In 2014, Lisa French had spinal surgical procedure. Earlier than the operation, she was advised she must pay $1,337 in out-of-pocket prices and that her insurance coverage would cowl the remainder. Nevertheless, 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 docket. On 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 may value sufferers some huge cash.
Dan Weissmann
Host and producer of “An Arm and a Leg.” Beforehand, Dan was a workers reporter for Market and Chicago’s WBEZ. His work additionally seems on All Issues Thought-about, Market, the BBC, 99 P.c Invisible, and Reveal, from the Middle for Investigative Reporting.
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Emily Pisacreta
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Adam Raymonda
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Afi Yellow-Duke
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Transcript: A $229,000 Medical Invoice Goes to Court docket
Observe: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can include errors. Please use the transcript as a device however examine 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 automotive crash, and her physician advised her that to maintain her backbone secure, she must get surgical procedure.
She requested the parents on the hospital what it was gonna value 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 mentioned, thanks.
Then, she and her husband sat down at their kitchen desk and talked it over: They’d a rainy-day fund. A thousand {dollars} they’d socked away, they saved it at dwelling, in money. Had been they able to spend all of it for this?
They determined they have 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 really acquired extra like 74 thousand.
However they determined that wasn’t sufficient. They determined they wished their full sticker worth: 303 thousand {dollars}. So that they billed Lisa French for the remainder: 229 thousand {dollars}.
And after they didn’t get it, they sued her.
Lisa French had her surgical procedure in 2014. The court docket case lastly acquired resolved final 12 months, in 2022, by the Colorado Supreme Court docket.
When you’ve been listening to this present for some time, you most likely keep in mind: We’ve got gotten VERY curious about understanding, after we get a wild medical invoice, what authorized rights do we now have? How can we use these rights to battle 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.
That is An Arm and a Leg, a present about why well being care prices so freaking a lot, and what we are able to perhaps 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 some of the enraging, terrifying, miserable elements of American life, and convey 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 numerous headlines– in 2018, when a jury heard it, in YEAR when an appeals court docket overturned the trial court docket, and final 12 months when the state supreme court docket made its ruling.
Not within the type of element that we’re gonna go into, however come on: Who can resist the headline?
Male Anchor: Nicely, tonight we now have a narrative of David versus Goliath. David being a girl who wanted spinal surgical procedure in 2014 Goliath, the hospital that charged her greater than $200,000 to do it.
Dan: So through the years, numerous 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.
Ultimately, she advised her lawyer: Don’t even inform me after they name anymore. I simply need to stay my life.
Honest 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 legislation 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 job in beginning the entire mess.
Ted Lavender: the corporate that she labored for had a well being advantages plan that was barely totally different than what you would possibly name run of the mill medical insurance.
Dan: It labored this fashion: They weren’t in-network with any hospitals. As a substitute, they’d simply take no matter invoice any hospital despatched, make their very own analysis of what a good worth could be, and ship the hospital a examine.
It’s a considerably uncommon mannequin– one survey says about 2 % of employers use a plan like this– however Ted Lavender says it usually works.
Ted Lavender: a really giant proportion of the time , the hospital would settle for the examine 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 hassle, 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 rigorously.
If that they had, they might’ve seen somewhat emblem below the insurance-company identify that mentioned, “supplier solely” — that’s: This plan solely has medical doctors and nurses and different PROVIDERS in community.
With hospitals, there’s no community, no “in-network fee.” We’ll simply ship a examine for what we expect is correct.
The identical health-benefits firm has a distinct plan, one which does have a hospital community. You understand how it’s. Insurance coverage firms, one million totally different plans, each one its personal snowflake.
The hospital mistook Lisa French’s snowflake for an additional one, and that’s how they got here up with that estimate.
Ted Lavender: primarily based 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 so they presumably would’ve been pleased with 56 thousand. However they acquired extra. They acquired about 75 thousand {dollars}.
However as soon as they acquired it, they wised as much as the error that they had made about Lisa French’s insurance coverage. They’d no settlement with the insurance coverage plan to just accept 56 thousand.
So, they determined: There’s no motive for us to not cost our full sticker worth right here.300 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 prematurely. However 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
After which on the backside was, you already know, subtracting the thousand she paid, subtracting the cash the insurance coverage paid, leaving a stability of 229,000 and alter
Dan: After all, Lisa French didn’t have 229 thousand {dollars}, or something prefer it.
