If Donald Glover wants to prove he respects Black women, Swarm isn’t it.
In 2013, when I was a freshman at Howard University, one of my friends was borderline obsessed with Childish Gambino’s music. Before that, I hadn’t heard much about Gambino — or his alter ego, then-comedian Donald Glover — but I was surprised when, in the midst of a conversation praising his artistry, my friend, who is also a Black woman, flatly said that the rapper didn’t like Black women, something she said was evident not only in his dating choices (at the time, the rumor was that he only dated Asian or white women) but in his lyrics. “Everyone knows that,” she said dismissively, with no anger or jealousy in her voice.
Now, a decade later, I remembered my college friend’s words after I finished watching Swarm, the new Amazon Prime TV show about a Black woman serial killer superfan named Dre (Dominique Fishback) co-created by Glover — who has since established himself as a talented creator and director — and Janine Nabers. Nabers, a Black woman, previously worked with Glover writing for his FX show Atlanta, a series that has been praised for its tender and complex depictions of Black men and widely critiqued for its caricatures of Black women.
Swarm — with its two-dimensional main character, storyline cluttered with misogynistic and racist tropes, and dubious conclusions about Black women fandoms — is perhaps the show that, for me, solidified the opinion my college friend expressed a decade ago. Glover’s hostility toward Black women no longer feels like an allegation. Because his work is so obvious, it serves as the archive of this aggression. Glover all but confirmed these concerns when he told Vulture that he had given Fishback very little direction or insight into Dre (she confirmed this in the same article), telling her, “You don’t have to find the humanity in your character. That’s the audience’s job … Think of it more like an animal and less like a person.”
Referring to a human being as an “it” or an animal is almost always a red flag that points to an individual’s deeper feelings, and it doesn’t feel like a coincidence that Glover, who has continuously been criticized for dehumanizing portrayals of Black women, would quite literally hinder an actor’s ability to find the humanity in a Black woman character.
Not only did Glover relate Dre to an animal, but he specified which one, after dismissing the character of Dre as not “that layered.” He said, “I wanted her performance to be brutal. It’s a raw thing. It reminds me of how I have a fear with dogs because I’m like, ‘You’re not looking at me in the eye, I don’t know what you’re capable of.’” With these damning quotes, Glover’s misogynoir is no longer subtext. It’s canon.
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Courtesy of Prime Video
Even though Swarm was co-created by a Black woman, featured a stunning performance by a Black woman (Fishback), and had Black women like Malia Obama in the writers’ room, Swarm’s misogynoir felt like a deeper, more direct insult to Black women than Glover’s previous projects. Instead of merely popping up on the occasional lyric or episode, hostility and mockery toward us permeate the show.
Swarm is set in Houston, Texas, and follows Dre, a young superfan of pop star Ni’jah (Nirine S. Brown), who in the show serves as a cringey mirror of the real-life Beyoncé. Dre has two important women in her life: Ni’jah and Dre’s foster sister, Marissa (Chloe Bailey), and they’re fatally intertwined. After listening to Ni’jah’s surprise release visual album about her rapper husband Caché’s infidelity (sound familiar?), Marissa dies by suicide, seemingly so impacted by both the album and her own boyfriend of three months (played by Damson Idris) cheating on her that she cannot live any longer.
With Marissa, the object of her psychosexual obsession, gone, Dre starts to unravel. Grief-stricken and kicked out of the funeral by Marissa’s biological family, Dre sets out in pursuit of meeting Ni’jah. This transforms into a cross-country killing spree, with Dre murdering people who speak badly about Ni’jah. “Who’s your favorite artist?” becomes her villainous catchphrase. If the answer isn’t Ni’jah, you’re likely to get a lecture on why it should be, and then bludgeoned to death. Dre finds her victims anywhere: her dead sister’s cheating boyfriend, Black male influencers and mechanics in the Twitter comments, a coworker’s white abusive boyfriend, the co-worker herself. Her murders aren’t complex. Anyone who is against Ni’jah, annoys Dre, or stands in Dre’s way of seeing Ni’jah doesn’t tend to live long. This, Glover says, is his attempt at examining extreme fan culture, whose adherents are often referred to as stans, a term originating from a classic Eminem song (I’ll return to that later). The problem is that this depiction of stan culture isn’t just problematic, it’s inaccurate.
