The Grand Tour, Twin Peaks, The Crown, and More – The Weekend Chill

Last Friday, Netflix announced that it had picked up Riverdale spin-off Sabrina the Teenage Witch to series, giving an order of two 10-episode seasons. Both seasons will be shot back-to-back, and will be released on the streaming service a year apart. The reason Netflix acquired the drama was because Riverdale has been a huge hit internationally. Riverdale showrunner Roberto Aguirre-Sacasa has written the script.

On Monday, Stranger Things was officially confirmed for a third season by Netflix on Twitter. Given the show’s popularity, and the talked-about plan to have four seasons by the Duffer Brothers, this was pretty much a set thing. It’s just “official” now.

Later that day, Netflix revealed that House of Cards would resume production in January 2018 without Kevin Spacey, who was ousted after a series of sexual misconduct allegations. The sixth and final season will focus instead on Robin Wright’s character, who plays the wife of Spacey’s character. Given the production delay, expect a similar delay in the release of the show.

And in even more Netflix news, we got a teaser trailer for an extravagant new sci-fi drama called Altered Carbon, which is set 300 years into the future where consciousness can be transferred into another body, allowing rich people to live forever. It stars Joel Kinnaman as Takeshi Kovacs, a former soldier tasked with solving the murder of a wealthy man’s last body. Altered Carbon is out February 2.

On Tuesday, a report from Deadline said that Quentin Tarantino has come up with “a great idea” for Star Trek, which he hopes to direct. He’s already talked with producer J.J. Abrams, who directed the first two chapters of Trek reboot trilogy, and a writer’s room is being assembled. The film will be rated R, as are all Tarantino films, Deadline’s sources said later in the week.

Disney and Fox’s discussions for the takeover of latter’s film and TV business are reportedly back on, with the former “closing in on a deal”, according to CNBC. Fox’s assets are said to be worth over $60 billion (about Rs. 3.87 lakh crore). While this deal would result in job losses at the two companies, it could likely give fans an Avengers and X-Men crossover.

Netflix finally gave us a release date for Black Mirror season 4 on Wednesday: it’s out December 29. All six new episodes of Charlie Brooker’s anthology sci-fi series will be out the last Friday of 2017, from directors such as actress Jodie Foster, Tim Van Patten (Game of Thrones), and David Slade (American Gods) among others. Here’s our review of the show, if you’re interested.

The live-action Pokemon film – Detective Pikachu – has snapped up Deadpool star Ryan Reynolds to voice everyone’s favourite Pokemon. He joins Justice Smith (Paper Towns) and Kathryn Newton (Big Little Lies). Filming begins next month in London.

EW gave us a first look at Sophie Turner’s (Game of Thrones) Jean Grey in the new X-Men movie, X-Men: Dark Phoenix on Thursday, alongside Jessica Chastain’s shapeshifting villain, a funeral being attended by Professor X and others, and the X-Jet in space. X-Men: Dark Phoenix is slated to release November 2, 2018.

The disappointment of Justice League has pushed Warner Bros. to shake-up its production division, with executives being shuffled around. Producer Jon Berg has been removed from his position at the head of the table, with the studio looking to bring in someone new to lead DC Films. WB President Toby Emmerich is also considering moving DC Films into the main production stable, like with Sony and Fox.

J.K. Rowling has defended the casting of Johnny Depp in her Fantastic Beasts universe, after fans voiced concern over his troubling split with ex-wife Amber Heard, amid growing social movement to punish perpetrators of sexual and physical misconduct in the wake of Harvey Weinstein accusations. Rowling said she can’t openly address concerns due to agreements in place “to protect the privacy of two people”, but that she was “not only comfortable sticking” with Depp, but “genuinely happy”.

After a week of marketing, the first trailer for Jurassic World: Fallen Kingdom arrived early Friday morning. It shows Claire (Bryce Dallas Howard) convincing Owen (Chris Pratt) to rescue the dinosaurs on Isla Nublar, where an imminent volcanic eruption puts the remaining creatures under threat.

That’s all the entertainment news for this week. Welcome back to The Weekend Chill, your one-stop destination for what to watch, play, or listen to this weekend. Here are the best picks:

The Crown
The second season of Netflix’s lavish multimillion-dollar production will enter the second decade of Queen Elizabeth II’s (Claire Foy) reign, from the Suez Crisis in 1956 to the Profumo affair scandal in 1963, which led to the resignation of the Queen’s third Prime Minister, Harold Macmillan. Between that, she’ll meet US President Kennedy (Michael C. Hall), and First Lady Jackie.

Meanwhile, her sister Princess Margaret (Vanessa Kirby) will meet her future husband Tony Armstrong-Jones (Matthew Goode). The Queen’s husband Philip (Matt Smith) will continue to struggle for autonomy, and life on his own terms. This will also be the final season for Claire Foy’s portrayal of the Queen, who will be replaced by Olivia Colman for the next two years.

Early reviews paint a highly favourable view of The Crown season 2, praising the work of Foy, and the execution of vision and the quality of writing from creator and writer Peter Morgan. Vulture’s Jen Chaney says: “On every level, The Crown is deserving of praise. But it’s that subtle emphasis on the idea that even the most stubborn among us can at least try to evolve that makes it vital end-of-2017 viewing.”

How to access: Netflix
Time commitment: 10 hours

The Grand Tour
The trio of former Top Gear hosts Jeremy Clarkson, Richard Hammond and James May return for a second season of their new motoring show on Amazon, which finds them on yet another globe-trotting adventure, from snow-clad peaks, and open plains, to the desert of Mozambique. Locations also include Croatia, Dubai, Spain, Switzerland, Colorado, and New York.

This year, the studio scenes involving the tent have been shot in the Cotswolds in England. And thankfully, The Grand Tour has cut back on some of the useless bits, turning the Celebrity Brain Crash into Celebrity Face Off, where celebrities actually race each other instead of dying in various silly ways.

