In 2014, Lisa French had spinal surgical procedure. Before the operation, she was advised she must pay $1,337 in out-of-pocket prices and that her insurance coverage would cowl the remainder. However, the hospital ended up sending French a invoice for $229,000. When she didn’t pay, it sued her.
The case went all the best way to the Colorado Supreme Court. In this episode of “An Arm and a Leg,” host Dan Weissmann finds out how the court docket dominated and the way the choice is reshaping the effective print on hospital payments in ways in which might price sufferers some huge cash.
Dan Weissmann
Host and producer of “An Arm and a Leg.” Previously, Dan was a employees reporter for Marketplace and Chicago’s WBEZ. His work additionally seems on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.
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Transcript: A $229,000 Medical Bill Goes to Court
Note: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can comprise errors. Please use the transcript as a device however verify the corresponding audio earlier than quoting the podcast.
Dan: Hey there–
Lisa French was a clerk for a trucking firm in Denver. She’d been in a automobile crash, and her physician advised her that to maintain her backbone steady, she should get surgical procedure.
She requested the parents on the hospital what it was gonna price her, out of pocket. They ran her insurance coverage and advised her: Your finish goes to be one thousand, 300 thirty-six {dollars}, and ninety cents.
She stated, thanks.
Then, she and her husband sat down at their kitchen desk and talked it over: They had a rainy-day fund. A thousand {dollars} they’d socked away, they saved it at house, in money. Were they able to spend all of it for this?
They determined they had been, and Lisa went to the hospital with a thousand {dollars} money.
She had the surgical procedure, it went effective. The hospital had been anticipating about 55 thousand {dollars} from Lisa’s insurance coverage. They truly acquired extra like 74 thousand.
But they determined that wasn’t sufficient. They determined they wished their full sticker value: 303 thousand {dollars}. So they billed Lisa French for the remainder: 229 thousand {dollars}.
And once they didn’t get it, they sued her.
Lisa French had her surgical procedure in 2014. The court docket case lastly acquired resolved final yr, in 2022, by the Colorado Supreme Court.
If you’ve been listening to this present for some time, you most likely bear in mind: We have gotten VERY excited about understanding, once we get a wild medical invoice, what authorized rights do we’ve? How can we use these rights to combat again? Even on a small scale, like in small claims court docket?
And although Lisa French’s case is a LONG means from small claims court docket, it has a LOT to show us about these questions.
This is An Arm and a Leg, a present about why well being care prices so freaking a lot, and what we are able to possibly do about it. I’m Dan Weissmann. I’m a reporter, and I like a problem. So our job on this present is to take one of the vital enraging, terrifying, miserable elements of American life, and produce you one thing entertaining, empowering, and helpful.
And I ought to say upfront: We gained’t be listening to from Lisa French instantly.
Her case made a number of headlines– in 2018, when a jury heard it, in YEAR when an appeals court docket overturned the trial court docket, and final yr when the state supreme court docket made its ruling.
Not within the sort of element that we’re gonna go into, however come on: Who can resist the headline?
Male Anchor: Well, tonight we’ve a narrative of David versus Goliath. David being a lady who wanted spinal surgical procedure in 2014 Goliath, the hospital that charged her greater than $200,000 to do it.
Dan: So over time, a number of reporters wished a sound chew from Lisa French. Her legal professional used to let her know when there was an inquiry, and he or she’d say sure or no.
Eventually, she advised her lawyer: Don’t even inform me once they name anymore. I simply wish to reside my life.
Fair sufficient.
So right here’s who we’ve acquired.
Ted Lavender: I’m Ted Lavender. I’m an legal professional in Atlanta, Georgia. I’ve been training regulation for 26 years,
Dan: And he spent a number of of these years representing Lisa French.
It’s most likely price answering one query up entrance: If Lisa French needed to empty her household’s rainy-day fund to pay the hospital a thousand bucks, who’s paying the lawyer from Atlanta?
The insurance coverage from her job. Which had performed a task in beginning the entire mess.
Ted Lavender: the corporate that she labored for had a well being advantages plan that was barely completely different than what you would possibly name run of the mill medical health insurance.
Dan: It labored this manner: They weren’t in-network with any hospitals. Instead, they’d simply take no matter invoice any hospital despatched, make their very own analysis of what a good value can be, and ship the hospital a verify.