There are countless issues with Swarm, but perhaps its most glaring one is how it fails to understand or speak truthfully to its supposed subject, employing what feels like irresponsible misinformation. Each episode — save episode six, which is a mockumentary about Dre’s violence — features a facetious play on the classic Hollywood disclaimer, asserting the events in the show as true and claiming “Any similarity to actual persons, living or dead, or actual events, is intentional.” This switcheroo immediately feels tired and unoriginal, like what a sophomore-year film student might find desperately inventive. It also confuses viewers in a most unproductive way. There were even a few people online who seem to be wondering whether Dre is a real killer still on the loose.
But none of the events portrayed in Swarm — save perhaps the incidents surrounding Ni’jah’s/Beyoncé’s husband being unfaithful — are true stories. That hasn’t stopped the creators from being coy about the falsity underlying their latest project. Glover has described the stories as “true-ish” and said Swarm is a “post-truth” TV series. Nabers told Vulture that, “The pilot story is a real event and the finale is a real event, and they exist in the world of internet rumors or a YouTube video or Twitter.”
If we leave aside for a minute that something existing as a rumor on the internet makes for a “real event” is a nearly Trumpian contradiction, as nonsensical as the phrase “alternative facts,” neither the pilot nor the finale are true stories either. As Nabers admitted to Shondaland, both Marissa’s suicide and existence were rumors that were never confirmed — although yes, the character does share the name of a woman who, urban legend holds, died following the release of Lemonade — and there certainly were no reports or rumors of a foster sister killing people in the aftermath. In the finale, Dre, now calling herself Tony and living as a masculine-presenting lesbian, runs onto the stage at a Ni’jah concert. In real life, there was a man named Anthony who ran onto the stage during a 2018 Beyoncé and Jay-Z concert, but there is nothing to suggest the real-life Anthony was a murderer or a violent person. The plotline most firmly rooted in reality is probably the one where Dre bites Beyoncé, but Beyoncé was allegedly bit by an actress, not a fan.
These are incredibly flimsy rumors to base an entire series off of, yet they alone are the creators’ justification to declare the series to be based on reality and a reflection of stan culture. It matters that these stories aren’t true, and that even gossip versions can’t be credited to violent stans. How can you claim to write a show that is exploring fandoms and mental health when you are stuffing it with an amalgamation of rumors and partially true stories, and calling it a meaningful statement?
Glover is an inventive and important artist (I’ve previously praised his exploration of Afrosurrealism in Atlanta), but sometimes he masks simple immaturity as a meta commentary. Consider his controversial 2022 Interview article where he interviewed himself. I’m sure he meant it to be daring. While it did cause a flurry of conversation, at its core it was tiring and confusing, and the ensuing social media noise spoke more to his troll-ish leanings than to his ability to give readers any real insight.
That interview was also one of the times that Glover addressed the criticisms of misogynoir he’s received for years. In the interview, Glover asked himself, “Are you afraid of Black women?” and replied to himself “Why are you asking me that?” Glover continued, still speaking to himself, “I feel like your relationship to them has played a big part in your narrative.” Replying again, he said, “I feel like you’re using Black women to question my Blackness.”
It was nonsensical, but also a way to make light of the very real concerns and questions the public has had for over a decade about his portrayal of Black women in songs and on TV. Even the phrasing of Black women playing “a big part in [his] narrative” is framed as though the interest in Glover’s relationship to and with Black women comes entirely from outside his work and isn’t a reaction to deliberate choices he’s made in his work. Glover is playing the role of precocious auteur here, stomping his feet, not wanting to respond meaningfully to any criticism but still desiring to be regarded as a great artist, courting controversy and resenting the inevitable visibility the controversy garners.
In this, Glover and even minor writers like Malia Obama are simultaneously too close and too removed from the subject matter — fame, and the people who worship the famous — to make an intelligent and compelling statement about it from a stan’s perspective. Glover admitted that they didn’t have an expert in fandom advise on the show and suggested to Vulture that the fame of some in the writers’ room qualified them to write about stans from this perspective. “We have people who are famous in the writers’ room and people you’d barely know. Everybody had a story about how they were roasted. Everyone had the same story of being like, ‘This person said something, and then some people jumped on the bandwagon, and it affected me,’” he said.
Glover has greatly benefited from hypervisibility, and yet perhaps understandably feels aggrieved by it. But through a lens where one sees themselves as a perpetual victim of visibility, whether that is a correct assessment or not, the behaviors of the public will perhaps always feel more aggressive or dangerous than they are.
Glover knows what his reputation is with regards to Black women, and yet with Swarm, he chose to take a Black, queer, mentally ill woman and make her the avatar of violent stans. All of those intersections of oppression — Black, LGBTQIA+, and people with a mental illness — are far more likely to be victims of violence rather than perpetrators.