The first episode, available Friday worldwide, takes place in Switzerland. The cars being compared include Lamborghini Aventador S, a Honda NSX, and Rimac Concept One, an all-electric Croatian supercar. Celebrities for the episode are Ricky Wilson (The Voice UK), and David Hasselhoff (America’s Got Talent).

The Grand Tour Is Great Because It Stole the Best Thing About Top Gear

How to access: Amazon Prime Video
Time commitment: 1 hour

Twin Peaks
When a spirit in the image of Laura Palmer (Sheryl Lee) told FBI Special Agent Dale Cooper (Kyle MacLachlan) in the season two finale that she would see him again in 25 years, no one – including creators Mark Frost and David Lynch – could’ve imagined that it would actually happen. But with Twin Peaks’ return as many years earlier this year, it did.

A third season, of 18 episodes, picked up the story of Cooper 25 years on, with the man still stuck in the parallel dimension called the Black Lodge. When he does get out, he becomes a diminished version of himself called Dougie Jones. For all those years, Cooper’s other self – inhabited by the evil spirit BOB – has been roaming the country, killing as he pleases.

The show’s revival was nothing like the original, and unlike anything else on TV. Unconstrained by any network ideas, Lynch – who directed all 18 episodes – doubled down on his ideas in the era of TV auteurs. Twin Peaks was still as surreal and suspenseful as it was, and more interested in delivering an experience than plot and closure.

Twin Peaks: The Return is now available on Blu-ray, which brings eight hours of bonus features, including several in-depth behind-the-scenes featurettes, a trio of making-of featurettes, a collection of promos produced by Lynch, and more. There are 10 half-hour documentaries that provide a look at Lynch’s direction.

twin peaks return finale Twin Peaks The Return finale The Weekend Chill

Photo Credit: Suzanne Tenner/Showtime

Twin Peaks’ Return Is Even More ‘Lynchian’ in the Era of TV Auteurs

How to access: Amazon US, Hotstar, or Showtime
Time commitment: 15 hours and 30 minutes

City of Ghosts
When ISIS took over the city of Raqqa, Syria, a handful of anonymous activists came together to create “Raqqa is Being Slaughtered Silently”, a citizen’s journalism movement that aimed to inform the world of the atrocities being committed behind the blackout laid down by the terror group. Soon, ISIS put a bounty on the heads of RBSS, torturing and executing them and their families if they were caught.

City of Ghosts – a documentary from Matthew Heineman, the film-maker behind the award-winning drug problem doc Cartel Land – follows the journey of these brave Raqqa citizens, from their early days at home to being on the run undercover, in southeast Turkey across the border from Syria, or departing for Germany after ISIS came for them in Turkey too.

With deeply personal access, City of Ghosts is a must-watch look at those willing to stand up against one of the greatest evils in the world today. It has received praise from all corners, with LA Times’ Kenneth Turan noting: “City of Ghosts demonstrates, in Hamoud’s phrase, that “the camera is more powerful than a weapon,” but it also shows the horrible price it extracts from those who wield it.”

How to access: Amazon Prime Video
Time commitment: 1 hour and 32 minutes

Other mentions:
Multiple films under Aamir Khan Productions are now on Netflix, including Lagaan (2001), Taare Zameen Par (2007), and Delhi Belly (2011). Dangal was already on the platform, if you’re wondering.

The third season of Angie Tribeca, the cop procedural parody from Rashida Jones, has arrived in full on Amazon Prime Video.

For more streaming choices, check out our monthly guide for Netflix. The 2015 biopic Steve Jobs with Michael Fassbender, and Amy Poehler-Tina Fey comedy Sisters are out this weekend.

88-year-old cult auteur Alejandro Jodorowsky’s autobiographical film, Endless Poetry (Poesía Sin Fin), about the years he spent as an aspiring poet in Chile, has now arrived on Blu-ray and rental.

So has the Israeli comedy The Women’s Balcony (Ismach Hatani) – Amazon Video, iTunes, and Blu-ray – which focuses on a group of women who rebel against their new rabbi and his ultra-traditionalist message.

Video games:
A Hat in Time
Funded off a Kickstarter in 2013, indie 3D platformer A Hat in Time arrived this week on consoles after its PC release back in October. The game stars Hat Kid, a space-farer who comes across a mafioso during her travels. Refusing to pay the toll he demands for crossing their town, she loses the Time Pieces that power her ship, and now must head down to the planet.

Split into four different chapters that take place in heavily varied worlds, A Hat in Time builds on its platforming mechanics with a lot of charm, eye-popping colour, and hat-crafting. The latter is crucial to Hat Kid building out her repertoire of attacks, with hats giving her the power to sprint faster, repel attacks, or use a grappling hook.

In our review of the game, we praised the game’s infectious personality, the option to craft new hats, and colourful environment, while noting its boss fights, and introductory chapter as issues. If you enjoy platformers, A Hat in Time is worth a shot.

How to access: PlayStation 4, Steam for Windows and macOS, or Xbox One
Time commitment: 15 hours

Reigns: Her Majesty
Building on the success of Reigns released last year, this standalone spin-off makes you a queen trying to keep a kingdom in check. The gameplay is still the same: it’s a cross between Tinder and a deck of tarot cards. You’ve to manage four variables: the Church, people, military, and finances. Each of those has a gauge, and if either one becomes full or empty, you’re dead.

Being a queen is tougher than a king, since you’ve to deal with complications that men aren’t bothered with. How you dress will attract comments from the clergy, who will try to prove witchcraft, and your faithfulness to your husband will be questioned. Reigns: Her Majesty avoids being in your face, but neatly weaves commentary on sexism through the game. How you navigate these personal and political quagmires will define your reign.

The decisions you take with one queen will also affect the next ruler, such as sending out explorers to search for undiscovered lands, or aligning yourself to a cult. Reviewers are praising the new game for improving upon the original, being simple enough for newcomers, and still providing depth for long sessions.

