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

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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  • 10 Ways To Lower Blood Pressure Naturally

    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.

    Increasingly many people, especially over a certain age, are taking so many medications that it precipitates a train of other medications to deal with the side effects of the previous ones. This is neither fun nor healthy. Of course, sometimes it’s a necessity, but often it’s not, so if you’d like to avoid blood pressure meds, here are some good first-line things, as recommended by Dr. Siobhan Deshauer:

    No-med options

    Dr. Deshauer recommends:

    1. Diet: follow the DASH diet by eating whole foods, lean / plant-based proteins, and reducing salt and processed foods to lower blood pressure by 5–6 points.
    2. Sodium reduction: limit sodium intake to 2g/day, focusing on reducing processed foods, which account for 80% of sodium consumption.
    3. Increase potassium intake: eat potassium-rich foods (e.g. fruit, vegetables) to lower blood pressure by 5–7 points but consult a doctor if you have kidney issues or take certain medications.
    4. Exercise: engage in isometric exercises like wall squats or planks, which lower systolic pressure by up to 8 points; any exercise is beneficial.
    5. Weight loss: lose weight (specifically: fat) if (and only if!) carrying excess fat, as each 1 kg (2.2 lbs) excess adiposity reduction can decrease blood pressure by 1 point.
    6. Limit alcohol: avoid consuming more than two alcoholic drinks per day, as it raises blood pressure.
    7. Quit smoking: stop smoking to prevent increased blood pressure and long-term vessel damage caused by nicotine.
    8. Improve sleep: aim for at least 6 hours of sleep per night, ideally 7–9, and seek medical advice if you suspect sleep apnea.
    9. Manage stress: adopt healthy stress management strategies to avoid the indirect effects of stress on blood pressure.
    10. Adopt a pet: pet ownership, particularly dogs, can lower blood pressure more effectively than some medications.

    For more on each of these, enjoy:

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    Ideal Blood Pressure Numbers Explained

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  • Natto vs Tofu – Which is Healthier?

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    Our Verdict

    When comparing nattō to tofu, we picked the nattō.

    Why?

    In other words, in the comparison of fermented soy to fermented soy, we picked the fermented soy. But the relevant difference here is that nattō is fermented whole soybeans, while tofu is fermented soy milk of which the coagulated curds are then compressed into a block—meaning that the nattō is the one that has “more food per food”.

    Looking at the macros, it’s therefore no surprise that nattō has a lot more fiber to go with its higher carb count; it also has slightly more protein. You may be wondering what tofu has more of, and the answer is: water.

    In terms of vitamins, nattō has more of vitamins B2, B4, B6, C, E, K, and choline, while tofu has more of vitamins A, B3, and B9. So, a 7:3 win for nattō, even before considering that that vitamin C content of nattō is 65x more than what tofu has.

    When it comes to minerals, nattō has more copper, iron, magnesium, manganese, potassium, and zinc, while tofu has more calcium, phosphorus, and selenium. So, a 6:3 win for nattō, and yes, the margins of difference are comparable (being 2–3x more for most of these minerals).

    In short, both of these foods are great, but nattō is better.

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    One Lump Mechanism Of Addiction Or Two?

    In Tuesday’s newsletter, we asked you to what extent, if any, you believe sugar is addictive; we got the above-depicted, below-described, set of responses:

    • About 47% said “Sugar is chemically addictive, comparable to alcohol”
    • About 34% said “Sugar is chemically addictive, comparable to cocaine”
    • About 11% said “Sugar is not addictive; that’s just excuse-finding hyperbole”
    • About 9% said “Sugar is a behavioral addiction, comparable to video gaming”

    So what does the science say?

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    False, by broad scientific consensus. As ever, the devil’s in the details definitions, but while there is still discussion about how best to categorize the addiction, the scientific consensus as a whole is generally: sugar is addictive.

    That doesn’t mean scientists* are a hive mind, and so there will be some who disagree, but most papers these days are looking into the “hows” and “whys” and “whats” of sugar addiction, not the “whether”.

    *who are also, let us remember, a diverse group including chemists, neurobiologists, psychologists, social psychologists, and others, often collaborating in multidisciplinary teams, each with their own focus of research.