Glover isn’t the first person to use art to explore violent fandom, but there’s reason to believe that many artists who do so aren’t critiquing society, but rather battling with their own inner conflict and guilt. Like Swarm, “Stan,” which some call Eminem’s magnum opus, was also not based on a real story. The song features the ramblings of a mentally ill fictional Eminem fan, who sees the rapper as his role model. Stan grows increasingly frustrated by the lack of response to his letters, so much so that he one day decides to kill his pregnant girlfriend and himself, emulating the song “’97 Bonnie & Clyde,” where Eminem raps about murdering his wife Kim and driving their daughter to dispose of the body. None of this had happened. But the song was influenced by Eminem receiving disturbing fan mail that made him feel haunted by the idea that one of his fans would, one day, decide to copy the extreme violence depicted in his songs. “Stan” was an attempt to course-correct, an expression of guilt, rather than a true account.
Glover’s own work isn’t nearly as violent as Eminem’s. But there’s something to be said about how, for the celebrity, perhaps the fear of the stan’s potential for great violence is more about the artist’s resentment of their own visibility, apprehension, or guilt about past actions, and the paranoia that comes with such an inhuman level of surveillance. To the celebrity, fandom is violent because of its sheer scale of demand and visibility. They lack the ability to see each fan as an individual and instead see them as a hive, as a swarm moving as one ominous cloud of danger, and through that lens, everything is magnified.
Perhaps this is also how Glover has come to see Black women, as a dangerous horde of screeching banshees that he must endure, but never capitulate to. Through this lens, it’s also often easy for many to dismiss the concerns about his misogynoir as romantic jealousy. While I won’t deny that this can sometimes exist — a feeling of entitlement to someone sexually because of their race — it is not what is happening to Glover. Black women are not upset because he is an object of desire we want to possess; we are upset because in his work, he has made us objects of horror and ridicule, or as mere plot devices to move Black men’s stories forward.
A disclaimer of my own: I am not a member of the Hive. I tend to listen to Beyonce’s new albums about a week after everyone else. And yet, I struggled to articulate what felt so hostile about Glover (supposedly a friend of Beyoncé’s, according to Nabers) using the momentum of her upcoming tour that honors Black queer music to portray a Black queer fan of hers as a murderous “dog.” Even the image of Beyoncé that Ni’jah has been cast in feels more like a mockery and less like a respectful nod. No effort was made to distinguish Ni’jah from Beyoncé. The literalism is lazy writing, and ironically makes the portrayal ring false, since Ni’jah captures all the aesthetics and mere facts of Beyoncé’s public life but almost none of the elements of why Black women enjoy Beyoncé’s music.
The political and racial significance of Lemonade is stripped here, removing the Black Southern specificity of the album and how it explored generational trauma, slavery, and police brutality. By casting Ni’jah’s album Festival as just an album about infidelity, the work of real-life poet Warsan Shire, who penned the poems that accompanied Lemonade’s visual album, is also erased here. Provocative, haunting, and sometimes disturbing, the Somali-British poet’s work is arguably some of the best we’ve seen from a Black woman poet in decades, and bore no small weight on the intensity with which many Black women, including myself, identified with Beyoncé’s 2016 album.
Still, no one is required to pay homage to Beyoncé. She is not sacred. However, why would a friend and peer construct a poorly made parody of what was, according to every indication, an incredibly personal album exploring infidelity, generational trauma, miscarriage, and motherhood? I have no intelligent insight to offer but this — it felt low, and mean.
When I tweeted about the misogynoir in Swarm, countless internet strangers rushed in to accuse me of erasing the Black women who worked on the show, including co-creator Janine Nabers and writer Malia Obama. But Black women are also capable of rendering other Black women into caricatures for the screen. Furthermore, according to Nabers, “[Glover] pitched the idea, and he directed the pilot, but his DNA is all over the show. He and I sat down before we even had a writers’ room and broke down each story together; we knew what the ending of the show was right away too. And that was great because that allowed us to have a clear blueprint to relay when we assigned our writers, all of whom are Black.” So it’s safe to say that while Swarm has many Black women on the team, Glover’s vision and philosophy are integral parts of the show and should not be dismissed.
And yet, that is what Black women are being asked to do — dismiss the idea of Glover being misogynistic as “silly,” according to Nabers, and to also embrace this show as some symbol of female power. “At the end of the day, I would hope that Black women watch this show and feel like they are seeing a part of Black femininity they haven’t seen before, and they’re drawn to it,” Nabers told Vulture. This is in contrast to Glover telling Vulture that he didn’t care about the audience or the internet or Beyoncé stans’ reaction to Swarm, saying, “I just refuse to take that into account because then we wouldn’t be able to make the things we want to make.”
