Patient Underwent One Surgery but Was Billed for Two. Even After Being Sued, She Refused To Pay.
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
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
- Her Hearing Implant Was Preapproved. Nonetheless, She Got $139,000 Bills for Months.
- 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.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
To tackle gendered violence, we also need to look at drugs, trauma and mental health
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
After several highly publicised alleged murders of women in Australia, the Albanese government this week pledged more than A$925 million over five years to address men’s violence towards women. This includes up to $5,000 to support those escaping violent relationships.
However, to reduce and prevent gender-based and intimate partner violence we also need to address the root causes and contributors. These include alcohol and other drugs, trauma and mental health issues.
Why is this crucial?
The World Health Organization estimates 30% of women globally have experienced intimate partner violence, gender-based violence or both. In Australia, 27% of women have experienced intimate partner violence by a co-habiting partner; almost 40% of Australian children are exposed to domestic violence.
By gender-based violence we mean violence or intentionally harmful behaviour directed at someone due to their gender. But intimate partner violence specifically refers to violence and abuse occurring between current (or former) romantic partners. Domestic violence can extend beyond intimate partners, to include other family members.
These statistics highlight the urgent need to address not just the aftermath of such violence, but also its roots, including the experiences and behaviours of perpetrators.
What’s the link with mental health, trauma and drugs?
The relationships between mental illness, drug use, traumatic experiences and violence are complex.
When we look specifically at the link between mental illness and violence, most people with mental illness will not become violent. But there is evidence people with serious mental illness can be more likely to become violent.
The use of alcohol and other drugs also increases the risk of domestic violence, including intimate partner violence.
About one in three intimate partner violence incidents involve alcohol. These are more likely to result in physical injury and hospitalisation. The risk of perpetrating violence is even higher for people with mental ill health who are also using alcohol or other drugs.
It’s also important to consider traumatic experiences. Most people who experience trauma do not commit violent acts, but there are high rates of trauma among people who become violent.
For example, experiences of childhood trauma (such as witnessing physical abuse) can increase the risk of perpetrating domestic violence as an adult.
Childhood trauma can leave its mark on adults years later. Roman Yanushevsky/Shutterstock Early traumatic experiences can affect the brain and body’s stress response, leading to heightened fear and perception of threat, and difficulty regulating emotions. This can result in aggressive responses when faced with conflict or stress.
This response to stress increases the risk of alcohol and drug problems, developing PTSD (post-traumatic stress disorder), and increases the risk of perpetrating intimate partner violence.
How can we address these overlapping issues?
We can reduce intimate partner violence by addressing these overlapping issues and tackling the root causes and contributors.
The early intervention and treatment of mental illness, trauma (including PTSD), and alcohol and other drug use, could help reduce violence. So extra investment for these are needed. We also need more investment to prevent mental health issues, and preventing alcohol and drug use disorders from developing in the first place.
Early intervention and treatment of mental illness, trauma and drug use is important. Okrasiuk/Shutterstock Preventing trauma from occuring and supporting those exposed is crucial to end what can often become a vicious cycle of intergenerational trauma and violence. Safe and supportive environments and relationships can protect children against mental health problems or further violence as they grow up and engage in their own intimate relationships.
We also need to acknowledge the widespread impact of trauma and its effects on mental health, drug use and violence. This needs to be integrated into policies and practices to reduce re-traumatising individuals.
How about programs for perpetrators?
Most existing standard intervention programs for perpetrators do not consider the links between trauma, mental health and perpetrating intimate partner violence. Such programs tend to have little or mixed effects on the behaviour of perpetrators.
But we could improve these programs with a coordinated approach including treating mental illness, drug use and trauma at the same time.
Such “multicomponent” programs show promise in meaningfully reducing violent behaviour. However, we need more rigorous and large-scale evaluations of how well they work.
What needs to happen next?
Supporting victim-survivors and improving interventions for perpetrators are both needed. However, intervening once violence has occurred is arguably too late.
We need to direct our efforts towards broader, holistic approaches to prevent and reduce intimate partner violence, including addressing the underlying contributors to violence we’ve outlined.
We also need to look more widely at preventing intimate partner violence and gendered violence.
We need developmentally appropriate education and skills-based programs for adolescents to prevent the emergence of unhealthy relationship patterns before they become established.
We also need to address the social determinants of health that contribute to violence. This includes improving access to affordable housing, employment opportunities and accessible health-care support and treatment options.
All these will be critical if we are to break the cycle of intimate partner violence and improve outcomes for victim-survivors.
The National Sexual Assault, Family and Domestic Violence Counselling Line – 1800 RESPECT (1800 737 732) – is available 24 hours a day, seven days a week for any Australian who has experienced, or is at risk of, family and domestic violence and/or sexual assault.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. In an emergency, call 000.