It’s a considerably uncommon mannequin– one survey says about 2 p.c of employers use a plan like this– however Ted Lavender says it usually works.
Ted Lavender: a really giant share of the time , the hospital would settle for the verify and nobody would hear something extra from the hospital, which in authorized parlance would imply acceptance
Dan: And as a backstop, in case there was any bother, the well being plan would ship a lawyer. That’s Ted.
And right here’s what occurred that led to all the difficulty in Lisa French’s case: Whoever ran her insurance coverage card on the hospital, they didn’t learn it very fastidiously.
If they’d, they might’ve seen a bit brand beneath the insurance-company identify that stated, “provider only” — that’s: This plan solely has medical doctors and nurses and different PROVIDERS in community.
With hospitals, there’s no community, no “in-network rate.” We’ll simply ship a verify for what we expect is true.
The identical health-benefits firm has a special plan, one which does have a hospital community. You understand how it’s. Insurance corporations, one million completely different plans, each one its personal snowflake.
The hospital mistook Lisa French’s snowflake for one more one, and that’s how they got here up with that estimate.
Ted Lavender: based mostly on their calculation, they anticipated to gather a complete of
$56,000, the 1,336 from Ms. French and the rest from her well being plan.
Dan: And they presumably would’ve been proud of 56 thousand. But they acquired extra. They acquired about 75 thousand {dollars}.
But as soon as they acquired it, they wised as much as the error they’d made about Lisa French’s insurance coverage. They had no settlement with the insurance coverage plan to just accept 56 thousand.
So, they determined: There’s no cause for us to not cost our full sticker value right here.Three hundred and three thousand {dollars}.
So Lisa French had been anticipating a invoice for 300 thirty-six {dollars} and ninety cents. That’s the distinction between what she’d been quoted and the thousand {dollars} she’d paid upfront. But the invoice she acquired wasn’t what she anticipated.
Ted Lavender: it turned out to be a whopper of a invoice. We ended up with an itemized invoice that confirmed each line merchandise for each cost that totaled this
$303,000
And then on the backside was, you already know, subtracting the thousand she paid, subtracting the cash the insurance coverage paid, leaving a steadiness of 229,000 and alter
Dan: Of course, Lisa French didn’t have 229 thousand {dollars}, or something prefer it.
Ted Lavender: Eventually she acquired a go to from the sheriff who served her with a lawsuit and he or she was sued for that $229,000.
Dan: And that’s the place Ted Lavender entered the scene.
The jury trial in 2018 took six days. As Ted Lavender says, it wasn’t precisely a splashy homicide trial, when it comes to drama.
Ted Lavender: this was a six day trial involving hospital billing. So, you already know, there was no homicide weapon. There was no aha, huge, gotcha second that was actually thrilling.
Dan: But Ted Lavender did his greatest. Like one time, when he acquired a hospital govt on the witness stand.
To stabilize Lisa French’s backbone, surgeons had implanted 13 items of metallic into her physique. So Ted Lavender had the hospital govt stroll the jury by means of the value for every of these bits of metallic. Or truly, the costs..
Ted Lavender: And I first confirmed him the itemized invoice and requested him to establish what they charged for these 13 items of {hardware} .
I had given him type of an outsized calculator that was sitting there in entrance of him on the witness stand, admittedly, for some dramatic impact
And by means of including these up on the itemized invoice, he arrived on the quantity which was $197,000.
Dan: 100 and ninety-seven thousand {dollars}. So that’s about two-thirds of the 300 and three thousand {dollars} the hospital is attempting to cost Lisa French.
And then the subsequent factor I did was I handed within the 13 invoices that we had acquired from the hospital,
Dan: That is, Ted handed the man the invoices the hospital had acquired — and paid — when it purchased these bits of metallic..
Ted Lavender: and I requested him so as to add up and inform this jury what did the hospital pay for these 13 items of {hardware}.
He’s including, and he’s including and he’s punching in numbers, and he’s turning pages and he’s including, and he’s including with every addition, with every plus the jury appeared to ease a bit nearer as much as the entrance of their chair, and finally he arrived on the complete, which was $31,000 and alter.