Reading this, it feels like “the audience” or “the internet” or even the specific group of “Beyoncé stans” are almost coded ways to both portray Black women critics — who would obviously be the ones with the most to say about this show — as too large in numbers to have their own minds worth listening to, and also so insular and irrational as to render their opinions irrelevant.
In another comment, Nabers called the show “a love letter to Black women,” which is an actual silly thing to say. Nabers later compares the love Dre has for Marissa to the love she has for her mother and sister, seemingly forgetting that the show starts with Dre non-consensually watching Marissa copulate with her boyfriend. She says that it’s supposedly important for Black women to be seen as serial killers on screen because it’s never been done before, apparently oblivious to the fact that Swarm is merely the latest in a long line of media to depict Black people as violent animals. These are nonsensical contradictions coming from both creators, a mishmash of words about empowerment and mental health and craft, all to disguise that they were given a bunch of money to troll viewers. The only genuinely amazing thing to come out of this venture is the awareness of Fishback’s acting talent.
If Swarm is a love letter to Black women, it is the kind of love letter you report to the authorities to receive a restraining order against the sender, the kind of worrying letter sent by a fan who doesn’t really understand the artist. And if Glover doesn’t understand Black women or fan culture, perhaps it’s best he refrains from writing about either.
Nylah Burton is a Chicago-based writer who covers entertainment, travel, and lifestyle. She has bylines in Vulture, Travel + Leisure, and Vogue. You can find her on Instagram.
If you think you’re being overcharged on medical bills, you probably are.
The cost of medical care in the United States is notoriously steep. From prescription drugs to knee replacements, the US outspends all other wealthy countries for nearly every procedure or medical service. These exorbitant costs are shouldered by patients, with about half of American adults reporting difficulties affording health care costs, according to Kaiser Family Foundation polling. Among the 19 percent of American households that carried medical debt in 2017, the median amount owed was $2,000 per household, according to US Census Bureau data. KFF surveys also show that excessive medical prices disproportionately affect those who are uninsured, Black and Hispanic adults, and people with lower incomes.
The expense of medical care, paired with a lack of transparency around how much these services will cost and why, can add to the shock and terror that comes with a medical bill. However, patients have tools and negotiating power to reduce these costs both before services are rendered and after they receive a bill. While many patients may resign themselves to paying the bill, there are a bevy of other cost-cutting options to exhaust first. “You should never ever pay any medical bill right away,” says Caitlin Donovan, the senior director of the National Patient Advocate Foundation.
Unfortunately, the responsibility is solely on the patient or their guardian to advocate for themselves; hospitals and medical providers will often not readily offer cost-reducing alternatives. Knowing the right questions to ask can help patients reduce or even avoid huge medical bills.
What to ask while you’re still at the hospital, doctor’s office, or pharmacy
There are questions you can ask providers and pharmacists before you get a test, procedure, or prescription filled to ensure you’re not paying more than you need to. In emergency situations, some of these questions won’t apply since there may not be time to shop around when it comes to lifesaving care. In non-emergency circumstances, the first thing a patient can do to avoid a large bill for something as simple as an office visit is to visit providers that are in-network with your insurance if you have it. Your insurance carrier’s website or app will have a search tool for in-network providers. Also check the list of accepted insurances on the physician’s website. If you’re still unsure if a doctor is in-network, call your insurance carrier and speak with a representative. “A lot of the time when we see people with really big bills,” says Casey Schwarz, the senior counsel for education and federal policy at the Medicare Rights Center, “it’s because they’re trying to access something that’s either not covered or out of network.”
These bargaining tactics require a significant amount of time and energy, and are made considerably more difficult when you’re not feeling well or English isn’t your first language. Under the Affordable Care Act, patients who speak limited English are entitled to a free qualified interpreter and translated medical documents. Health care providers must inform patients that they offer interpreting services. When booking an appointment, tell the scheduler you will need an interpreter during your visit.
For non-emergency procedures and appointments at in-network physicians, here are some financial questions to ask before you leave the office.
How much will this cost?
Since 2021, federal law has required all hospitals to list pricing information online for services, such as blood work or X-rays, provided during inpatient admission and outpatient visits. These posted costs include the insurance prices and cash prices — that is, to pay without using insurance — which are often lower than insurance prices. However, studies found many hospitals did not list their prices, or if they did, the data was confusing and inconsistent. A review from the price transparency nonprofit PatientRightsAdvocate.org found that just a quarter of the country’s largest hospitals listed all of their prices for every single insurance carrier.