How to access: Android, iOS, or Steam for Windows, macOS, and Linux
Time commitment: As much as you want, really

Ixigo Looks Beyond Chatbots With ‘Tara’, Its Voice-Based AI-Powered Assistant

Although the Internet should have disrupted the travel industry, the fact is that even as companies like Cleartrip, MakeMyTrip, Ibibo and others have grown into huge enterprises day, old-fashioned travel agents you can talk to still represent a big part of the industry. But what if even the travel agent you talk to could be replaced by an intelligent voice agent?

We’re not talking about a chatbot – despite a lot of chatter around conversational commerce, the fact is that most chatbots are just dumb replacements for IVRs – but voice assistants similar to Siri and Cortana. The difference is that these voice-based assistants/ agents are dedicated solely to helping you get the best travel deals. That’s the idea behind Ixigo’s new voice assistant Tara, which will be launching in 2018 as part of the Ixigo app, aside from its standalone avatar.

Gadgets 360 caught up with Rajnish Kumar, the co-founder and CTO of Ixigo, to learn more about Tara, and how it’s different from chatbots. “Tara is a culmination of all the building blocks and technology we’ve built over the years. Those things had to happen in a certain sequence or order,” says Kumar. “The first few years we spent a lot of time harnessing a lot of data from the Internet, from our partners, APIs etc, and we created a user interface where people could search from a wide set of data sources and find what they’re looking for.”

But what makes an assistant like Tara so different from a typical chatbot though? According to Kumar, the use of AI is integral to Tara, and is driven by the needs of a conversational interface. “You can’t expect a conversational option to push 500 different options unlike a dropdown menu, so there’s a need to know the user much better,” says Kumar. “An AI-driven platform like this also helps avoid the issues of a rules based platform, and what happens is that the more people use Tara, the better she will understand them, and the more personalised she would become.”

In a demo, Tara is quippy and helpful, asking about holiday preferences and making booking suggestions. The assistant knows what your frequent flier details are and asks which dates work best for you, before making a specific suggestion. It looks smart and capable, though one can’t actually be sure until the company launches the feature next year.

tara lowest fare ixigo

With Tara, Ixigo wants to proactively ask you about your plans, make suggestions based on your interests, and try and engage with you. It might start by guessing that since you travel each winter to a beach, you may wish to do so this year too, and make a suggestion – and if you’re interested and start looking into tickets, it might suggest picking the next weekend because its price prediction engine knows that’s when the tickets are going to be cheapest.

To make its suggestions, Ixigo uses a lot of data, from call transcripts, to emails with complaints, to chat histories from customer support. All the data that the company has been able to gather about a user goes into the training model, and the results are a smart interface that can actively reach out to the user with a voice call when they’re free, and engage them in a conversation about booking the next family holiday. At least, that’s the idea.

“All these searches, user interactions, user behaviour was captured in our system that allowed us to build personalisation,” adds Kumar. “And then as technology evolved voice became more mainstream. AI was a big revolution in the last five years. I think because people had enough data to crunch, and computational power became more easily available. I think these were the factors in a lot of people creating very narrow AIs to perform very specific tasks.”

MakeMyTrip is a majority investor in Ixigo, but it operates independently. To stand out in a market dominated by a couple of big players, Ixigo has instead tried to make use of technology. It rolled out a chatbot to manage questions around travel last year, and even built a price prediction engine to help you save money when traveling. However, with recent developments around voice-powered interfaces, Kumar is betting that this is the future of user interaction.

MakeMyTrip’s Anshuman Bapna Says Everyone’s Ignoring This Part of the Travel Business

“We all know that the UI is going to undergo a paradigm shift, and if you ask me the future is one where the UI becomes much much thinner or disappears, AR combined with voice platforms will make UI completely invisible and conversational,” he says. “Voice as an interface is really really ripe now. If you just think about the Indian context, there is a huge amount of new users that are going to come online – specifically through mobile devices – and it would be a tall order for them to learn the bespoke interfaces of tens of apps. The most natural way for them to interact would be to just ask questions and get answers. Even Google tells that a lot of people do voice-based search, even on YouTube, on WhatsApp.”

It’s a point Google has also raised in general when talking to app developers in India – telling them to focus on Bharat, and make apps for the next billion Internet users. And as an added advantage, companies like Ixigo don’t have to solve for voice from the ground up.

Indian Developers Need to Focus on ‘Bharat’, Says Google

“We don’t need to solve voice, build our own speech recognition system or a text to speech system – these have already been done,” says Kumar. “What we’ve built with Tara is the advanced natural language understanding we’ve built that’s completely powered by deep learning and the contextual awareness that allows the experience to be hyper-personalised.”

It all sounds very futuristic, but the inspiration for Tara lies very much in the past. “We went back 10-15 years to how people were booking travel back then. And back then there used to be a travel agent who knew you and your family personally, who would give you a personalised experience,” says Kumar. “But he was obviously biased and didn’t have comprehensive data. The way you planned your travel though was very natural. But 10 years later, a lot of online travel portals came in. But they were not very intelligent.”

“Tara is our vision of the future. She doesn’t come with the baggage of a human travel agent,” he continues. “And more importantly, she’s 24×7. Even customer support – our training models are so strong that we’re in a position where we can automate our customer support to 70-80 percent. The possibilities are limitless really.”

One Year In, How Indian Travellers Helped Shape Cleartrip Local

tara data scoop ixigo

And there’s a case to be made still for travel agents. ‘If you want to today book a trip from Mumbai, six days in Egypt, four days in Madrid, and back, you cannot do that online,” says Varun Gupta, CEO of travel company Goomo. “You need to talk to a travel agent because the number of moving parts you have to manage is… you can disaggregate and buy the different parts online, but it will almost always be more expensive.”

“Also, sometimes people want assistance. India has roughly 20 million outbound departures every year, and 60-65 million passport holders,” adds Gupta. “For a lot of people, going from Ludhiana to Ooty is like going to a place that’s unfamiliar, and they want advice. Then they’ll go to Dubai, Singapore, Thailand, and they’re not sure – when I land there, will I get a taxi, is it safe, is it the right location, are these the right things to see? If you have the time and the intelligence, you can probably figure it out online, but for me, as I’m getting older, it’s sometimes better to ask someone.”

