Patient Underwent One Surgery but Was Billed for Two. Even After Being Sued, She Refused To Pay.
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Jamie Holmes says a surgery center tried to make her pay for two operations after she underwent only one. She refused to buckle, even after a collection agency sued her last winter.
Holmes, who lives in northwestern Washington state, had surgery in 2019 to have her fallopian tubes tied, a permanent birth-control procedure that her insurance company agreed ahead of time to cover.
During the operation, while Holmes was under anesthesia, the surgeon noticed early signs of endometriosis, a common condition in which fibrous scar tissue grows around the uterus, Holmes said. She said the surgeon later told her he spent about 15 minutes cauterizing the troublesome tissue as a precaution. She recalls him saying he finished the whole operation within the 60 minutes that had been allotted for the tubal ligation procedure alone.
She said the doctor assured her the extra treatment for endometriosis would cost her little, if anything.
Then the bill came.
The Patient: Jamie Holmes, 38, of Lynden, Washington, who was insured by Premera Blue Cross at the time.
Medical Services: A tubal ligation operation, plus treatment of endometriosis found during the surgery.
Service Provider: Pacific Rim Outpatient Surgery Center of Bellingham, Washington, which has since been purchased, closed, and reopened under a new name.
Total Bill: $9,620. Insurance paid $1,262 to the in-network center. After adjusting for prices allowed under the insurer’s contract, the center billed Holmes $2,605. A collection agency later acquired the debt and sued her for $3,792.19, including interest and fees.
What Gives: The surgery center, which provided the facility and support staff for her operation, sent a bill suggesting that Holmes underwent two separate operations, one to have her tubes tied and one to treat endometriosis. It charged $4,810 for each.
Holmes said there were no such problems with the separate bills from the surgeon and anesthesiologist, which the insurer paid.
Holmes figured someone in the center’s billing department mistakenly thought she’d been on the operating table twice. She said she tried to explain it to the staff, to no avail.
She said it was as if she ordered a meal at a fast-food restaurant, was given extra fries, and then was charged for two whole meals. “I didn’t get the extra burger and drink and a toy,” she joked.
Her insurer, Premera Blue Cross, declined to pay for two operations, she said. The surgery center billed Holmes for much of the difference. She refused to pay.
Holmes said she understands the surgery center could have incurred additional costs for the approximately 15 minutes the surgeon spent cauterizing the spots of endometriosis. About $500 would have seemed like a fair charge to her. “I’m not opposed to paying for that,” she said. “I am opposed to paying for a whole bunch of things I didn’t receive.”
The physician-owned surgery center was later purchased and closed by PeaceHealth, a regional health system. But the debt was turned over to a collection agency, SB&C, which filed suit against Holmes in December 2023, seeking $3,792.19, including interest and fees.
The collection agency asked a judge to grant summary judgment, which could have allowed the company to garnish wages from Holmes’ job as a graphic artist and marketing specialist for real estate agents.
Holmes said she filed a written response, then showed up on Zoom and at the courthouse for two hearings, during which she explained her side, without bringing a lawyer. The judge ruled in February that the collection agency was not entitled to summary judgment, because the facts of the case were in dispute.
More From Bill Of The Month
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- It’s Called an Urgent Care Emergency Center — But Which Is It?
- He Fell Ill on a Cruise. Before He Boarded the Rescue Boat, They Handed Him the Bill.
Representatives of the collection agency and the defunct surgery center declined to comment for this article.
Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms, said it was absurd for the surgery center to bill for two operations and then refuse to back down when the situation was explained. “It’s like a Kafka novel,” she said.
Corlette said surgery center staffers should be accustomed to such scenarios. “It is quite common, I would think, for a surgeon to look inside somebody and say, ‘Oh, there’s this other thing going on. I’m going to deal with it while I’ve got the patient on the operating table.’”
It wouldn’t have made medical or financial sense for the surgeon to make Holmes undergo a separate operation for the secondary issue, she said.
Corlette said that if the surgery center was still in business, she would advise the patient to file a complaint with state regulators.
The Resolution: So far, the collection agency has not pressed ahead with its lawsuit by seeking a trial after the judge’s ruling. Holmes said that if the agency continues to sue her over the debt, she might hire a lawyer and sue them back, seeking damages and attorney fees.
She could have arranged to pay off the amount in installments. But she’s standing on principle, she said.
“I just got stonewalled so badly. They treated me like an idiot,” she said. “If they’re going to be petty to me, I’m willing to be petty right back.”
The Takeaway: Don’t be afraid to fight a bogus medical bill, even if the dispute goes to court.