You should be able to access the price list on the hospital’s website (which can be a tricky process in itself; the New York Times has some tips on how to parse the data) but if you can’t, get in touch with the billing department to ask for the price. Make sure you’re looking at a spreadsheet of costs and not using the estimator tool, which Cynthia Fisher, the founder and chairman of PatientRightsAdvocate.org, says produces inaccurate estimates.
“Everybody should know what is that discounted cash price,” Fisher says. “What is my insured rate? How does my insured rate compare to other insurance rates? And guess what? You have the right to not accept that insurance rate if it’s egregiously higher.” In practice, this means informing the billing department that you do not want to use your insurance and will pay out of pocket.
Beyond the listed prices within hospital systems, if you are uninsured or will probably pay cash, health care providers must provide you with a “good faith estimate” in writing before you’re treated, says Dawn Greene, the operations manager at medical bill advocate service Resolve. These estimates include the cost of the procedure and any associated costs, like lab tests or anesthesia for a surgery. Should your final bill total $400 or more over the estimate, you can file a dispute with the provider. Those disputes should start with a call to the billing department.
For those with high-deductible insurance plans who are generally healthy and have historically never hit their deductible, it may be cheaper to pay cash, without using insurance, for a procedure or medication. “Let’s say that you have a serious medical issue, you’re going to be taking a lot of expensive medicines all the time, and you’re for sure going to hit your deductible. It’s better to go through your insurance so you can hit your deductible sooner and then you don’t have to pay for anything,” says Carolyn McClanahan, founder of financial planning firm Life Planning Partners. “But if you’re a normally healthy person, and you just come down with something short term, then if you have a high-deductible plan, it is probably better to pay cash.”
Check online databases like Healthcare Bluebook and Fair Health Consumer, which provide fair price estimates for many kinds of office visits and procedures based on your location, to make sure you’re being offered a fair price. The online tool Solv provides patients the costs for common procedures in their area if they’re not using insurance.
Should the listed cost for your insurance carrier or the cash price be beyond what you can spend, ask to see the financial assistance or charity care policy. “People don’t realize how many of them actually qualify for financial assistance from hospitals,” Donovan says. Each state or hospital will have their own eligibility requirements for financial assistance. In New Jersey and Massachusetts, for example, patients are eligible for free care if they have a family income of up to 200 percent of the federal poverty level. (The poverty guideline for a single person is $14,580 in 2023 and $30,000 for a family of four.) Even if you make more than that, you could still be eligible for a discounted rate.
If you’re still not comfortable with the price, you can research costs at other hospitals to find one that fits your budget. This can be time-consuming and frustrating, especially if you’re sick. While Donovan is not a proponent of shopping for care, she says patients can save money on imaging costs by opting for X-rays, ultrasounds, MRIs, and CT scans at freestanding clinics outside of hospital systems. So if it’s not urgent, it’s worth looking for the cheapest facility. You can call and ask for their rates over the phone, Donovan says.
How can I lower the cost of this medication?
Your doctor probably won’t know the exact cost of medication when they’re prescribing it — especially when it comes to what your insurance will or won’t cover — but they’ll know if there is a generic brand or even an over-the-counter medicine available that will undoubtedly be cheaper. You can even ask the pharmacist if there is a generic or OTC version of the drug they can give you instead. “Sometimes [doctors] prescribe pain medicine that’s actually equivalent to three Advil, 600 milligrams,” Fisher says. “Why pay for an expensive prescription when you probably have it at home in your medicine cabinet?”
Fisher recommends asking the pharmacist the price of the medication if you were to pay cash versus if it were to be covered through insurance. Often, the cash rate is much lower, she says. You can also ask the pharmacist if they have access to any discount cards or coupons from the drug manufacturer, Donovan says. Keep in mind that discount cards cannot be used with insurance.
Platforms like GoodRx offer price comparisons for medications at pharmacies near you and provide coupons for discounted medications. You won’t be able to use your insurance with GoodRx coupons. Mark Cuban’s platform Cost Plus Drugs lists discounted drug prices; your doctor will have to write the prescription to the company’s pharmacy partner, which will then mail you the medication. Cost Plus Drugs accepts Capital Blue Cross, Rightway, and other select insurances. Again, paying cash for these discounted options may be considerably cheaper than going through insurance.