The ultimate goal for Ixigo is to have the AI reach a stage where you don’t need to research options anywhere else. “Imagine a scenario where if you were planning a trip and had to book a hotel, spent a week doing the research and reading up on trip advisor and asking your friends; and in the other universe the system recommended a hotel and it was the same – that is the holy grail,” says Kumar.

Of course, there’s a question about the kind of privacy trade-offs are involved in making something like this genuinely useful, but Kumar believes it’s not a challenge. “People will give away their data, as long as you’re offering a great product that will actually help them.”

Taken For A Ride? Ambulances Stick Patients With Surprise Bills

One patient got a $3,660 bill for a 4-mile ride. Another was charged $8,460 for a trip from one hospital that could not handle his case to another that could. Still another found herself marooned at an out-of-network hospital, where she’d been taken by ambulance without her consent.

These patients all took ambulances in emergencies and got slammed with unexpected bills. Public outrage has erupted over surprise medical bills — generally out-of-network charges that a patient did not expect or could not control — prompting 21 states to pass laws protecting consumers in some situations. But these laws largely ignore ground ambulance rides, which can leave patients stuck with hundreds or even thousands of dollars in bills, with few options for recourse, finds a Kaiser Health News review of 350 consumer complaints in 32 states.

Patients usually choose to go to the doctor, but they are vulnerable when they call 911 — or get into an ambulance. The dispatcher picks the ambulance crew, which, in turn, often picks the hospital. Moreover, many ambulances are not summoned by patients. Instead, the crew arrives at the scene having heard about an accident on a scanner, or because police or a bystander called 911.

Betsy Imholz, special projects director at the Consumers Union, which has collected over 700 patient stories about surprise medical bills, said at least a quarter concern ambulances.

“It’s a huge problem,” she said.

Forty years ago, most ambulances were free for patients, provided by volunteers or town fire departments using taxpayer money, said Jay Fitch, president of Fitch & Associates, an emergency services consulting firm. Today, ambulances are increasingly run by private companies and venture capital firms. Ambulance providers now often charge by the mile and sometimes for each “service,” like providing oxygen. If the ambulance is staffed by paramedics rather than emergency medical technicians, that will result in a higher charge — even if the patient didn’t need paramedic-level services. Charges range widely from zero to thousands of dollars, depending on billing practices.

The core of the problem is that ambulance and private insurance companies often can’t agree on a fair price, so the ambulance service doesn’t join the insurance network. That leaves patients stuck in the middle with out-of-network charges that are not negotiated, Imholz said.

This happens to patients frequently, according to one recent study of over half a million ambulance trips taken by patients with private insurance in 2014. The study found that 26 percent of these trips were billed on an out-of-network basis.

That figure is “quite jarring,” said Loren Adler, associate director for the USC-Brookings Schaeffer Initiative and co-author of recent research on surprise billing.

The KHN review of complaints revealed two common scenarios leaving patients in debt: First, patients get in an ambulance after a 911 call. Second, an ambulance transfers them between hospitals. In both scenarios, patients later learn the fee is much higher because the ambulance was out-of-network, and after their insurer pays what it deems fair, they get a surprise bill for the balance, also known as a “balance bill.”

The Better Business Bureau has received nearly 1,200 consumer complaints about ambulances in the past three years; half were related to billing, and 46 mentioned out-of-network charges, spokeswoman Katherine Hutt said.

While the federal government sets reimbursement rates for patients on Medicare and Medicaid, it does not regulate ambulance fees for patients with private insurance. In the absence of federal rules, those patients are left with a fragmented system in which the cost of a similar ambulance ride can vary widely from town to town. There are about 14,000 ambulance services across the country, run by governments, volunteers, hospitals and private companies, according to the American Ambulance Association.

(Heidi de Marco/KHN)

For a glimpse into the unpredictable, fragmented system, consider the case of Roman Barshay. The 46-year-old software engineer, who lives in Brooklyn, N.Y., was visiting friends in the Boston suburb of Chestnut Hill last November when he took a nasty fall.

Barshay felt a sharp pain in his chest and back and had trouble walking. An ambulance crew responded to a 911 call at the house and drove him 4 miles to Brigham and Women’s Hospital, taking his blood pressure as he lay down in the back. Doctors there determined he had sprained tendons and ligaments and a bruised foot, and released him after about four hours, he said.

After Barshay returned to Brooklyn, he got a bill totaling $3,660 — which is $915 for each mile of the ambulance ride. His insurance had paid nearly half, leaving him to pay the remaining $1,890.50.

“I thought it was a mistake,” Barshay said.

But Fallon Ambulance Service, a private company, was out-of-network for his UnitedHealthcare insurance plan.

“The cost is outrageous,” said Barshay, who reluctantly paid the $1,890.50 after Fallon sent it to a collection agency. If he had known what the ride would cost, he said, he would at least have been able to refuse and “crawl to the hospital myself.”

“You feel horribly to send a patient a bill like that,” said Peter Racicot, senior vice president of Fallon, a family-owned company based outside Boston.

But ambulance companies are “severely underfunded” by Medicare and Medicaid, Racicot said, so Fallon must balance the books by charging higher rates for patients with private insurance.

Racicot said his company has not contracted with Barshay’s insurer because they couldn’t agree on a fair rate. When insurers and ambulance companies can’t agree, he said, “unfortunately, the subscribers wind up in the middle.”

It’s also unrealistic to expect EMTs and paramedics at the scene of an emergency to determine whether the company takes a patient’s insurance, Racicot added.

Ambulance services have to charge enough to subsidize the cost of keeping crews ready around-the-clock even if no calls come in, said Fitch, the ambulance consultant. In a third of the cases where an ambulance crew answers a call, he added, they end up not transporting anyone and the company typically isn’t reimbursed for the trip.

In part, Barshay had bad luck. If the injury had happened just a mile away inside Boston city limits, he could have ridden a city ambulance, which would have charged $1,490, according to Boston EMS, a sum that his insurer probably would have covered in full.