    Here’s what the Center of Alcohol and Substance Use Studies has to say, for example:

    Sugar Addiction: More Serious Than You Think

    Sugar is a chemical addiction, comparable to alcohol: True or False?

    True, broadly, with caveats—for this one, the crux lies in “comparable to”, because the neurology of the addiction is similar, even if many aspects of it chemically are not.

    In both cases, sugar triggers the release of dopamine while also (albeit for different chemical reasons) having a “downer” effect (sugar triggers the release of opioids as well as dopamine).

    Notably, the sociology and psychology of alcohol and sugar addictions are also similar (both addictions are common throughout different socioeconomic strata as a coping mechanism seeking an escape from emotional pain).

    See for example in the Journal of Psychoactive Drugs:

    Sweet Preference, Sugar Addiction and the Familial History of Alcohol Dependence: Shared Neural Pathways and Genes

    On the other hand, withdrawal symptoms from heavy long-term alcohol abuse can kill, while withdrawal symptoms from sugar are very much milder. So there’s also room to argue that they’re not comparable on those grounds.

    Sugar is a chemical addiction, comparable to cocaine: True or False?

    False, broadly. There are overlaps! For example, sugar drives impulsivity to seek more of the substance, and leads to changes in neurobiological brain function which alter emotional states and subsequent behaviours:

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    Cocaine triggers a release of dopamine (as does sugar), but cocaine also acts directly on our brain’s ability to remove dopamine, serotonin, and norepinephrine:

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    …meaning that in terms of comparability, they (to use a metaphor now, not meaning this literally) both give you a warm feeling, but sugar does it by turning up the heating a bit whereas cocaine does it by locking the doors and burning down the house. That’s quite a difference!

    Sugar is a behavioral addiction, comparable to video gaming: True or False?

    True, with the caveat that this a “yes and” situation.

    There are behavioral aspects of sugar addiction that can reasonably be compared to those of video gaming, e.g. compulsion loops, always the promise of more (without limiting factors such as overdosing), anxiety when the addictive element is not accessible for some reason, reduction of dopaminergic sensitivity leading to a craving for more, etc. Note that the last is mentioning a chemical but the mechanism itself is still behavioral, not chemical per se.

    So, yes, it’s a behavioral addiction [and also arguably chemical in the manners we’ve described earlier in this article].

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    You might want to check out:

    Beating Food Addictions: When It’s More Than “Just” Cravings

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    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.

    Kaitlin Day, RMIT University and Sharayah Carter, RMIT University

    Intermittent fasting has gained popularity in recent years as a dietary approach with potential health benefits. So you might have been surprised to see headlines last week suggesting the practice could increase a person’s risk of death from heart disease.

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    We don’t know if the authors controlled for other factors that can influence health, such as body weight, medication use or diet quality. It’s likely some of these questions will be answered once the full details of the study are published.

    It’s also worth noting that participants may have eaten during a shorter window for a range of reasons – not necessarily because they were intentionally following a time-restricted diet. For example, they may have had a poor appetite due to illness, which could have also influenced the results.

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    Although this research may have a number of limitations, its findings aren’t entirely unique. They align with several other published studies using the NHANES data set.

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    Another study in people with diabetes showed those who ate more frequently had a lower risk of death from heart disease.

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    But I thought intermittent fasting was healthy?

    There are conflicting results about intermittent fasting in the scientific literature, partly due to the different types of intermittent fasting.

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    RCTs indicate intermittent fasting yields comparable improvements in these areas to other dietary interventions, such as daily moderate energy restriction.

    A group of people eating around a table.
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    However, they often focus on specific groups and short-term outcomes. On average, these studies follow participants for around 12 months, leaving long-term effects unknown.

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    There’s no simple answer to this question. RCTs have shown it appears a safe option for weight loss in the short term.

    However, people in the NHANES dataset who eat within a limited period of the day appear to be at higher risk of dying from heart disease. Of course, many other factors could be causing them to eat in this way, and influence the results.

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    Kaitlin Day, Lecturer in Human Nutrition, RMIT University and Sharayah Carter, Lecturer Nutrition and Dietetics, RMIT University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

    The Conversation

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    Our Verdict

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