Siobhan O’Dean, Postdoctoral Research Associate, The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney; Lucinda Grummitt, Postdoctoral Research Fellow, The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, and Steph Kershaw, Research Fellow, The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Share This Post
-
The Hormone Therapy That Reduces Breast Cancer Risk & More
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
The Hormone Balancing Act
We’ve written before about menopausal HRT:
What You Should Have Been Told About Menopause Beforehand
…and even specifically about the considerations when it comes to breast cancer risk:
Menopausal Hormone Replacement Therapy
this really does bear reading, by the way—scroll down to the bit about breast cancer risk, because it’s not a simple increased/decreased risk; it can go either way, and which way it goes will depend on various factors including your medical history and what HRT, if any, you are taking.
Hormone Modulating Therapy
Hormone modulating therapy, henceforth HMT, is something a little different.
Instead of replacing hormones, as hormone replacement therapy does, guess what hormone modulating therapy does instead? That’s right…
MHT can modulate hormones by various means, but the one we’re going to talk about today does it by blocking estrogen receptors,
Isn’t that the opposite of what we want?
You would think so, but since for many people with an increased breast cancer risk, the presence of estrogen increases that risk, which leaves menopausal (peri- or post) people in an unfortunate situation, having to choose between increased breast cancer risk (with estrogen), or osteoporosis and increased dementia risk, amongst other problems (without).
However, the key here (in fact, that’s a very good analogy) is in how the blocker works. Hormones and their receptors are like keys and locks, meaning that the wrong-shaped hormone won’t accidentally trigger it. And when the right-shaped hormone comes along, it gets activated and the message (in this case, “do estrogenic stuff here!” gets conveyed). A blocker is sufficiently similar to fit into the receptor, without being so similar as to otherwise act as the hormone.
In this case, it has been found that HMT blocking estrogen receptors was sufficient to alleviate the breast cancer risk, while also being associated with a 7% lower risk of developing Alzheimer’s disease or related dementias, with that risk reduction being even greater for some demographics depending on race and age. Black women in the 65–74 age bracket enjoyed a 24% relative risk reduction, with white women of the same age getting an 11% relative risk reduction. Black women enjoyed the same benefits after that age, whereas white women starting it at that age did not get the same benefits. The conclusion drawn from this is that it’s good to start this at 65 if relevant and practicable, especially if white, because the protective effect is strongest when gained aged 65–69.
Here’s a pop-science article that goes into the details more deeply than we have room for here:
Hormone therapy for breast cancer linked with lower dementia risk
And here’s the paper itself; we highly recommend reading at least the abstract, because it goes into the numbers in much more detail than we reasonably can here. It’s a huge cohort study of 18,808 women aged 65 years or older, so this is highly relevant data:
Want to learn more?
If you’d like a much deeper understanding of breast cancer risk management, including in the context of hormone therapy, you might like this excellent book that we reviewed recently:
The Smart Woman’s Guide to Breast Cancer – by Dr. Jenn Simmons
Take care!
Share This Post
-
Do Hard Things – by Steve Magness
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
It’s easy to say that we must push ourselves if we want to achieve worthwhile things—and it’s also easy to push ourselves into an early grave by overreaching. So, how to do the former, without doing the latter?
That’s what this book’s about. The author, speaking from a background in the science of sports psychology, applies his accumulated knowledge and understanding to the more general problems of life.
Most of us are, after all, not sportspeople or if we are, not serious ones. Those few who are, will get benefit from this book too! But it’s mostly aimed at the rest of us who are trying to work out whether/when we should scale up, scale back, change track, or double down:
- How much can we really achieve in our career?
- How about in retirement?
- Do we ever really get too old for athletic feats, or should we keep pressing on?
Magness brings philosophy and psychological science together, to help us sort our way through.
Nor is this just a pep talk—there’s readily applicable, practical, real-world advice here, things to enable us to do our (real!) best without getting overwhelmed.
The style is pop-science, very easy-reading, and clear and comprehensible throughout—without succumbing to undue padding either.
Bottom line: this is a very pleasant read, that promises to make life more meaningful and manageable at the same time. Highly recommendable!
Click here to check out Do Hard Things, and get the most out of life!
Share This Post
-
What the Health – by Kip Andersen, Keegan Kuhn, & Eunice Wong
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
This is a book from the makers of the famous documentary of the same name. Which means that yes, they are journalists not scientists, but they got input from very many scientists, doctors, nutritionists, and so forth, for a very reliable result.
It’s worth noting however that while a lot of the book is about the health hazards of a lot of the “Standard American Diet”, or “SAD” as it is appropriately abbreviated, a lot is also about how various industries
bribelobby the government to either push, or give them leeway to push, their products over healthier ones. So, there’s a lot about what would amount to corruption if it weren’t tied up in legalese that makes it just “lobbying” rather than bribery.The style is mostly narrative, albeit with very many citations adding up to 50 pages of references. There’s also a recipe section, which is… fairly basic, and despite getting a shoutout in the subtitle, the recipes are certainly not the real meat of the book.
The recipes themselves are entirely plant-based, and de facto vegan.
