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.
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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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Kettlebell Swings Are Not What Most People Think They Are (They’re Better)
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Commonly assumed to be mostly a shoulders-and-arms exercise, they’re actually mostly about the hips and core:
From the hips
Correctly executed kettlebell swings primarily strengthens muscles from the hamstrings and glutes the to abs and back; in other words, muscles whose strength is essential for power, posture, and injury prevention.
The core in particular is not to be underestimated, with deep stabilizing muscles supporting posture, balance, and movement. Strengthening these areas can also help reduce lower back pain.
How to do it correctly: start with your feet shoulder-width apart (this is important, if you like having knees) and grip the kettlebell with both hands. Hinge at your hips, lowering the kettlebell between your legs while keeping your back flat and core engaged. Then, drive your hips forward explosively to swing the kettlebell up to shoulder height before allowing it to return down with control. The most common mistake is using the arms to lift the kettlebell, but the real power should come from the hips to maximize benefits and prevent injury.
Example workout: 30 seconds of kettlebell swings followed by 30 seconds of rest, repeated for 10 sets. This 10-minute routine provides a full-body workout that builds strength and endurance. As you progress, you can increase the weight, duration, number of sets, etc.
Timeline of changes: within a few weeks of regular kettlebell swings, you should notice stronger glutes, better endurance, and improved posture. After a month, you may experience reduced lower back pain (if you had lower back pain) and more power in your everyday movements. By two to three months, visible muscle definition and fat loss are likely to become noticeable, along with increased overall strength.
For more on all of this plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
Body Sculpting with Kettlebells for Women – by Lorna Kleidman
Take care!
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Beetroot vs Red Cabbage – Which is Healthier?
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Our Verdict
When comparing beetroot to red cabbage, we picked the red cabbage.
Why?
Both are great, and both have their strengths!
In terms of macros, beetroot has very slightly more protein, carbs, and fiber, but the margins of difference are very small in each case. However, in terms of glycemic index, red cabbage has the considerably lower glycemic index, of 32 (low) as opposed to beetroot’s GI of 64 (medium). On the strength of this GI difference, we call this category a win for red cabbage.
In the category of vitamins, beetroot has more of vitamin B9, while red cabbage has a lot more of vitamins A, B1, B2, B3, B6, C, E, K, and choline. By strength of numbers and also by having very large margins of difference on most of those, red cabbage is the clear winner here.
When it comes to minerals, beetroot has more copper, magnesium, manganese, phosphorus, and potassium, while red cabbage has more calcium (and about ⅓ of the sodium). By the numbers, this is a win for beetroot, though it’s worth noting that the margins of difference were small, i.e. red cabbage was right behind beetroot on each of those.
Adding up the sections makes for an overall red cabbage win, but as we say, beetroot is great too, especially when it comes to minerals!
As ever, enjoy either or both; diversity is good.
Want to learn more?
You might like to read:
No, beetroot isn’t vegetable Viagra. But here’s what it can do!
Enjoy!
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Remember – by Dr. Lisa Genova
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Memory is often viewed as one thing—either you have a good memory, or you don’t. At best, a lot of people have a vague idea of selective memory. But, the reality is much more complex—and much more interesting.
Dr. Genova lays out clearly and simply the various different kinds of memory, how they work, and how they fail. Some of these kinds of memory operate on completely different principles than others, and/or in different parts of the brain. And, it’s not just “a memory for faces” or a “memory for names”, nor even “short term vs long term”. There’s working memory, explicit and implicit memory, semantic memory, episodic memory, muscle memory, and more.
However, this is not just an interesting book—it’s also a useful one. Dr. Genova also looks at how we can guard against failing memory in later years, and how we can expand and grow the kinds of memory that are most important to us.
The style of the book is very conversational, and not at all textbook-like. It’s certainly very accessible, and pleasant to read too.
Bottom line: memory is a weird and wonderful thing, and this book shines a clear light on many aspects of it—including how to improve the various different kinds of memory.
Click here to check out Remember (we recommend to do it now before you forget!
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Do We Need Sunscreen In Winter, Really?
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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 keep seeing advice that we shoudl wear sunscreen out in winter even if it’s not hot or sunny, but is there actually any real benefit to this?❞
Short answer: yes (but it’s indeed not as critical as it is during summer’s hot/sunny days)
Longer answer: first, let’s examine the physics of summer vs winter when it comes to the sun…
In summer (assuming we live far enough from the equator to have this kind of seasonal variation), the part of the planet where we live is tilted more towards the sun. This makes it closer, and more importantly, it’s more directly overhead during the day. The difference in distance through space isn’t as big a deal as the difference in distance through the atmosphere. When the sun is more directly overhead, its rays have a shorter path through our atmosphere, and thus less chance of being blocked by cloud cover / refracted elsewhere / bounced back off into space before it even gets that far.