Debt collectors often seek summary judgment, which allows them to garnish wages or take other measures to seize money without going to the trouble of proving in a trial that they are entitled to payments. If the consumers being sued don’t show up to tell their side in court hearings, judges often grant summary judgment to the debt collectors.
However, if the facts of a case are in dispute — for example, because the defendant shows up and argues she owes for just one surgery, not two — the judge may deny summary judgment and send the case to trial. That forces the debt collector to choose: spend more time and money pursuing the debt or drop it.
“You know what? It pays to be stubborn in situations like this,” said Berneta Haynes, a senior attorney for the National Consumer Law Center who reviewed Holmes’ bill for KFF Health News.
Many people don’t go to such hearings, sometimes because they didn’t get enough notice, don’t read English, or don’t have time, she said.
“I think a lot of folks just cave” after they’re sued, Haynes said.
Emily Siner reported the audio story.
After six years, we’ll have a final installment with NPR of our Bill of the Month project in the fall. But Bill of the Month will continue at KFF Health News and elsewhere. We still want to hear about your confusing or outrageous medical bills. Visit Bill of the Month to share your story.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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The Real Benefit Of Genetic Testing
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Genetic Testing: Health Benefits & Methods
Genetic testing is an oft-derided American pastime, but there’s a lot more to it than finding out about your ancestry!
Note: because there are relatively few companies offering health-related genetic testing services, and we are talking about the benefits of those services, some of this main feature may seem like an advert.
It’s not; none of those companies are sponsoring us, and if any of them become a sponsor at some point, we’ll make it clear and put it in the clearly-marked sponsor segment.
As ever, our only goal here is to provide science-backed information, to enable you to make your own, well-informed, decisions.
Health genomics & genetic testing
The basic goal of health genomics and genetic testing is to learn:
- What genetic conditions you have
- Clearcut genetic conditions, such as Fragile X syndrome, or Huntington’s disease
- What genetic predispositions you have
- Such as an increased/decreased risk for various kinds of cancer, diabetes, heart conditions, and so forth
- What genetic traits you have
- These may range from “blue eyes” to “superathlete muscle type”
- More specifically, pharmacogenomic information
- For example, “fast caffeine metabolizer” or “clopidogrel (Plavix) non-responder” (i.e., that drug simply will not work for you)
Wait, what’s the difference between health genomics and genetic testing?
- Health genomics is the science of how our genes affect our health.
- Genetic testing can be broadly defined as the means of finding out which genes we have.
A quick snippet…
More specifically, a lot of these services look at which single nucleotide polymorphisms (SNPs, pronounced “snips”) we have. While we share almost all of our DNA with each other (and indeed, with most vertebrates), our polymorphisms are the bits that differ, and are the bits that, genetically speaking, make us different.
So, by looking just at the SNPs, it means we “only” need to look at about 3,000,000 DNA positions, and not our entire genome. For perspective, those 3,000,000 DNA positions make up about 0.1% of our whole genome, so without focusing on SNPs, the task would be 1000x harder.
For example, the kind of information that this sort of testing may give you, includes (to look at some “popular” SNPs):
- rs53576 in the oxytocin receptor influences social behavior and personality
- rs7412 and rs429358 can raise the risk of Alzheimer’s disease by more than 10x
- rs6152 can influence baldness
- rs333 resistance to HIV
- rs1800497 in a dopamine receptor may influence the sense of pleasure
- rs1805007 determines red hair and sensitivity to anesthetics
- rs9939609 triggers obesity and type-2 diabetes
- rs662799 prevents weight gain from high fat diets
- rs12255372 linked to type-2 diabetes and breast cancer
- rs1799971 makes alcohol cravings stronger
- rs17822931 determines earwax, sweating and body odor
- rs1333049 coronary heart disease
- rs1051730 and rs3750344 nicotine dependence
- rs4988235 lactose intolerance
(You can learn about these and more than 100,000 other SNPs at SNPedia.com)
I don’t know what SNPs I have, and am disinclined to look them up one by one!
The first step to knowing, is to get your DNA out of your body and into a genetic testing service. This is usually done by saliva or blood sample. This writer got hers done many years ago by 23andMe and was very happy with that service, but there are plenty of other options.
Healthline did an independent review of the most popular companies, so you might like to check out:
Healthline: Best DNA Testing Kits of 2023
Those companies will give you some basic information, such as “6x higher breast cancer risk” or “3x lower age-related macular degeneration risk” etc.
However, to really get bang-for-buck, what you want to do next is:
- Get your raw genetic data (the companies above should provide it); this will probably look like a big text file full of As, Cs, Gs, and Ts, but it make take another form.
- Upload it to Promethease. When this writer got hers done , the cost was $2; that price has now gone up to a whopping $12.