Ted Lavender: Ultimately 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, by way of 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, massive, gotcha second that was actually thrilling.
Dan: However Ted Lavender did his greatest. Like one time, when he acquired a hospital government on the witness stand.
To stabilize Lisa French’s backbone, surgeons had implanted 13 items of steel into her physique. So Ted Lavender had the hospital government stroll the jury by the value for every of these bits of steel. Or really, the costs..
Ted Lavender: And I first confirmed him the itemized invoice and requested him to determine what they charged for these 13 items of {hardware} .
I had given him form of an outsized calculator that was sitting there in entrance of him on the witness stand, admittedly, for some dramatic impact
And thru including these up on the itemized invoice, he arrived on the quantity which was $197,000.
Dan: 100 and ninety-seven thousand {dollars}. In order that’s about two-thirds of the 300 and three thousand {dollars} the hospital is making an attempt to cost Lisa French.
After which the following factor I did was I handed within the 13 invoices that we had acquired from the hospital,
Dan: That’s, Ted handed the man the invoices the hospital had acquired — and paid — when it purchased these bits of steel..
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 somewhat nearer as much as the entrance of their chair, and finally he arrived on the whole, which was $31,000 and alter.
Dan: So the hospital’s charging like six and a half occasions 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: In order that was a superb second for Lisa French’s aspect. I imply getting the jury mad on the different aspect, that’s a win.
And the massive calculator wasn’t Ted Lavender’s solely visible: He additionally had an enormous post-it observe, the place he wrote down, in magic marker, all of the totally 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 non-public insurance coverage.
Dan: That’s lower than half of what they have been making an attempt to cost Lisa French. And so they accepted lower than that — a LOT much less — from government-funded insurance coverage, like Medicare, Medicaid, or Tricare, which covers of us within the navy.
Ted Lavender: The typical of what they might’ve accepted for these. Procedures that Ms. French had have been $63,199. Once more, Ms. French and her insurance coverage firm mixed paid virtually $75,000.
Dan: You possibly can hear that post-it rustling round. It was a superb prop, he’s held onto it. So, he’d proven the jury that the hospital charged a HUGE markup, and that what they have been suing Lisa French for was means, far more than they charged anyone else.
On the hospital’s aspect, they have been like, Yeah, however that is our precise sticker worth. And Lisa French signed a chunk of paper that mentioned she would pay “all fees of the hospital.”
So the hospital was like, yep, and these are our fees. That 303 thousand {dollars}, it comes from an inventory we maintain. It’s referred to 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 fees of the hospital” — was she particularly agreeing to pay what was on the chargemaster?
And right here’s one factor which may’ve made jurors somewhat 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 mentioned it was a commerce secret.
Ted Lavender: they went during trial. By no means 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 they usually refuse to supply it on the premise that it was confidential and proprietary.
Dan: By withholding that checklist, the hospital might have helped Ted Lavender make his argument: How may Lisa French have identified what she was signing up for, if she couldn’t see the costs?
Ted Lavender: if we are able to’t get it by our subpoena energy, how on the earth 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: Ultimately, 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 cheap.
The jury determined she owed the hospital seven hundred seventy six {dollars} and 74 cents
Mainly, 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 evening greater than anticipated: She owed a price for late check-out.
After all the hospital didn’t take that mendacity down. They appealed the result– and gained! Ted Lavender appealed that call, which is how the case ended up in entrance of the Colorado Supreme Court docket.
We’ve really acquired tape of these proceedings. They’re kinda juicy. Plus the 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 Well being Information–previously often known as Kaiser Well being Information.
They’re a nationwide newsroom producing in-depth journalism about well being care in America. We’ll have extra details about KFF Well being Information on the finish of this episode.
OK, so Lisa French’s case was headed to the Colorado Supreme Court docket.
And right here’s the massive subject. Keep in mind how the jury discovered that Lisa French hadn’t really agreed to pay the hospital’s chargemaster worth, 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 legislation — 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 deal with the Supreme Court docket, he led with these citations.
Mike McConnell: All the questions that you’ve got raised have been addressed in additional than a dozen instances across the nation. rigorously and completely.
Justice Richard L. Gabriel: Nicely, let me push again on you. Good morning to you, Mr. McConnell.
Mike McConnell: Good morning.