Patients with Medicare are unable to use coupons from the manufacturer for drugs. However, many people are eligible for the Medicare Savings Program, which reduces drug costs down to a flat rate, says Schwarz, of the Medicare Rights Center. You can apply for the Medicare Savings Program through your state Medicare agency. There is an additional Extra Help program, which also reduces drug costs, that patients can enroll in through the Social Security Administration.
If you were prescribed medication for an ongoing or extended period of time, ask your doctor at your annual checkup if the medication is still necessary, McClanahan says. Eliminating or lowering the dosage of a drug will also lower your expenses. However, you should never defy your doctor’s instructions to take name-brand medication or scale back on dosage in order to save money.
Do I really need this test or procedure?
Sometimes doctors will order a litany of tests in order to diagnose a potential issue. The costs for even routine blood work can add up, depending on the labs ordered. Tell your physician you’re concerned about the cost of the tests, Donovan says, and ask something along the lines of, “I’m worried about finances. Are we getting a lot of value added for these tests?” For example, Donovan was told she would need monthly ultrasounds during one of her pregnancies — a considerable expense. “I was like, ‘That seems like low-value, high-cost care,’” she says. The physician quickly said the monthly ultrasounds weren’t necessary unless she experienced any complications.
“Here’s the thing about providers,” Donovan says, “as soon as you sound like you know what you’re talking about, all of a sudden they’re going to treat you like you know what you’re talking about.”
McClanahan suggests inquiring about what exactly the doctor is hoping to see in the test. “If they can’t answer that question, do you really need that test?” she says.
Can we keep the conversation limited to what the billing department would consider a preventative visit?
As a part of most health insurance plans, preventative services — like annual checkups, immunizations, and common screenings — are free. However, after reviewing a doctor’s notes from an appointment, some billing departments will categorize — or code — a free preventative visit as another type of appointment entirely, resulting in a bill. A doctor simply asking you how you feel emotionally can change the coding of a visit. “So many people come to us with that very same problem,” Fisher says.
Fisher says patients should feel empowered to tell their doctor, “This is my annual checkup. Let’s keep our conversation within the bounds of that type of visit,” while they’re in the exam room with their doctor.
If you’re being asked to pay while on the way out of the office, remind the person asking you for money that you were here for a preventative visit and to change the code on the visit. Should you receive a bill in the mail weeks later, call the doctor’s billing department and explain the situation: The appointment was coded incorrectly and you should not be charged. You may need to call your insurance company as well.
How to negotiate a medical bill
Opening a medical bill and seeing an astronomical number can come as a shock. After the procedure or appointment, patients must double-check the accuracy of billing departments and exhaust all other options to lower the bill before paying. Here’s where to start and what to ask for.
Can I see an itemized bill?
“It’s estimated that about 60 percent of medical bills that are issued have errors,” says Greene, of Resolve. Always ask to see an itemized bill to make sure you’re being charged correctly. Were you double charged for something? Charged for a service you did not receive? You can also compare the costs on your bill with the hospital’s posted prices to ensure you’re not being overcharged. “If they say a CT scan is $5,000 on their website and they’re charging you $6,000, then you know that there’s an issue with the billing and you bring that to the hospital’s attention,” Greene says.
If you’re going through insurance, compare the bill with the explanation of benefits (EOB) you received from your insurance. The explanation of benefits outlines what costs your insurance will cover. “Never pay any bill until you get that,” Donovan says, “and then you just compare that amount on the EOB to the amount you’re being billed. If those amounts don’t match … you should start making phone calls.” There’s no hard and fast rule on who to call first — your insurance or the provider’s billing department — but make sure you’re bringing up the issue with both of these departments, Donovan says. Even if your insurance denies claims for medically necessary tests or procedures — as recent ProPublica reporting found is common at Cigna — you should appeal the rejection.
Fisher recalls a patient who came to PatientRightsAdvocate.org to help dispute a $15,000 EpiPen charge from a hospital visit. Once the patient alerted the hospital of his insurance carrier, the price dropped to $4,900 — still considerably higher than the $70 he would have spent at a pharmacy with a prescription. The patient referenced the hospital’s price list and found the maximum the hospital could charge patients for an EpiPen was $600 without insurance, and $300 if he used his insurance. “He wrote a letter to his insurer and the hospital showing that they way overcharged him,” Fisher says. “They both wrote back saying that there must have been a glitch in the system.” The patient’s bill for the EpiPen was eliminated, Fisher says. Referencing the fair market price listed at Healthcare Bluebook and Fair Health Consumer can also be a useful negotiating tool to lower your bill.
Can I get on a payment plan?
