies and more. The Inc. 5000 ranked The Penny Hoarder as the fastest-growing private media company in the U.S. in 2017.

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