Dan: That is Justice Richard L Gabriel, stepping proper in. He notes that these dozen different selections all relaxation on one unique case, from 2008, the place a court docket had mentioned: We are able to’t intervene in well being care pricing. Courts shouldn’t strive. Well being 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 might not be the neatest folks on the earth, however it is a contract and why ought to the hospital business— totally different than some other business on the planet —have totally different guidelines for contract ideas?
Dan: The hospital lawyer argued that hospitals couldn’t predict all the things that may occur in a affected person’s care. In truth, the hospital can’t even management it: Solely physicians can resolve what remedy to order.
Mike McConnell: You possibly can, uh, I suppose think about that hospitals ought to have the ability to predict prematurely what a specific doctor goes to order for a specific affected person. Um, and, uh, maybe, you already know, clearly you’re feeling that’s the means it must be. It isn’t the best way it’s, however now
Justice Melissa Hart: Mr. Mr. McConnell, I’m sorry, to interrupt…
Dan: Right 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 value and inform her that. So it’s, it appears false to me that they will’t do it. After all, they will’t predict with absolute certainty. On this case, she had the additional evening keep within the hospital and he or she paid for that. However they will predict in a case like this, they usually do.
Dan: The justices didn’t appear super-persuaded by McConnell’s response to that. And that left yet another massive query in entrance of the justices.
When Lisa French signed a doc promising to pay “all fees,” was she undoubtedly agreeing to pay 300 and three thousand {dollars}? Or 229 after insurance coverage.
The appeals court docket discovered that the chargemaster fee — the 303 thousand — had been “integrated by reference” to the doc she’d signed, formally referred to as the “hospital providers settlement.”
The supreme court docket wasn’t satisfied. Right 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 may 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 supply, all fees not in any other case paid by insurance coverage. She understood that the hospital fees would, she was answerable for paying the hospital fees that her insurance coverage firm did it,
Justice Richard L. Gabriel: No matter it was. They may have charged her a billion {dollars} and he or she’s your place to be she’s sure as a result of she agreed. All fees means all fees.
Dan: Huh! There wasn’t an actual comeback to that.
The Supreme Court docket dominated towards the hospital, unanimously. Particularly, they dominated that the chargemaster– the 303 thousand {dollars}– had not been “integrated by reference” to the piece of paper Lisa French had signed.
She didn’t know these chargemaster checklist costs even existed. How may she conform to pay them?
In order that meant, the court docket dominated that, quote, “the hospital providers agreements left the value time period open.”
Which is language which will ring a bell, should you’ve been listening to this present. It’s a authorized precept — a bedrock of contract legislation:
How the legislation treats an open-price contract — a contract that doesn’t specify a worth time period.
Right here’s a refresher on that precept from Ted Lavender.
Ted Lavender: should 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 worth that it’s important to pay. After which they provide you your meal.
You enter that contract with an precise worth time period
Dan: However you may also enter an open-price contract — a contract with out a worth time period.
Ted Lavender: if in case you have a contract with out a worth time period, with out a particular worth in it, then the legislation infer into that contract an affordable worth.
Dan: In different phrases, a contract with the value time period OPEN will not be a clean examine. I don’t need to pay no matter quantity the opposite aspect makes up.
And that’s what the Colorado Supreme Court docket discovered right here.
They dominated that, quote, “ideas of contract legislation can actually be utilized to hospital-patient contracts.” They are saying, a court docket might have dominated in any other case in 2008, and different courts might have cited that opinion. We disagree.
The Colorado Supreme Court docket is saying, even in well being care, when no worth is specified– when the value time period is open– you may have the proper to an affordable worth.
Sure!
And that’s why Lisa French’s case is so fascinating to us, right here on this present.
As a result of we’ve talked right here about utilizing this authorized precept to battle again towards outrageous payments.
We’ve heard from one man, Jeffrey Fox, who really took a hospital to small claims court docket to implement his proper to an affordable worth. And gained.
We’ve heard from a listener who tried and failed, however mentioned, extra of us ought to do this.
And this Colorado determination looks like excellent news for anyone curious about doing one thing like that.
However truthfully, it additionally raises a number of issues that I had not identified about earlier than. First:
Nicely, there ARE all these different instances on the market, in different states, that observe 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.”
However courts in different states aren’t sure by Colorado’s determination. 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 conform to pay the hospital’s CHARGEMASTER charges?” May she be required to pay them then? Even when they have been a billion {dollars}?