Dan: So the hospital’s charging like six and a half instances what they paid. And that’s two thirds of this 300 thousand greenback invoice.
Ted Lavender: It simply, you already know, the jury seemingly didn’t like that.
Dan: So that was a very good second for Lisa French’s facet. I imply getting the jury mad on the different facet, that’s a win.
And the large calculator wasn’t Ted Lavender’s solely visible: He additionally had a large post-it notice, the place he wrote down, in magic marker, all of the completely different costs the hospital accepted for the surgical procedure, relying on who was paying.
Ted Lavender: and we acquired these numbers from the hospital, they might’ve accepted $146,000 from personal insurance coverage.
Dan: That’s lower than half of what they had been attempting to cost Lisa French. And they accepted lower than that — a LOT much less — from government-funded insurance coverage, like Medicare, Medicaid, or Tricare, which covers people within the navy.
Ted Lavender: The common of what they might’ve accepted for these. Procedures that Ms. French had had been $63,199. Again, Ms. French and her insurance coverage firm mixed paid virtually $75,000.
Dan: You can hear that post-it rustling round. It was a very good prop, he’s held onto it. So, he’d proven the jury that the hospital charged a HUGE markup, and that what they had been suing Lisa French for was means, far more than they charged anyone else.
On the hospital’s facet, they had been like, Yeah, however that is our precise sticker value. And Lisa French signed a chunk of paper that stated she would pay “all charges of the hospital.”
So the hospital was like, yep, and these are our costs. That 303 thousand {dollars}, it comes from a listing we preserve. It’s known as the chargemaster. That’s what Lisa French was signing up for.
And this grew to become one thing the jury needed to resolve:
When Lisa French signed a chunk of paper saying she’d pay “all charges of the hospital” — was she particularly agreeing to pay what was on the chargemaster?
And right here’s one factor that may’ve made jurors a bit skeptical on that rating: The hospital by no means confirmed that chargemaster checklist to Lisa French. Not earlier than her surgical procedure, not after it. They stated it was a commerce secret.
Ted Lavender: they went throughout trial. Never producing it although. We, we, we requested on the very starting, as soon as the lawsuit was filed, , principally you get to ask questions. Give me this info, give me info that helps your case or helps my case.
And we ask particularly for the cost grasp and so they refuse to supply it on the idea that it was confidential and proprietary.
Dan: By withholding that checklist, the hospital could have helped Ted Lavender make his argument: How might Lisa French have recognized what she was signing up for, if she couldn’t see the costs?
Ted Lavender: if we are able to’t get it by means of our subpoena energy, how on this planet would Lisa Friendship been in a position to make use of it by, had she requested?
And admittedly she didn’t ask for it, but when she had, absolutely they wouldn’t have given it to her both.
Dan: In the top, the jury agreed: Lisa French had not particularly agreed to pay the hospital’s chargemaster costs.
And the one different different was: She agreed to pay one thing affordable.
The jury determined she owed the hospital seven hundred seventy six {dollars} and 74 cents
Basically, that’s the 300 and a few left over from the unique estimate, plus some further — as a result of she wound up staying within the hospital one night time greater than anticipated: She owed a payment for late check-out.
Of course the hospital didn’t take that mendacity down. They appealed the end result– and gained! Ted Lavender appealed that call, which is how the case ended up in entrance of the Colorado Supreme Court.
We’ve truly acquired tape of these proceedings. They’re kinda juicy. Plus the end result, and why it issues for the remainder of us. That’s proper after this.
This episode of An Arm and a Leg is produced in partnership with KFF Health News–previously often known as Kaiser Health News.
They’re a nationwide newsroom producing in-depth journalism about well being care in America. We’ll have extra details about KFF Health News on the finish of this episode.
OK, so Lisa French’s case was headed to the Colorado Supreme Court.
And right here’s the large difficulty. Remember how the jury discovered that Lisa French hadn’t truly agreed to pay the hospital’s chargemaster value, the 300 and three thousand {dollars}?
The hospital argued: The jury by no means ought to’ve been requested to think about that query.
The regulation — authorized precedent — makes it open and shut: The appeals court docket had agreed. And it had cited different instances from courts across the nation.
So when the hospital’s lawyer, Mike McConnell, acquired as much as handle the Supreme Court, he led with these citations.