Very few states have laws limiting ambulance charges, and most state laws that protect patients from surprise billing do not apply to ground ambulance rides, according to attorney Brian Werfel, consultant to the American Ambulance Association. And none of the state surprise-billing protections applies to people with self-funded employer-sponsored health insurance plans, which are regulated only by federal law.  That’s a huge exception: 61 percent of privately insured employees are covered by self-funded employer-sponsored plans.

Some towns that hire private companies to respond to 911 calls may regulate fees or prohibit balance billing, Werfel said, but each locality is different.

Insurance companies try to protect patients from balance billing by negotiating rates with ambulance companies, said Cathryn Donaldson, spokeswoman for America’s Health Insurance Plans. But “some ambulance companies have been resistant to join plan networks” when insurance companies offer Medicare-based rates, she said.

Medicare rates vary widely by geographic area. On average, ambulance services make a small profit on Medicare payments, according to a report by the U.S. Government Accountability Office. If a patient uses a basic life support ambulance in an emergency, in an urban area, for instance, Medicare payments range from $324 to $453, plus $7.29 per mile. Medicaid rates tend to be significantly lower.

There’s evidence of “waste and fraud” in the ambulance industry, Donaldson added, citing a 2015 study from the Office of Inspector General at the U.S. Department of Health and Human Services. The report concluded Medicare paid over $50 million in improper ambulance bills, including for supposedly emergency-level transport that ended at a nursing home, not a hospital. One in 5 ambulance services had “questionable billing practices,” the report found.

Most complaints reviewed by Kaiser Health News did not appear to involve fraudulent charges. Instead, patients got caught in a system in which ambulance services can legally charge thousands of dollars for a single trip — even when the trip starts at an in-network hospital.

Devin Hall of Brentwood, Calif., is fighting a $7,110 bill from American Medical Response for an out-of-network ambulance ride. He has spent months calling the hospital, his insurer and the ambulance provider trying to resolve the matter. “These charges are exorbitant — I just don’t think what AMR is doing is right,” Hall says. (Heidi de Marco/KHN)

That’s what happened to Devin Hall, a 67-year-old retired postal inspector in Northern California. While he faces stage 3 prostate cancer, Hall is also fighting a $7,109.70 out-of-network ambulance bill from American Medical Response, the nation’s largest ambulance provider.

On Dec. 27, 2016, Hall went to a local hospital with rectal bleeding. Since the hospital didn’t have the right specialist to treat his symptoms, it arranged for an ambulance ride to another hospital about 20 miles away. Even though the hospital was in-network, the ambulance was not.

Hall was stunned to see that AMR billed $8,460 for the trip. His federal health plan, the Special Agents Mutual Benefit Association, paid $1,350.30 and held Hall responsible for $727.08, records show. The health plan paid that amount because AMR’s charges exceeded its Medicare-based fee schedule, according to its explanation of benefits. But AMR turned over his case to a debt collector, Credence Resource Management, which sent an Aug. 25 notice seeking the full balance of $7,109.70.

“These charges are exorbitant — I just don’t think what AMR is doing is right,” said Hall, noting that he had intentionally sought treatment at an in-network hospital.

He has spent months on the phone calling the hospital, his insurer and AMR trying to resolve the matter. Given his prognosis, he worries about leaving his wife with a legal fight and a lien on their Brentwood, Calif., house for a debt they shouldn’t owe.

After being contacted by Kaiser Health News, AMR said it has pulled Hall’s case from collections while it reviews the billing. After further review, company spokesman Jason Sorrick said the charges were warranted because it was a “critical care transport, which requires a specialized nurse and equipment on board.”

Sorrick faulted Hall’s health plan for underpaying, and said Hall could receive a discount if he qualifies for AMR’s “compassionate care program” based on his financial and medical situation.

“In this case, it appears the patient’s insurance company simply made up a price they wanted to pay,” Sorrick said.

In July, a California law went into effect that protects consumers from surprise medical bills from out-of-network providers, including some ambulance transport between hospitals. But Hall’s case occurred before that, and the state law doesn’t apply to his federal insurance plan.

Hall, a retired postal inspector in Northern California, receives radiation treatment for his stage 3 prostate cancer in October 2017. (Heidi de Marco/KHN)

Given his prognosis, Hall says he worries about leaving his wife with a legal fight and a lien on their Brentwood, Calif., house for a debt they shouldn’t owe. (Heidi de Marco/KHN)

The consumer complaints reviewed by Kaiser Health News reveal a wide variety of ways that patients are left fighting big bills:

  • An older patient in California said debt collectors called incessantly, including on Sunday mornings and at night, demanding an extra $500 on top of the $1,000 that his insurance had paid for an ambulance trip.
  • Two ambulance services responded to a New Jersey man’s 911 call when he felt burning in his chest. One charged him $2,100 for treating him on the scene for less than 30 minutes — even though he never rode in that company’s ambulance.
  • A woman who rolled over in her Jeep in Texas received a bill for a $26,400 “trauma activation fee” — a fee triggered when the ambulance service called ahead to the emergency department to assemble a trauma team. The woman, who did not require trauma care, fought the hospital to get the fee waived.

In other cases, patients face financial hardship when ambulances take them to out-of-network hospitals. Patients don’t always have a choice in where to seek care; that’s up to the ambulance crew and depends on the protocols written by the medical director of each ambulance service, said Werfel, the ambulance association consultant.

Sarah Wilson, a 36-year-old microbiologist, had a seizure at her grandmother’s house in rural Ohio on March 18, 2016, the day after having hip surgery at Akron City Hospital. When her husband called 911, the private ambulance crew that responded refused to take her back to Akron City Hospital, instead driving her to an out-of-network hospital that was 22 miles closer. Wilson refused care because the hospital was out-of-network, she said. Wilson wanted to leave. But “I was literally trapped in my stretcher,” without the crutches she needed to walk, she said. Her husband, who had followed by car, wasn’t allowed to see her right away. She ended up leaving against medical advice at 4 a.m. She landed in collections for a $202 hospital bill for a medical examination, which damaged her credit score, she said.