Of their determination, The Colorado court docket wrote that the chargemaster charges are “more and more arbitrary” and “inflated” and “have misplaced any direct connection to hospitals precise value.”
So Ted Lavender thinks they may’ve mentioned, No, we are able to’t be held to a billion {dollars}, simply by including the phrase “chargemaster.”
Ted Lavender: I believe they might’ve answered that. No, however they didn’t come proper out and really reply that.
Dan: As a result of they didn’t HAVE to reply that query.
Ted Lavender: Courts routinely, in reality, 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 “integrated by reference” into papers she signed.
These papers didn’t didn’t point out the chargemaster in any respect– and the hospital saved that chargemaster as a commerce secret. Open, shut.
However… hospitals aren’t supposed to maintain these charges secret anymore. For the final couple of years, due to an government 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 once I heard from a listener in Atlanta.
Cindi Gatton: my identify is Cindy Gatton and I’ve been an unbiased affected person advocate for 11 years now.
Dan: Cindi’s job helps folks cope with medical payments, however she had really written to me about her expertise as a affected person.
Earlier than a medical appointment, she acquired the standard varieties on-line, together with one for “Affected person Monetary Settlement and Duties”
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 the factor it says, affected person understands and agrees that he, she will probably be cost. The Piedmont Healthcare Normal 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 stunning, that appears price noting.
Cindi Gatton: it simply feels fallacious to me. It feels actually fallacious as a result of it, it jogs my memory of, you already know, you, you go to an internet site they usually provide you with their phrases and situations. No person reads these. I don’t learn them. You click on sure so 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 being attentive to the Lisa French determination and considering:
There’s a wedge right here perhaps we may 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 affordable worth. In any case, 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 massive homework assignments:
First, if I’m curious about seeing how we are able to use our authorized rights to battle again towards outrageous, unreasonable payments — and I’m —
I have to study extra about which states acknowledge our rights to an affordable worth in well being care, and which of them … perhaps don’t. I’m on it, and should you’ve acquired any ideas, please deliver them.
That’s the primary project, and for the second, I’d love your assist: What number of hospitals are utilizing this “chargemaster” language today in these monetary responsbility paperwork they ask us to signal?
Do me a favor: See if you will get a replica of that doc from any hospital system or physician group the place you get seen. And ship me a replica of it?
Redact something you want to. And likewise know: we’re not aiming to share this with anyone outdoors our reporting workforce.
Right here’s what occurred once I tried this.
A hospital the place I get seen makes use of a portal referred to as MyChart– numerous hospitals use it. I simply logged on to MyChart there, and I did somewhat digging round. I discovered a hyperlink to one thing referred to as “My Paperwork.” And I discovered a type there referred to as Common Consent.”
It has stuff about monetary duty.
It doesn’t point out chargemaster charges. Nevertheless it’s a 12 months 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 it and I wrote in two x Medicare charges.
Dan: In different phrases, as an alternative of claiming “I’ll pay the chargemaster charges,” it says, “I’ll pay two occasions the Medicare fee.”
We’ve heard about this technique earlier than, from former ProPublica reporter Marshall Allen, who wrote about it in his e book, “By no means Pay the First Invoice.”
Right here’s the rationale. Medicare pays lower than most industrial insurance coverage; hospitals say that a minimum of generally they lose cash on Medicare. Doubling it appears … beneficiant sufficient. Nevertheless it additionally units a restrict.
In order that’s what Cindi wrote on her printout.
Cindi Gatton: I’ve been taking it with me once 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: To this point, she says, no one’s requested for it.
And, I don’t suppose anyone will probably be confused, however simply to verify, I’ll say: This isn’t authorized recommendation. I’m not a lawyer. Cindi’s not a lawyer.
She’s only a particular person going to the physician, doing her greatest to not depart too many openings the place she may get actually screwed. And I’m gonna strive following her instance.
And I’ve acquired one other request for you: When 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 might be 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? E-mail from a listener. [Thank you, Terry N, for that note last year! Took us a minute, but we got to this.]
Thanks for listening. You completely rule. I’ll catch you quickly.
Until then, deal with 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 Classes.
Gabrielle Healy is our managing editor for viewers. She edits the First Help Package E-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 Well being Information–previously often known as Kaiser Well being Information.
That’s a nationwide newsroom producing in-depth journalism about well being care in America, and a core program at KFF — an unbiased supply of well being coverage analysis, polling, and journalism.
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