- You will then get a report that will cross-reference your data with everything known about SNPs, and give a supremely comprehensive, readable-to-the-human-eye, explanation of what it all means for you—from much more specific health risk prognostics, to more trivial things like whether you can roll your tongue or smell decomposed asparagus metabolites in urine.
A note on privacy: anything you upload to Promethease will be anonymized, and/but in doing so, you consent to it going into the grand scientific open-source bank of “things we know about the human genome”, and thus contribute to the overall sample size of genetic data.
In our opinion, it means you’re doing your bit for science, without personal risk. But your opinion may differ, and that’s your decision to make.
Lastly, on the pros and cons of pharmacogenetic testing specifically:
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- What genetic conditions you have
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This Chair Rocks: A Manifesto Against Ageism – by Ashton Applewhite
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It’s easy to think of ageism as being 80% “nobody will hire me because I am three years away from standard retirement age”, but it’s a lot more pervasive than that. And some of it, perhaps the most insidious, is the ageism that we can sometimes internalize without thinking it through.
10almonds readers love to avoid/reverse aging (and this reviewer is no different!), but it’s good once in a while to consider our priorities and motivations, for example:
- There is merit in being able to live without disability or discomfort
- There is harm in feeling a need to pass for younger than we are
And yet, even things such as disabilities are, Applewhite fairly argues, not to be feared. Absolutely avoided if reasonably possible of course, yes, but if they happen they happen and it’s good that we be able to make our peace with that, because most people have at least some kind of disability before the end, and can still strive to make the most of the precious gift that is life. The goal can and should be to play the hand we’re dealt and to live as well as we can—whatever that latter means for us personally.
Many people’s life satisfaction goes up in later years, and Applewhite hypothesizes that while some of that can be put down to circumstances (often no longer overwhelmed with work etc, often more financially stable), a lot is a matter of having come to terms with “losing” youth and no longer having that fear. Thus, a new, freer age of life begins.
The book does cover many other areas too, more than we can list here (but for example: ranging from pro/con brain differences to sex and intimacy), and the idea that long life is a team sport, and that we should not fall into the all-American trap of putting independence on a pedestal. Reports of how aging works with close-knit communities in the supercentenarian Blue Zones can be considered to quash this quite nicely, for instance.
The style is casual and entertaining, and yet peppered with scholarly citations, which stack up to 30 pages of references at the back.
Bottom line: getting older is a privilege that not everyone gets to have, so who are we to squander it? This book shares a vital sense of perspective, and is a call-to-arms for us all to do better, together.
Click here to check out This Chair Rocks, and indeed rock it!
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Women Living Deliciously – by Florence Given
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“Wouldst thou like to live deliciously?” as the line goes, and this book answers that, and how.
While roundly aimed at women, as per the title, this book will be of benefit to anyone who finds that society has wanted to keep you small and contained, and that perhaps you were meant for better.
The book is divided into three sections:
- Excavating
- Planting
- Blooming
…which broadly describes the process the author takes us through, of:
- Digging up what is wrong
- Putting better things in place
- Enjoying life
This is important, because otherwise a lot of people will understandably exhort us to step 3 (enjoying life), without really thinking about steps 1 and 2.
Her wording of it is important too, it wasn’t just being flowery for floweriness’ sake—rather, it highlights the nature of the process: while “enjoy life” seems like a thing-in-itself (as Kant might say), in reality, there’s another necessary thing (or series of things) behind it. In contrast, the gardening metaphor renders it clear: how will your flowers bloom if you do not plant them? And what good will planting them do if the soil is not right for them?
So, she gives us a “ground upwards” therapeutic approach.
The style throughout is casual but sincere and heartfelt, and while this is a book of personal change rather than social change, it does reference feminism throughout so if that’s not for you, then neither is this book.
Bottom line: this is a lot more than just a pep talk or a book of platitudes; it’s a lot of concrete, applicable stuff to markedly live life better.
Click here to check out Women Living Deliciously, and live deliciously!
PS: we notice a one-star review on Amazon expressed disappointment upon discovering that this is not a recipe book. So please be aware, the only recipe in this book is the recipe for a fulfilling and vibrant life 😎
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Should I get a weighted vest to boost my fitness? And how heavy should it be?
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Exercise training while wearing a weighted vest is undergoing somewhat of a renaissance. Social media posts and trainers are promoting them as a potential strategy for improving fitness and health.
Exercising with additional weight attached to the body is nothing new. This idea has been used with soldiers for many centuries if not millennia – think long hikes with a heavy pack.
The modern weighted vest comes in a range of designs that are more comfortable and can be adjusted in terms of the weight added. But could one be helpful for you?