Ken Joseph, chief paramedic of Emergency Medical Transport Inc., the private ambulance company that transported Wilson, said company protocol is to take patients to the “closest appropriate facility.” Serving a wide rural area with just two ambulances, the company has to get each ambulance back to its station quickly so it can be ready for the next call, he said.

Patients like Wilson are often left to battle these bills alone, because there are no federal protections for patients with private insurance.

Rep. Lloyd Doggett (D-Texas), who has been pushing for federal legislation protecting patients from surprise hospital bills, said in a statement that he supports doing the same for ambulance bills.

Meanwhile, patients do have the right to refuse an ambulance ride, as long as they are over 18 and mentally capable.

“You could just take an Uber,” said Adler, of the Schaeffer Initiative. But if you need an ambulance, there’s little recourse to avoid surprise bills, he said, “other than yelling at the insurance company after the fact, or yelling at the ambulance company.”

KHN correspondent Chad Terhune contributed to this report.

KHN’s coverage of end-of-life and serious illness issues is supported in part by the Gordon and Betty Moore Foundation.


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Pixar's Coco Is a Beautiful, Good-Natured Celebration of Family


The protagonist of Pixar’s latest family adventure Coco is a 12-year-old Mexican boy called Miguel Rivera (Anthony Gonzalez), who longs to be a musician. There’s just one problem: his family hates music, and forbids anyone to go anywhere near it. It’s not that they don’t find it pleasing, but it has to do with a disturbing incident in the family’s long-gone past. An animated papel picado sequence tells us that Miguel’s great-great-grandfather left his wife and young daughter for his love of music, and so his wife ensured that no one would come near the artform again.

Now, just like the rest of his family, Miguel is being groomed to become a shoe-maker. Being the youngest in the household, he has no option but to do as they say. Behind his family’s back though, Miguel aspires to perform at a local music competition on Día de los Muertos – the Day of the Dead, a popular Mexican festival – and has a garage attic full of mementos of a great singer who hails from his city, Ernesto de la Cruz (Benjamin Bratt), including posters and a videotape of his well-known moments from the various films he starred in, before his untimely death.

But as he tries to sneak his way out for the event that evening, he’s caught by his family. His grandma Abuelita (Renée Victor) is enraged, and his attempts at trying to convince her only make her angrier, causing her to smash his beloved guitar into the ground. Miguel bursts out crying, and wonders the town square in hope of finding a guitar, to no avail. Out of options, he ends up at the monument to his hero Ernesto, and breaks in to steal the famous guitar hanging above his tomb.

A delighted Miguel strums the guitar and unknowingly ends up being transported to the land of the Dead. He’s at once both shocked and confused, as he finds himself running right through living people, while crashing into strangers with skeleton faces whom he has never seen, like in a fever dream. Before he can start to make sense, he knocks into dead relatives, who seemingly recognise him from earlier visits to the graveyard on the Day of the Dead.

His dead family realise that Miguel has somehow “crossed over” – the land of the Dead is like an afterlife – and wonder how it happened. Together, they set out to fix the situation and return him to his home, but his love for music again lands him in trouble with his dead family too, from where the film turns into an adventure on two fronts: Miguel trying to find Ernesto, whom he believes is his long-lost great-great-grandfather, and family trying to locate him. The boy befriends a trickster called Héctor (Gael García Bernal) to help him, while his family enlists the help of a spirit animal alebrije Pepita, that looks like a jaguar mixed with an eagle.

The land of the Dead operates on some byzantine rules devised by the Pixar team, where the ones who have passed away being allowed to crossover to the land of the living on the day of the festival to see their loved ones, as long as their living family has put up a picture of them on an ofrenda, an altar used for the Day of the Dead. It even has a totalitarian security checkpoint which scans your face to see if your picture has been put up, and you’re not allowed to cross otherwise.

pixar coco ancestors Pixar Coco

Of course, if you think about the arrangements of this afterlife for more than two minutes, it can all disintegrate very quickly. Sure, you can’t die unless you’re forgotten by the living, but should people be beholden to their blood relatives even after they’re dead? The point Coco is trying to make is that we should never forget our past, and remember who came before us. But being a family-friendly movie, it can’t talk about toxic relationships, and that not everyone is worth remembering or remembered well.

Even for the topics it does tackle, Coco doesn’t offer up the kind of surprising wisdom we’ve seen in Pixar’s greatest hits. There’s no sequence that rivals the emotional power from Toy Story 3 about growing up, or Ratatouille about the consequences of chasing your dreams. It gets its central point across with a lot of heart, and lays down that family should support you, and not use togetherness as an excuse to hold you down, but there’s no added insight beyond that for the adults in the audience.

The screenplay too is predictable at times, with convenient happenings or last-minute saves that should have been better worked out. And as wonderful as it is to proclaim and fuel the idea that everyone should pursue their dream, Coco isn’t smart enough to acknowledge that practicality played a big part in Miguel’s upbringing, even as it hints at the risks that litter the creative path, thanks to an eleventh-hour twist that sends up the motto that drives our protagonist.

pixar coco city Pixar Coco

Visually though, it’s a treat. The world of Coco is beautifully conceptualised and brought to life in a gorgeous, eye-popping fashion, with special mention for the aforementioned alebrije, which have their basis in Mexican folk art and have been rendered as multi-coloured fantastical creatures. And given that most of the film takes place during a single night, there’s a much heavier contrast in Coco, unlike most other sunnier, bright Pixar films.

That doesn’t have any reflection on the handling of the subject matter, which is still the traditional Disney-Pixar blend of cheery, tear-jerking, and fun. For the last one, that means tons of visual gags with skeletons, which manifests in body parts detaching and putting themselves back together in all sorts of ways. None of it is macabre or scary though. Coco also squeezes laughs from a bumbling street dog Miguel calls Dante, who follows him around everywhere and is the only living being that can see him after he crosses over.

