Jamie Holmes says a surgery center tried to get her to pay for two surgeries when she only had one. She refused to give in, even when a debt collector sued her last winter.
Holmes, who lives in northwest Washington state, underwent surgery in 2019 to have her fallopian tubes tied, a permanent contraceptive measure that her insurance company had agreed to cover in advance.
During the surgery, while Holmes was still under anesthesia, the surgeon noticed early signs of endometriosis, a common condition in which fibrous scar tissue forms around the uterus, Holmes said. She said the surgeon later told her he cauterized the offending tissue for about 15 minutes as a precaution. She recalls him saying he completed the entire surgery within the 60 minutes allotted for the tubal ligation alone.
She said the doctor assured her that the additional treatment for endometriosis would cost her little or nothing.
Then came the bill.
The patient: Jamie Holmes, 38, of Lynden, Washington, who was insured with Premera Blue Cross at the time.
Medical services: A tubal ligation operation and treatment of endometriosis detected during the operation.
Service provider: Pacific Rim Outpatient Surgery Center in Bellingham, Washington, which has since been purchased, closed and reopened under a new name.
Total bill: $9,620. The insurance company paid the network center $1,262. After adjusting for rates allowed in 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 that provided the space and support staff for her surgery sent a bill showing that Holmes had undergone two separate surgeries: one to ligate her fallopian tubes and one to treat endometriosis. Each surgery cost $4,810.
Holmes said there were no such problems with the surgeon and anesthesiologist’s individual bills, which were paid by the insurer.
Holmes suspected that someone in the center’s billing department mistakenly thought she had been on the operating table twice. She said she tried to explain it to staff, but to no avail.
She said it was like ordering a meal at a fast food restaurant, getting extra fries and then having to pay for two whole meals. “I didn’t get the extra burger, the drink and the toy,” she joked.
Her insurer, Premera Blue Cross, refused to pay for two surgeries, she said. The surgery center billed Holmes for much of the difference. She refused to pay.
Holmes said she understands that the surgery center may have incurred additional costs for the 15 minutes or so the surgeon spent cauterizing the endometriosis lesions. About $500 would have seemed reasonable to her. “I don’t mind paying for that,” she said. “I’m against paying for a whole bunch of things I didn’t get.”
The doctor-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 debt collection agency asked the court for summary judgment, which would have allowed the company to garnish wages from Holmes’s work as a graphic designer and marketing specialist for real estate agents.
Holmes said she filed a written response and then appeared via Zoom and at the courthouse for two hearings where she presented her side of the case without bringing a lawyer. The judge ruled in February that the debt collector was not entitled to summary judgment because the facts of the case were disputed.
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Representatives of the collection agency and the closed operations center declined to comment for this article.
Sabrina Corlette, co-director of Georgetown University’s Center for Health Insurance Reform, said it was absurd that the surgery center would bill for two surgeries and then refuse to budge when the situation was explained. “It’s like something out of a Kafka novel,” she said.
Corlette said surgical center staff should be used to such scenarios. “I think it’s quite common for a surgeon to look inside a patient and say, ‘Oh, there’s something else. I’ll take care of that while I have the patient on the operating table.'”
It would have made no medical or financial sense for the surgeon to subject Holmes to a separate operation for the secondary problem, she said.
Corlette said if the surgery center was still in business, she would advise the patient to file a complaint with state regulators.
The solution: So far, the debt collection agency has not pursued its case and has not sought a trial following the judge’s ruling. Holmes said if the agency continues to sue her over the debt, she could hire a lawyer and sue them for damages and attorney’s fees.
She could have agreed to pay in installments. But she would stick to her principles, she said.
“I was just stonewalled like that. They treated me like an idiot,” she said. “If they’re going to be petty to me, I’m willing to be just as petty.”
The conclusion: Don’t be afraid to take action against an incorrect medical bill, even if the dispute ends up in court.
Debt collectors often seek summary judgment, which allows them to garnish wages or take other actions to seize money without having to go through the hassle of proving in a court case that they are entitled to payment. When the consumers being sued don’t show up to present their side at court hearings, judges often grant summary judgment to debt collectors.
However, if the facts of a case are disputed — for example, if the defendant appears and argues that she owes only for one surgery, not two — the judge may deny summary judgment and take the case to trial. That forces the debt collector to make a decision: spend more time and money collecting the debt or drop the case.
“You know what? In situations like this, it pays to be persistent,” said Berneta Haynes, a senior staff attorney at the National Consumer Law Center who reviewed Holmes’ bill for KFF Health News.
Many people do not go to such hearings, sometimes because they were not informed in time, do not read English or do not have time, she said.
“I think a lot of people just give in” after being sued, Haynes said.
KFF Health News is a national newsroom that produces in-depth coverage of health issues and is one of the core operating programs of KFF – an independent source of health policy research, polling and journalism. Learn more about KFF and subscribe to the free KFF Health News Morning Briefing.