ZR10/Shutterstock What the research says
One of the earliest research studies, reported in 1993, followed 36 older people wearing weighted vests during a weekly exercise class and at home over a 20-week period. Wear was associated with improvements in bone health, pain and physical function.
Since then, dozens of papers have evaluated the exercise effects of wearing a weighted vest, reporting a range of benefits.
Not surprisingly, exercise with a weighted vest increases physiological stress – or how hard the body has to work – as shown by increased oxygen uptake, heart rate, carbohydrate utilisation and energy expenditure.
Adding weight equal to 10% of body weight is effective. But it doesn’t appear the body works significantly harder when wearing 5% extra weight compared to body weight alone.
Does more load mean greater injury risk?
A small 2021 study suggested additional weights don’t alter the biomechanics of walking or running. These are important considerations for lower-limb injury risk.
The safety considerations of exercising with weighted vests have also been reported in a biomechanical study of treadmill running with added weight of 1% to 10% of body weight.
While physiological demand (indicated by heart rate) was higher with additional weight and the muscular forces greater, running motion was not negatively affected.
To date no research studies have reported increased injuries due to wearing weighted vests for recreational exercise. However a 2018 clinical study on weight loss in people with obesity found back pain in 25% of those wearing such vests. Whether this can be translated to recreational use in people who don’t have obesity is difficult to say. As always, if pain or discomfort is experienced then you should reduce the weight or stop vest training.
Better for weight loss or bone health?
While wearing a weighted vest increases the energy expenditure of aerobic and resistance exercise, research to show it leads to greater fat loss or retaining muscle mass is somewhat inconclusive.
One older study investigated treadmill walking for 30 minutes, three times a week in postmenopausal women with osteoporosis. The researchers found greater fat loss and muscle gain in the participants who wore a weighted vest (at 4–8% body weight). But subsequent research in obese older adults could not show greater fat loss in participants who wore weighted vests for an average of 6.7 hours per day.
There has been considerable interest in the use of weighted vests to improve bone health in older people. One 2003 study reported significant improvements in bone density in a group of older women over 32 weeks of weighted vest walking and strength training compared to a sedentary control group.
But a 2012 study found no difference in bone metabolism between groups of postmenopausal women with osteoporosis walking on a treadmill with or without a weighted vest.
Making progress
As with any exercise, there is a risk of injury if it is not done correctly. But the risk of weighted vest training appears low and can be managed with appropriate exercise progression and technique.
If you are new to training, then the priority should be to simply start exercising and not complicate it with wearing a weighted vest. The use of body weight alone will be sufficient to get you on the path to considerable gains in fitness.
Once you have a good foundation of strength, aerobic fitness and resilience for muscles, joints and bones, using a weighted vest could provide greater loading intensity as well as variation.
It is important to start with a lighter weight (such as 5% bodyweight) and build to no more than 10% body weight for ground impact exercises such as running, jogging or walking.
For resistance training such as squats, push-ups or chin-ups, progression can be achieved by increasing loads and adjusting the number of repetitions for each set to around 10 to 15. So, heavier loads but fewer repetitions, then building up to increase the load over time.
While weighted vests can be used for resistance training, it is probably easier and more convenient to use barbells, dumbbells, kettle bells or weighted bags.
The benefits of added weight can also be achieved by adding repetition or duration. Geert Pieters/Unsplash The bottom line
Weighted vest training is just one tool in an absolute plethora of equipment, techniques and systems. Yes, walking or jogging with around 10% extra body weight increases energy expenditure and intensity. But training for a little bit longer or at a higher intensity can achieve similar results.
There may be benefits for bone health in wearing a weighted vest during ground-based exercise such as walking or jogging. But similar or greater stimulus to bone growth can be achieved by resistance training or even the introduction of impact training such as hopping, skipping or bounding.
Exercising with a weighted vest likely won’t increase your injury risk. But it must be approached intelligently considering fitness level, existing and previous injuries, and appropriate progression for intensity and repetition.
Rob Newton, Professor of Exercise Medicine, Edith Cowan University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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ADHD… As An Adult?
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ADHD—not just for kids!
Consider the following:
- If a kid has consistent problems paying attention, it’s easy and common to say “Aha, ADHD!”
- If a young adult has consistent problems paying attention, it’s easy and common to say “Aha, a disinterested ne’er-do-well!”
- If an older adult has consistent problems paying attention, it’s easy and common to say “Aha, a senior moment!”
Yet, if we recognize that ADHD is fundamentally a brain difference in children (and we do; there are physiological characteristics that we can test), and we can recognize that as people get older our brains typically have less neuroplasticity (ability to change) than when we are younger rather than less, then… Surely, there are just as many adults with ADHD as kids!