Hospitals are usually willing to work with patients to receive any amount of a bill, Donovan says, so you should negotiate a payment plan if the lump sum is too large after checking for any errors. Consider all of your other expenses before agreeing to a monthly payment amount. If the billing department employee you’re speaking with isn’t receptive to your needs, Donovan suggests ending the conversation and calling back in a day or so — you might get an employee who’s more amenable. (This advice works for any of the interactions you may have with the billing department.) Again, ask to see information about financial aid as well because you likely qualify for some amount of assistance.
The nature of the American medical system requires a lot of patients: ensuring they’re staying in-network, double-checking bills for errors, advocating for low-cost care. Organizations like the Patient Advocate Foundation and Resolve work with patients to negotiate their bills with hospitals, so don’t be afraid to ask for help.
“Patients have the right not to be discriminatorily overcharged,” Fisher says. “No one should accept medical debt.”
Inside the lucrative, distinctly nonacademic world of online classes.
A digitized woman with long blonde hair dances in front of a blank spreadsheet. She’s showing you how to remove blank columns, or maybe to combine cells, or perhaps how to create a new formula to help you format an entire row. She is ecstatic to be there.
The woman is 30-year-old Kat Norton, better known as “Miss Excel,” who in 2020 began going viral for her high-energy, 15-second TikTok dances superimposed with hacks for navigating the popular data software program Microsoft Excel. Within months, she’d launched her very own digital class: the Excelerator Course, made up of 100 sub-10-minute video tutorials and packaged for the price of $297. Students can complete the tutorials and corresponding workbooks at their own pace, on their own time. They choose between the original or the advanced course (or shell out $997 for a course on the full Microsoft Office Suite), going from a total Excel newbie to a pro in just 12 hours.
The classes were a hit, particularly among her core audience of 25- to 35-year-olds who were looking to bulk up their resumes or improve their marketability; many of them were working from home due to the pandemic and considering a potential career change. And Norton is the platonic example of an online course teacher: She’s proficient in an in-demand skill and, perhaps most importantly, she’s very good at selling it.
@miss.excel Did you know all 3?!
♬ Blow Your Mind (Mwahchallenge) - Dua Lipa
But no one, not even Norton, could have predicted what a gold mine she’d stumbled upon: Within two months of opening the original course, she says, she earned more from class sales than she made at her corporate day job (which included, among other things, training people how to use Excel) which she’s since quit to be Miss Excel full time. She now estimates she works about 15 hours a week, spending the rest of the time exploring the outdoors in Sedona, Arizona, with her boyfriend, who handles sales for the company. So far, they say they’ve enrolled more than 16,000 people; there have been multiple occasions on which they brought in more than six figures in a single day, claims confirmed by documentation reviewed by Vox. “It’s when I do the webinars,” she says of the live classes she streams from wherever she wants whenever she wants, “those are the massive cash influx days.”
Norton and many other influencers are cashing in on the online course boom, a cottage industry in which anyone can learn a money-making or otherwise life-improving skill — the Microsoft Office suite, email marketing, “gut health,” equitable household labor, how to get a tech job, self-confidence — from someone they already trust. These courses, hosted on one of the dozens of make-your-own course platforms like Teachable or Kajabi, can run from a few hundred bucks to thousands of dollars, from a day-long “intensive” to a months-long course. What most of them have in common is that they’re undertaken completely independently — for the majority, students aren’t part of a specific cohort, but can sign up and complete the work whenever they want. All of the coursework is typically prepared long before they ever sign up: the videos, the worksheets, the content — all are premade and prerecorded, meaning that every time someone new joins the program, the teacher makes money. If a creator gets lucky, they can spend only a few weeks or months building a course that will continue to earn them profit for years to come.
It makes sense, then, why so many of these classes are about business; even online courses devoted to “boosting your confidence” are pretty explicitly geared toward improving one’s marketability. The online course creator is a distinctly American character, one who preaches that the surest way to financial stability is self-employment, and more important than any singular interest — science, art, sports, whatever — is your ability to sell it to everyone else.
You could, if you really wanted to, write off all influencer online courses as cynical cash grabs by people who know their followers will fork over any amount of money for their tutelage. But that wouldn’t tell the whole story. The travel YouTuber Damon Dominique’s foreign language courses, for instance, are full of funny and beautifully edited videos in which he teaches students conversational French or Spanish, interspersed with entertaining stories about his escapades hitting on men at European raves. Like Norton of Miss Excel, Dominique already had a background in language teaching, but decided to launch a course when the pandemic made it difficult to film travel videos.