Mike McConnell: All of the questions that you’ve got raised have been addressed in additional than a dozen instances across the nation. fastidiously and totally.
Justice Richard L. Gabriel: Well, let me push again on you. Good morning to you, Mr. McConnell.
Mike McConnell: Good morning.
Dan: This is Justice Richard L Gabriel, stepping proper in. He notes that these dozen different choices all relaxation on one authentic case, from 2008, the place a court docket had stated: We can’t intervene in well being care pricing. Courts shouldn’t strive. Health care is simply too sophisticated.
Justice Gabriel wasn’t satisfied.
Justice Richard L. Gabriel: I suppose the query I’ve is why, you already know? I, you already know, we will not be the neatest folks on this planet, however it is a contract and why ought to the hospital trade— completely different than every other trade on the planet —have completely different guidelines for contract ideas?
Dan: The hospital lawyer argued that hospitals couldn’t predict the whole lot that might occur in a affected person’s care. In truth, the hospital can’t even management it: Only physicians can resolve what remedy to order.
Mike McConnell: You can, uh, I suppose think about that hospitals ought to have the ability to predict upfront what a selected doctor goes to order for a selected affected person. Um, and, uh, maybe, you already know, clearly you’re feeling that’s the means it should be. It isn’t the best way it’s, however now
Justice Melissa Hart: Mr. Mr. McConnell, I’m sorry, to interrupt…
Dan: Here’s justice Melissa Hart breaking in
Justice Melissa Hart: …the hospital did present an estimate on this case. They did calculate what they thought this was going to price and inform her that. So it’s, it appears false to me that they’ll’t do it. Of course, they’ll’t predict with absolute certainty. In this case, she had the additional night time keep within the hospital and he or she paid for that. But they’ll predict in a case like this, and so they do.
Dan: The justices didn’t appear super-persuaded by McConnell’s response to that. And that left another huge query in entrance of the justices.
When Lisa French signed a doc promising to pay “all charges,” was she undoubtedly agreeing to pay 300 and three thousand {dollars}? Or 229 after insurance coverage.
The appeals court docket discovered that the chargemaster price — the 303 thousand — had been “incorporated by reference” to the doc she’d signed, formally known as the “hospital services agreement.”
The supreme court docket wasn’t satisfied. Here’s Justice Richard Gabriel once more.
Justice Richard L. Gabriel: There’s no reference to the cost grasp on the face of the hospital providers settlement.
How might she have assented to one thing she by no means even knew existed?
Dan: And right here’s how the hospital’s lawyer responded.
Mike McConnell: When she learn the availability, all costs not in any other case paid by insurance coverage. She understood that the hospital costs would, she was liable for paying the hospital costs that her insurance coverage firm did it,
Justice Richard L. Gabriel: Whatever it was. They might have charged her a billion {dollars} and he or she’s your place to be she’s certain as a result of she agreed. All costs means all costs.
Dan: Huh! There wasn’t an actual comeback to that.
The Supreme Court dominated towards the hospital, unanimously. Specifically, they dominated that the chargemaster– the 303 thousand {dollars}– had not been “incorporated by reference” to the piece of paper Lisa French had signed.
She didn’t know these chargemaster checklist costs even existed. How might she comply with pay them?
So that meant, the court docket dominated that, quote, “the hospital services agreements left the price term open.”
Which is language which will ring a bell, when you’ve been listening to this present. It’s a authorized precept — a bedrock of contract regulation:
How the regulation treats an open-price contract — a contract that doesn’t specify a value time period.
Here’s a refresher on that precept from Ted Lavender.
Ted Lavender: when you go to McDonald’s and order a, 1 / 4 pounder with cheese and you already know, worth meal quantity three, they inform you the value and that’s the value that you need to pay. And then they offer you your meal.
You enter that contract with an precise value time period
Dan: But it’s also possible to enter an open-price contract — a contract with out a value time period.
Ted Lavender: when you’ve got a contract with out a value time period, with out a particular value in it, then the regulation infer into that contract an inexpensive value.
Dan: In different phrases, a contract with the value time period OPEN isn’t a clean verify. I don’t must pay no matter quantity the opposite facet makes up.
And that’s what the Colorado Supreme Court discovered right here.