After all, that rather goes with the linear nature of time and the progressive nature of getting older.
So why do kids get diagnoses so much more often than adults?
Parents—and schools—can find children’s ADHD challenging, and it’s their problem, so they look for an explanation, and ADHD isn’t too difficult to find as a diagnosis.
Meanwhile, adults with ADHD have usually developed coping mechanisms, have learned to mask and/or compensate for their symptoms, and we expect adults to manage their own problems, so nobody’s rushing to find an explanation on their behalf.
Additionally, the stigma of neurodivergence—especially something popularly associated with children—isn’t something that many adults will want for themselves.
But, if you have an ADHD brain, then recognizing that (even if just privately to yourself) can open the door to much better management of your symptoms… and your life.
So what does ADHD look like in adults?
ADHD involves a spread of symptoms, and not everyone will have them all, or have them in the same magnitude. However, very commonly most noticeable traits include:
- Lack of focus (ease of distraction)
- Conversely: high focus (on the wrong things)
- To illustrate: someone with ADHD might set out to quickly tidy the sock drawer, and end up Marie Kondo-ing their entire wardrobe… when they were supposed to doing something else
- Conversely: high focus (on the wrong things)
- Poor time management (especially: tendency to procrastinate)
- Forgetfulness (of various kinds—for example, forgetting information, and forgetting to do things)
Want To Take A Quick Test? Click Here ← this one is reputable, and free. No sign in required; the test is right there.
Wait, where’s the hyperactivity in this Attention Deficit Hyperactivity Disorder?
It’s often not there. ADHD is simply badly-named. This stems from how a lot of mental health issues are considered by society in terms of how much they affect (and are observable by) other people. Since ADHD was originally noticed in children (in fact being originally called “Hyperkinetic Reaction of Childhood”), it ended up being something like:
“Oh, your brain has an inconvenient relationship with dopamine and you are driven to try to correct that by shifting attention from boring things to stimulating things? You might have trouble-sitting-still disorder”
Hmm, this sounds like me (or my loved one); what to do now at the age of __?
Some things to consider:
- If you don’t want medication (there are pros and cons, beyond the scope of today’s article), you might consider an official diagnosis not worth pursuing. That’s fine if so, because…
- More important than whether or not you meet certain diagnostic criteria, is whether or not the strategies recommended for it might help you.
- Whether or not you talk to other people about it is entirely up to you. Maybe it’s a stigma you’d rather avoid… Or maybe it’ll help those around you to better understand and support you.
- Either way, you might want to learn more about ADHD in adults. Today’s article was about recognizing it—we’ll write more about managing it another time!
In the meantime… We recommended a great book about this a couple of weeks ago; you might want to check it out:
Click here to see our review of “The Silent Struggle: Taking Charge of ADHD in Adults”!
Note: the review is at the bottom of that page. You’ll need to scroll past the video (which is also about ADHD) without getting distracted by it and forgetting you were there to see about the book. So:
- Click the above link
- Scroll straight to the review!
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What Most People Don’t Know About Hearing Aids
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Dr. Juliëtte Sterkens, a doctor of audiology, makes things clearer in this TEDx talk:
The sound of the future
Half of all adults experience hearing loss by the age of 75, and by 85, that goes up to two thirds. Untreated hearing loss leads to depression, social isolation, cognitive decline, and even an increased fall risk.
It’s not just about reduced volume though; Dr. Sterkens points out that for many (like this writer!) it’s more a matter of unequal pitch perception and difficulty in speech clarity. Most hearing aids just amplify sound, and don’t fully restore clarity, especially beyond a short range.
However, technology keeps marching forwards there have been improvements in the move from analog to digital, and today’s bluetooth-enabled hearing aids often do a lot better, especially in the case of things like TV transmitters and clip-on microphones.
Out and about, you might see signs sometimes saying “Hearing Loop Enabled”, and those transmit sound directly to telecoil-equipped hearing aids—venues with public address systems are legally required to provide hearing accommodations like this. Many hearing aids include telecoils, but users often aren’t informed or don’t have them activated, which is unfortunate, because telecoils improve hearing dramatically in loop-enabled venues.
Dr. Sterkens makes a plea for us to, as applicable,
- Activate telecoils and insist on them in new hearing aids.
- Advocate for assistive listening systems in public venues.
- Use available resources like the Hearing Loss Association of America for tools and information.
- Familiarize ourselves with accessibility laws and report non-compliance.
- Aim to make the world more accessible for people with hearing loss through advocacy, technology, and awareness.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
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