For creators like Dominique, online courses are a welcome respite from the erratic and unpredictable nature of making content on internet platforms. “There’s a change in the algorithm every few months, and right now it’s all moving toward short-form video,” he says. It took him about six months to organize, film, and edit the course, offered on the digital course platform Teachable, which, like most course platforms, takes either a percentage of the revenue or costs creators a few thousand dollars per year to use, depending which pricing model they choose. So far, more than 5,000 people have taken his $199 French course.
Teachable doesn’t consider itself as a replacement for higher education, per se, but it does hope to supplement it. “Most people never go to college, and they need a solution that works with them and their life,” explains Teachable general manager Mark Haseltine. “The challenge with traditional education is it’s so expensive, and it’s on the school’s time, not the individual’s time. A lot of professors are more concerned about their own reputation.” Influencers, he argues, are experts at engaging with their audiences, who in turn trust them to educate in a way they’re already familiar with.
Academics, however, don’t always see influencers as the best professors. “Some of [these influencers] do have legitimate training in their field, and some don’t, but they’re able to position themselves as credible experts by using these acceptable boundaries and patterns for communication authenticity,” explains Emily Hund, a research affiliate at the Center on Digital Culture and Society at the University of Pennsylvania’s Annenberg School for Communication. “In the realm of parenting stuff, there are so many people selling parenting courses from every possible angle. On one hand, it’s great when it comes from an actual trained psychologist because now more people can access helpful tips. On the other hand, every day you’re getting content about what might be wrong with your kid. It creates this strange dynamic, this shift to selling ways of thinking and ways of approaching the world.”
Consider, for instance, the kind of person most closely associated with influencer courses. YouTuber Jake Paul advertised his “Financial Freedom Movement” course in 2020 with a fiery screed against traditional schooling: “I’m sick of our education system and how it’s teaching kids 0 real life skills for them to secure there (sic) own future,” he tweeted. His solution? A $20 per month course where kids can learn skills like becoming an Uber driver or food delivery worker to support themselves while they network their way to social media stardom. (The program’s website is no longer functioning.)
Or take YouTuber and motivational speaker Brendon Burchard, who for $997 a year can teach you how to be a millionaire. Specifically, he will teach you to become an influencer, using “seven-figure marketing strategies” to market, well, yourself. The idea is that if you sign up for a course by Burchard, you too could someday become a Burchard: someone who tweets about “ownership mindset” and “high performance habits” and produces YouTube videos about “the power of encouragement.” Evangelical Christian influencer Bethany Beal’s $1,900 “She Works Smart” course is more explicit: The end goal is for you to start your own online course business “so that you can make money on autopilot.”
And boy, are people trying to make money on autopilot. Online courses can run the gamut from shady (professional misogynist and alleged sex trafficker Andrew Tate’s $50 per month “Hustler’s University,” where students learn crypto trading and dropshipping) to explicitly criminal (there is at least one six-week course in which $945 will get you an in-depth lesson on how to steal credit cards and use them to pay for fancy vacations). They’ve earned the online course industry a bit of a bad rap on the wider internet; in YouTube videos, Medium posts, Reddit threads, and tweets, people vent their frustrations about being endlessly marketed to in this specific way. “All of these influencers peddling this shit contributes to people putting less and less value into teaching and more into just marketing themselves as products,” describes one Reddit commenter. “It’s an MLM but in human form.”
Nicole Ouellette, the founder of a marketing consulting company called Breaking Even Communications, was introduced to influencer courses through the small business owners she worked with, many of whom said they’d paid for expensive business courses from people like Burchard or financial influencer Grant Cardone. “At first I thought, maybe these people know more than I do,” Ouellette says, laughing. “And then I started looking into it.”
What irked her most about them was that her clients were made to believe that the only reason the advice didn’t “work” was that they didn’t do it properly. “I’ve said this in business meetings before: ‘If there was one thing that ‘worked,’ I would tell you what it is, make you pay me $10,000 for it, and lie on a beach.’” She found that the courses her clients took followed the same formula and gave the same advice: find your target market, “start with why,” and build your “click funnel.” (“Click funnel” is a term that comes up often in online marketing speak; the basic idea is turning your existing connections into paying customers by sending them increasingly irresistible emails.)
Another thing that can help? A recession. “People get a little more desperate for money and think they need to start a side hustle,” says Ouellette. “I’ve had more than one business owner sitting in my conference room, crying, asking if I can save their business. These courses seem very tempting, especially if an influencer says that the last two courses were full and there’s a waiting list. You think they really know what they’re talking about.”