They dominated that, quote, “principles of contract law can certainly be applied to hospital-patient contracts.” They say, a court docket could have dominated in any other case in 2008, and different courts could have cited that opinion. We disagree.
The Colorado Supreme Court is saying, even in well being care, when no value is specified– when the value time period is open– you could have the appropriate to an inexpensive value.
Yes!
And that’s why Lisa French’s case is so attention-grabbing to us, right here on this present.
Because we’ve talked right here about utilizing this authorized precept to combat again towards outrageous payments.
We’ve heard from one man, Jeffrey Fox, who truly took a hospital to small claims court docket to implement his proper to an inexpensive value. And gained.
We’ve heard from a listener who tried and failed, however stated, extra of us ought to do this.
And this Colorado resolution looks like excellent news for anyone excited about doing one thing like that.
But actually, it additionally raises a couple of issues that I had not recognized about earlier than. First:
Well, there ARE all these different instances on the market, in different states, that comply with the 2008 case, the one that claims well being care is simply too sophisticated for courts to get into.
And yeah, right here’s Colorado saying, “No it isn’t.”
But courts in different states aren’t certain by Colorado’s resolution. Hm. And second: there’s additionally one thing the Colorado court docket DIDN’T resolve:
What if the paper Lisa French signed had specified, “I agree to pay the hospital’s CHARGEMASTER rates?” Could she be required to pay them then? Even in the event that they had been a billion {dollars}?
In their resolution, The Colorado court docket wrote that the chargemaster charges are “increasingly arbitrary” and “inflated” and “have lost any direct connection to hospitals actual cost.”
So Ted Lavender thinks they could’ve stated, No, we are able to’t be held to a billion {dollars}, simply by including the phrase “chargemaster.”
Ted Lavender: I feel they might’ve answered that. No, however they didn’t come proper out and truly reply that.
Dan: Because they didn’t HAVE to reply that query.
Ted Lavender: Courts routinely, actually, it’s virtually an goal of appeals courts. They reply as few a lot of questions as potential to get to a solution. ,
Dan: So the Colorado court docket simpley dominated that in Lisa French’s case, the chargemaster charges weren’t “incorporated by reference” into papers she signed.
Those papers didn’t didn’t point out the chargemaster in any respect– and the hospital saved that chargemaster as a commerce secret. Open, shut.
But… hospitals aren’t supposed to maintain these charges secret anymore. For the final couple of years, due to an govt order from the Trump administration, federal guidelines have required them to submit their chargemaster to the web.
And so I had all that in thoughts after I heard from a listener in Atlanta.
Cindi Gatton: my identify is Cindy Gatton and I’ve been an impartial affected person advocate for 11 years now.
Dan: Cindi’s job helps folks cope with medical payments, however she had truly written to me about her expertise as a affected person.
Before a medical appointment, she acquired the standard types on-line, together with one for “Patient Financial Agreement and Responsibilities”
Cindi Gatton: so I believed, you already know what? I’m gonna print it and simply see precisely what it says. And I’m studying by means of the factor it says, affected person understands and agrees that he, she can be cost. The Piedmont Healthcare Standard cost grasp charges for all providers not coated by a payer or which can be self-pay.
I’ve by no means seen that earlier than, and it shocked me that there was a reference to cost grasp charges within the monetary disclosure.
Dan: And Cindi has been coping with medical payments full-time for a decade. She’s seen loads. So when she says it’s new, and that it’s surprising, that appears price noting.
Cindi Gatton: it simply feels unsuitable to me. It feels actually unsuitable as a result of it, it jogs my memory of, you already know, you, you go to a web site and so they provide you with their phrases and circumstances. Nobody reads these. I don’t learn them. You click on sure as a way to transfer on with what it’s you wanna do, which is to get care, to be seen by the physician to, you already know, have your process.
And I don’t know this, this feels, um, it feels manipulative to me
Dan: Yeah, and to me, it feels ominous. Like attorneys who work for hospitals have been taking note of the Lisa French resolution and pondering:
There’s a wedge right here possibly we might exploit. Like, if we get you to signal a doc that claims “chargemaster” on it, we’re getting you to signal away your proper to an inexpensive value. After all, the court docket in Colorado didn’t come out and say that wouldn’t be kosher.