Another important part of a Pixar film are its songs, and here, they contribute heavily to Coco’s Mexican feel. Most of them are sung in English, as is the film itself (spoken not sung), with only a bare minimum sprinkling of phrases in Spanish that everyone already knows. It’s a necessary shortcut on the part of the studio, as a fully-subtitled film would make it tougher for its younger target audience.

pixar coco home Pixar Coco

If you’re wondering why the film is called Coco, that’s the name of Miguel’s great-grandmother. It’s a bit workshopped because Disney was first interested in naming it after the festival itself. It applied for a copyright but backed down after severe backlash from the Mexican-American community about hijacking their culture. Seeing the response, it changed the title to Coco, and hired a vocal critic in cartoonist Lalo Alcaraz as a cultural adviser to avoid any blames of “cultural appropriation”.

Thankfully, the final product is a wholesome love letter to a beloved occasion, which tugs at your heart strings just like a Mariachi’s guitarrón. Coco has already become the highest-grossing film of all time in Mexico since its release there last month, and it’s poised to earn millions more worldwide, given its crowd-pleasing nature and the empty weeks to follow before the next big blockbuster.

One Year In, How Indian Travellers Helped Shape Cleartrip Local

Just about two years ago, Cleatrip launched Activities, a curated collection of things to do in the cities you were visiting. One year down the line, this had turned into Cleartrip Local, which covered things like horse riding trips, spa visits, and amusement parks. To find out more about how the program has done over the past year, Gadgets 360 caught up with Suman De, Product Head – Local and Platforms at Cleartrip. The Bengaluru-based executive has been with Cleartrip for five years now, and he says the creation of Local was a strategic bet on the part of the company to get its large user base to engage with the app more frequently.

“The travel industry is a very need-based product,” says De, explaining that in India the number of trips a family takes is very low. “The frequency of a typical travel user is two to three trips per year, compared to the global trend of 12 to 15 trips a year.” This includes small weekend getaways, trips by only some members of the family, and of course the big family vacations, but in India, the amount of time people spend traveling is pretty limited.

“So if someone is traveling in January, then the next time they travel might be in October, so there’s nothing in between to keep the customer on the platform,” says De. “So to plug that hole in consecutive travel, we wanted to build a product where, when you are in your city, it gives you the means of discovering means of spending time, weekends, with friends, family, and so on.”

In the last year, the company has also observed some interesting trends in the kind of users that it gets for Local, showing that it’s not just for the existing customers but rather, bringing in a new audience for Cleartrip.

local trip plans cleartrip

“For Travel, the demographic group is around 35 years old, and more… very male-dominated, at around 90 percent male,” says De, explaining, “that’s to say, the people making the booking, regardless of who is traveling. So in terms of travellers the numbers are closer, but it’s mostly males who are actually using the app, and making the booking.”

“On the other hand, for Local the age group is much lower, around 25 years old,” he continues, “and there’s a much lesser skew towards male versus female users, at around 65 percent male.”

With around 2,000 daily users for Local (De didn’t divulge how many users Cleartrip averages) there are shifts during the week – “70 percent of bookings happen on weekends,” De says – and the users book for theme parks most heavily.

“In cities like Delhi, day-outings, or resorts you can visit with friends, these are a big thing, that the locals are using,” says De, “Whereas in a place like Goa, where tourism is actually pretty unorganised for the most part, there’s a lot of stuff like car rentals, and parasailing for tourists, while Bangalore [Bengaluru] will see go-karting, bowling.”

cleartrip local search cleartrip

“There’s a lot of crossover between Travel and Local as well,” De adds. “Travel users are often consumers of Local. Among the people who have been traditional travel users, and have tried Local, we see that they kind of stay with Cleartrip 25 percent more than other people”

That doesn’t mean that Local is like a loyalty business for Cleartrip though. Since it brings in a new demographic of users, it’s actually able to help with customer acquisition. “In the last one year, 75 percent of the customers who have tried Local were actually new to Cleartrip,” says De. “We had never seen these customers – and this ties in to the demographics that I talked about. Once Local came around, we started getting this new segment on to Cleartrip. And 20 percent of this 75 percent has converted to Travel users within a three-month period of use.”

Another interesting trend that has come up with the focus on local is bringing users from smaller cities. “We’ve seen a lot of interest from non-metro cities, in Pune, Chandigarh, Hyderabad. The whole Rishikesh-Nainital-Mussoorie belt as well, in some ways the northern hills context it’s very similar to the Goa experience, it needs to be organised,” says De.

travel local2 cleartrip

Along the way, Cleartrip has also played around a lot with the design of Local, changing the way things like Search work, going from a more browsing based product to one that has a Guided Navigation that makes suggestions based on your interests and history. “What we do is a blend of algorithm plus curation, and we have our own editorial team who curate – these are the top activities, and a new activity comes in, a new supplier comes on board, no algorithm will ever pick that up so the editorial team takes that decision,” explains De.

One thing that hasn’t changed since the launch of Local is the fact that it’s not a standalone app, but a toggle in the Cleartrip app. Travel and Local are not going to be merged because they’re completely different experiences says De, but at the same time, Local isn’t going to become a separate app either.

“One of the biggest things in India is about space on the phone,” he says. “You don’t want people to have to install two apps if you can help it. Also a lot of the code and assets that we use are common so it kind of is not very optimal to have two apps, and it’s not efficient from a business and marketing perspective also, and nor from the consumer perspective.”

Under the Spell of Sunny Puerto Rico

You know things are going truly well when the huge family contention is about whether to sprinkle in the rain woods waterfall or loll around on the white-sand shoreline.

You know things are surprisingly better when you understand you can do both in a single day and not charge the persistence or enthusiasm of three youngsters.

From our weeklong base at a rental apartment suite in the Rio Grande, there are a lot of them on destinations like Airbnb; we had such level headed discussions, the sort of basic leadership that get-aways ought to be about.

It was winter break for our three, ages 11 to 15, and having not gone far since a move from Mexico almost two years prior, they pushed for somewhere warm off the territory.