Bottom line: this one’s more of a polemic against industry malfeasance than it is a textbook of nutrition science, but there is enough information in here that it could have been the textbook if it wanted to, changing only the style and not the content.
Click here to check out What The Health, and make informed choices about yours!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Practical Programming for Strength Training – by Mark Rippetoe & Andy Baker
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Strength training is an important part of overall health maintenance, but it can be hard to find a good guide to progressive strength improvement that isn’t a bodybuilding book.
This one gives a ground-upwards approach, explaining small details to even quite basic things, before taking the reader through to more advanced progressions, and how to get the most strength-building out of each exercise over time.
As such, this is a good book for anyone of any level from beginner to quite experienced, and you can hop in at any point since there are always catch-up summaries and/or reiterations of the previous concepts that we’re now building on from.
The authors do also talk nutrition, hormones, and so forth, but most of it is about the exercises and the progressions thereof.
There is a slightly patronizing chapter towards the end, about “special populations”, for example offering “novice and intermediate training for women”, but it doesn’t take away from the majority of the book, as the exercises don’t care about your gender. Muscles are muscles, and we all start from wherever we are. Yes, testosterone boosts muscle mass, but let’s face it, there are a lot of women in the world who are stronger than a lot of men.
One thing to bear in mind is that a lot of this is barbell training, so you will need a barbell (or access to one at a gym). If purely bodyweight training is your preference, or perhaps some other form of weightlifting (e.g. kettlebells or such) then this isn’t the book for that.
Bottom line: if strength training is your focus and you like barbells, then this is a great book to take you quite a way along that road.
Click here to check out Practical Programming For Strength Training, and get stronger!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Is “Extra Virgin” Worth It?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I was wondering, is the health difference important between extra virgin olive oil and regular?❞
Assuming that by “regular” you mean “virgin and still sold as a food product”, then there are health differences, but they’re not huge. Or at least: not nearly so big as the differences between those and other oils.
Virgin olive oil (sometimes simply sold as “olive oil”, with no claims of virginity) has been extracted by the same means as extra virgin olive oil, that is to say: purely mechanical.
The difference is that extra virgin olive oil comes from the first pressing*, so the free fatty acid content is slightly lower (later checked and validated and having to score under a 0.8% limit for “extra virgin” instead of 2% limit for a mere “virgin”).
*Fun fact: in Arabic, extra virgin is called “البكر الممتاز“, literally “the amazing first-born”, because of this feature!
It’s also slightly higher in mono-unsaturated fatty acids, which is a commensurately slight health improvement.
It’s very slightly lower in saturated fats, which is an especially slight health improvement, as the saturated fats in olive oil are amongst the healthiest saturated fats one can consume.
On which fats are which:
The truth about fats: the good, the bad, and the in-between
And our own previous discussion of saturated fats in particular:
Can Saturated Fats Be Healthy?
Probably the strongest extra health-benefit of extra virgin is that while that first pressing squeezes out oil with the lowest free fatty acid content, it squeezes out oil with the highest polyphenol content, along with other phytonutrients:
If you enjoy olive oil, then springing for extra virgin is worth it if that’s not financially onerous, both for health reasons and taste.
However, if mere “virgin” is what’s available, it’s no big deal to have that instead; it still has a very similar nutritional profile, and most of the same benefits.
Don’t settle for less than “virgin”, though.
While some virgin olive oils aren’t marked as such, if it says “refined” or “blended”, then skip it. These will have been extracted by chemical means and/or blended with completely different oils (e.g. canola, which has a very different nutritional profile), and sometimes with a dash of virgin or extra virgin, for the taste and/or so that they can claim in big writing on the label something like:
a blend of
EXTRA VIRGIN OLIVE OIL
and other oils…despite having only a tiny amount of extra virgin olive oil in it.
Different places have different regulations about what labels can claim.
The main countries that produce olives (and the EU, which contains and/or directly trades with those) have this set of rules:
International Olive Council: Designations and definitions of Olive Oils
…which must be abided by or marketers face heavy fines and sanctions.
In the US, the USDA has its own set of rules based on the above:
USDA | Olive Oil and Olive-Pomace Oil Grades and Standards
…which are voluntary (not protected by law), and marketers can pay to have their goods certified if they want.
So if you’re in the US, look for the USDA certification or it really could be:
- What the USDA calls “US virgin olive oil not fit for human consumption”, which in the IOC is called “lamp oil”*
- crude pomace-oil (oil made from the last bit of olive paste and then chemically treated)
- canola oil with a dash of olive oil
- anything yellow and oily, really
*This technically is virgin olive oil insofar as it was mechanically extracted, but with defects that prevent it from being sold as such, such as having a free fatty acid content above the cut-off, or just a bad taste/smell, or some sort of contamination.
See also: Potential Health Benefits of Olive Oil and Plant Polyphenols
(the above paper has a handy infographic if you scroll down just a little)
Where can I get some?
Your local supermarket, probably, but if you’d like to get some online, here’s an example product on Amazon for your convenience
Enjoy!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