So, the place I’m touchdown on the finish of this story is: I’ve acquired a pair huge homework assignments:
First, if I’m excited about seeing how we are able to use our authorized rights to combat again towards outrageous, unreasonable payments — and I’m —
I must study extra about which states acknowledge our rights to an inexpensive value in well being care, and which of them … possibly don’t. I’m on it, and when you’ve acquired any ideas, please carry them.
That’s the primary project, and for the second, I’d love your assist: How many hospitals are utilizing this “chargemaster” language today in these monetary responsbility paperwork they ask us to signal?
Do me a favor: See if you may get a duplicate of that doc from any hospital system or physician group the place you get seen. And ship me a duplicate of it?
Redact something you must. And additionally know: we’re not aiming to share this with anyone outdoors our reporting group.
Here’s what occurred after I tried this.
A hospital the place I get seen makes use of a portal known as MyChart– a number of hospitals use it. I simply logged on to MyChart there, and I did a bit digging round. I discovered a hyperlink to one thing known as “My Documents.” And I discovered a kind there known as Universal Consent.”
It has stuff about monetary duty.
It doesn’t point out chargemaster charges. But it’s a yr previous. It additionally says it’s expired.
And right here’s an thought I acquired from Cindi, which I’m gonna strive– and which appears price passing round.
When Cindi discovered that chargemaster language within the doc from her Hospital, right here’s what she did. She printed it out and adjusted it:
Cindi Gatton: what I did is as an alternative of the usual cost grasp charges, I drew a line by means of it and I wrote in two x Medicare charges.
Dan: In different phrases, as an alternative of claiming “I’ll pay the chargemaster rates,” it says, “I’ll pay two times the Medicare rate.”
We’ve heard about this technique earlier than, from former ProfessionalPublica reporter Marshall Allen, who wrote about it in his e book, “Never Pay the First Bill.”
Here’s the rationale. Medicare pays lower than most industrial insurance coverage; hospitals say that at the very least typically they lose cash on Medicare. Doubling it appears … beneficiant sufficient. But it additionally units a restrict.
So that’s what Cindi wrote on her printout.
Cindi Gatton: I’ve been taking it with me after I go to be seen that in the event that they ask me for the doc that I can say, you already know, right here it’s.
Dan: So far, she says, no one’s requested for it.
And, I don’t suppose anyone can be confused, however simply to ensure, I’ll say: This isn’t authorized recommendation. I’m not a lawyer. Cindi’s not a lawyer.
She’s only a individual going to the physician, doing her greatest to not depart too many openings the place she might get actually screwed. And I’m gonna strive following her instance.
And I’ve acquired one other request for you: If you do this trick of printing the factor out, exxing out the chargemaster language and writing 2 x medicare charges– LET ME KNOW WHAT HAPPENS, OK?
The place to do all that is on our web site at arm and a leg present dot com, slash contact. That’s arm and a leg present dot com, slash, contact.
You are this present’s secret weapon. You’re our eyes and ears. Cindi Gatton’s a listener who acquired in contact.
How did I first study Lisa French’s case? Email from a listener. [Thank you, Terry N, for that note last year! Took us a minute, but we got to this.]
Thank you for listening. You completely rule. I’ll catch you quickly.
Till then, care for your self.
This episode of An Arm and a Leg was produced by me, Dan Weissmann, with assist from Emily Pisacreta, and edited by Afi Yellow-Duke.
Daisy Rosario is our consulting managing producer. Adam Raymonda is our audio wizard. Our music is by Dave Winer and Blue Dot Sessions.
Gabrielle Healy is our managing editor for viewers. She edits the First Aid Kit Newsletter.
Bea Bosco is our consulting director of operations. Sarah Ballema is our operations supervisor.
An Arm and a Leg is produced in partnership with KFF Health News–previously often known as Kaiser Health News.
That’s a nationwide newsroom producing in-depth journalism about well being care in America, and a core program at KFF — an impartial supply of well being coverage analysis, polling, and journalism.
And sure, you probably did hear the identify Kaiser in there, and no: KFF isn’t affiliated with the well being care big Kaiser Permanente. You can study extra about KFF Health News at arm and a leg present dot com, slash KFF.
Zach Dyer is senior audio producer at KFF Health News. He is editorial liaison to this present.
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