We stopped in Puerto Rico,  a place where we had for the longest time been itching to go and which, while a district, is sufficiently far off the terrain (just shy of four hours from Kennedy Airport), and socially separated, as well, to check in their retribution.

Having lived in warm atmospheres for quite a long while, we found that even this gentle winter in New York was granulating on us so that any normal sunlamp would do.

The Rio Grande, a seaside and wilderness resort town around 20 miles east of the capital, San Juan, couldn’t have been more flawless, given that practically every fascination could be come to in 30 minutes or less.

Our civil arguments developed into which day excursion was all the more fulfilling.

In spite of the fact that Puerto Rico has a tendency to summon pictures of palms and shorelines, the rain woods right not far off called, as something somewhat extraordinary.

You could do awful than begin with the rain woodland.

The El Yunque National Forest, a grassy field the span of San Francisco and the main tropical rain forest in the United States backwoods framework, has trails that are spotless, very much kept up and all around set apart from the streets slicing through it. They pipe you through a rain woods covering, ringing with the tweets, croaks, and screeches of flying creatures, frogs, and different creatures, to luring swimming gaps and waterfalls with enough chill in the water to invigorate from the almost 90-degree warm however insufficient to keep you out.

La Coca Trail, for example, rises and falls on its winding way to the huge result: a thundering waterfall and pool that coax you for a plunge and, on the off chance that you can endure the pelting, a shower. A climb somewhat downstream offers more private unwinding.

Angelito Trail close-by gives a simpler walk and all the more smooth showering in a vast stream. However, local people disclosed to us it could get energetic after overwhelming downpours. One common pool there was sufficiently profound for our two young men to bounce from a rope swing.

Tropical rain forest

You might consider bugs, especially mosquitoes, given the Zika flare-up that happened in Puerto Rico and somewhere else a year ago.

However, going to in February, we found there were not armies of them, and generous, cool ocean breezes kept them under control and the atmosphere very wonderful.

Zika cases are on the meltaway, Puerto Rican wellbeing authorities have stated, and the infection, which can bring about birth deformities, is fundamental of worry to pregnant ladies and couples who are attempting to wind up distinctly pregnant. Places with Zika flare-ups are alright for the normal Voyager; however, we followed the safety measure of the Centers for Disease Control and Prevention to liberally apply repellent with DEET, as we typically do when going to the tropics.

Truly, our greatest tension needed to do with giving the children enough of the shoreline time they requested.

Pick your pleasure.

An anonymous shoreline a couple of minutes not far off from our flat perplexing, and open using a way of wooden boards, offered savage waves, which pleased the youngsters as they contorted in the twisting break, however, kept me on protect. The sand and grass shoreline was limited and scattered with kelp, the sort of moderately separated place you may pine for a lone local people involvement, yet it may frustrate if you expect comfort and, perhaps, an umbrella.

Puerto Rico ensures free to shorelines, even at resorts. Those shorelines, obviously, have a tendency to be very much kept up and close comforts like a bar. It can be precarious getting to them, however. Our flat complex was around the curve from the Wyndham Grand Rio Mar Beach Resort and Spa, with its manicured grounds, eateries, gambling clubs, fairway and all around selected rooms.

Ask at the security entryway where the shoreline is, and you are guided not far off to a place that is not the resort. However, if you say you might want to pay for a day go to the inn or to visit the gambling club or eateries, you are waved in and can stop in the carport, which charges by the hour and is a short stroll down away to the shoreline.

Travel Dispatch

We had a great time, in any case, at an open shoreline called Playa Luquillo 10 minutes not far off. For $5.50, we stopped, set up our seats and joined nearby families and kindred deal seekers. There are snack bars, and the shoreline adjoins a line of sustenance and trinket stands.

Merchants drop by peddling new fish from coolers. We attempted the shrimp, and flame broiled octopus in custom made a magic sauce and pursued the seller for additional.

Be that as it may, the best shoreline by a long shot, and a standout amongst the most dynamite we have found in our times of going in Mexico and the Caribbean, was Culebra Island.

It requires around a 15-mile drive east of Rio Grande to a ship at the ocean side town of Fajardo; it’s an intelligent thought to arrive an hour or more before the planned time to guarantee a seat.

After a ship outing of an hour to an hour and a half, contingent upon to what extent it takes to board everybody, you touch base at an offbeat shoreline town with taxi transports prepared to whisk you to shorelines, snorkeling, Jet Skis and different exercises minutes away. With our youngsters developing restless, we selected the nearest shoreline, Playa Flamenco, and were enchanted.

Nearly all that we did after that wavered on disappointment.

A well-known fascination is evening time kayaking in a bioluminescent sound in Fajardo. With a guide driving the way, you paddle for a half-hour through a dull mangrove, thumping trees and different pontoons en route as fledglings get used to exploring, into a substantial narrows where luminescent rises from smaller scale life forms trail your hand as you go it through the water.

It was an exercise for me as my buddy, my 11-year-old child, comfortable in his backrest-prepared spot, became burnt out on paddling and floated off to rest at a certain point. What’s more, general I figure I was expecting sci-fi level radiance, yet the scary course through the mangrove, with a fish dashing and sprinkling to the surface, go for the experience.

Three emerged for us.

The crisp offerings at La Familia Bakery 2, including tasty sweet bread, are an obvious requirement, and it’s quite recently off Highway 3 in the Rio Grande huge market.

Lluvia, a current breakfast and lunch bistro you’ll pass making a course for El Yunque, offers gorgeous Puerto Rico-developed espresso and dishes like waffles with bacon cooked in them and a breakfast “glass” flooding with egg, cheddar, pesto sauce and home fries.

Be that as it may, El Verde BBQ, a roadside remain along Highway 186 with its Puerto Rican road nourishment, is the one we would backpedal to instant. However, the great passage is corridor stopping up.

The one social stop we will recollect is somewhat out of the way, in Loiza, a little town, which is the center of Afro-Puerto Rican history. The Afro-Puerto Rican singer Samuel Lind has a meandering display and workshop where he offers canvases and prints.