In winter, the opposite of all that is true.
Morning/evening also somewhat replicate this compared to midday, because the sun being lower in the sky has a similar effect to seasonal variation causing it to be less directly overhead.
For this reason, even though visually the sun may be just as bright on a winter morning as it is on a summer midday, the rays have been filtered very differently by the time they get to us.
This is one reason why you’re much less likely to get sunburned in the winter, compared to the summer (others include the actual temperature difference, your likely better hydration, and your likely more modest attire protecting you).
However…
The reason it is advisable to wear sunscreen in winter is not generally about sunburn, and is rather more about long-term cumulative skin damage (ranging from accelerated aging to cancer) caused by the UV rays—specifically, mostly UVA rays, since UVB rays (with their higher energy but shorter wavelength) have nearly all been blocked by the atmosphere.
Here’s a good explainer of that from the American Cancer Society:
UV (Ultraviolet) Radiation and Cancer Risk
👆 this may seem like a no-brainer, but there’s a lot explained here that demystifies a lot of things, covering ionizing vs non-ionizing radiation, x-rays and gamma-rays, the very different kinds of cancer caused by different things, and what things are dangerous vs which there’s no need to worry about (so far as best current science can say, at least).
Consequently: yes, if you value your skin health and avoidance of cancer, wearing sunscreen when out even in the winter is a good idea. Especially if your phone’s weather app says the UV index is “moderate” or above, but even if it’s “low”, it doesn’t hurt to include it as part of your skincare routine.
But what if sunscreens are dangerous?
Firstly, not all sunscreens are created equal:
Learn more: Who Screens The Sunscreens?
Secondly: consider putting on a protective layer of moisturizer first, and then the sunscreen on top. Bear in mind, this is winter we’re talking about, so you’re probably not going out in a bikini, so this is likely a face-neck-hands job and you’re done.
What about vitamin D?
Humans evolved to have more or less melanin in our skin depending on where we lived, and white people evolved to wring the most vitamin D possible out of the meagre sun far from the equator. Black people’s greater melanin, on the other hand, offers some initial protection against the sun (but any resultant skin cancer is then more dangerous than it would be for white people if it does occur, so please do use sunscreen whatever your skintone).
Nowadays many people live in many places which may or may not be the places we evolved for, and so we have to take that into account when it comes to sun exposure.
Here’s a deeper dive into that, for those who want to learn:
Take care!
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Felt Time – by Dr. Marc Wittmann
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This book goes far beyond the obvious “time flies when you’re having fun / passes slowly when bored”, or “time seems quicker as we get older”. It does address those topics too, but even in doing so, unravels deeper intricacies within.
The author, a research psychologist, includes plenty of reference to actual hard science here, and even beyond subjective self-reports. For example, you know how time seems to slow down upon immediate apparent threat of violent death (e.g. while crashing, while falling, or other more “violent human” options)? We learn of an experiment conducted in an amusement park, where during a fear-inducing (but actually safe) plummet, subjective time slows down yes, but measures of objective perception and cognition remained the same. So much for adrenal superpowers when it comes to the brain!
We also learn about what we can change, to change our perception of time—in either direction, which is a neat collection of tricks to know.
The style is on the dryer end of pop-sci; we suspect that being translated from German didn’t help its levity. That said, it’s not scientifically dense either (i.e. not a lot of jargon), though it does have many references (which we like to see).
Bottom line: if you’ve ever wished time could go more quickly or more slowly, this book can help with that.
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The Menopause Manifesto – by Dr. Jen Gunter
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From the subtitle, you may wonder: with facts and feminism? Is this book about biology or sociology?
And the answer is: both. It’s about biology, principally, but without ignoring the context. We do indeed “live in a society”, and that affects everything from our healthcare options to what is expected of us as women.
So, as a warning: if you dislike science and/or feminism, you won’t like this book.
Dr. Jen Gunter, herself a gynaecologist, is here to arm us with science-based facts, to demystify an important part of life that is commonly glossed over.
She talks first about the what/why/when/how of menopause, and then delivers practical advice. She also talks about the many things we can (and can’t!) usefully do about symptoms we might not want, and how to look after our health overall in the context of menopause. We learn what natural remedies do or don’t work and/or can be actively harmful, and we learn the ins and outs of different hormone therapy options too.
Bottom line: no matter whether you are pre-, peri-, or post-menopausal, this is the no-BS guide you’ve been looking for. Same goes if you’re none of the above but spend any amount of time close to someone who is.
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