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Her hearing implant was preapproved. Nonetheless, she got $139,000 bills for months.
Caitlyn Mai woke up one morning in middle school so dizzy she couldn’t stand and deaf in one ear, the result of an infection that affected one of her cranial nerves. Though her balance recovered, the hearing never came back.
Growing up, she learned to cope — but it wasn’t easy. With only one functioning ear, she couldn’t tell where sounds were coming from. She couldn’t follow along with groups of people in conversation — at social gatherings or at work — so she learned to lip-read.
For many years, insurers wouldn’t approve cochlear implants for single-sided deafness due to concerns that it would be hard to train the brain to manage signals from a biological ear and one that hears with the aid of an implant. But research on the detrimental effects of single-sided deafness and improvements in technique changed all that.
So Mai, now 27 and living near Oklahoma City, was thrilled last fall to get a prior authorization letter from her insurer saying she was covered for cochlear implant surgery.
She had successful outpatient surgery to implant the device in December and soon after was eagerly attending therapy to get her brain accustomed to its new capabilities.
“It was amazing. When I’d misplaced my phone and it rang, I could tell where the sound was coming from and find it,” she said.
Then the bill came.
The Patient: Caitlyn Mai, who is insured through her husband’s job by HealthSmart, which is owned by UnitedHealth Group.
Medical Services: Cochlear implant surgery, including the operating room, anesthesia, surgical supplies, and drugs.
Service Provider: SSM Health Bone & Joint Hospital at St. Anthony, an orthopedic hospital in Oklahoma City that is part of SSM Health, a Catholic health system in the central U.S.
Total Bill: $139,362.74 — or, with a “prompt pay discount” if she paid about two months after surgery, $125,426.47.
What Gives: Providers and insurers often have disagreements over how a bill is submitted or coded, and as they work through them (or don’t), the patient is left holding the bag, facing sometimes huge bills.
“I almost had a heart attack when I opened the bill,” Mai said of the first monthly missive, which arrived in late December. She said she was so upset she left work to investigate. Before surgery, “I’d even checked that all hospitals and doctors were in-network and that I’d met my deductible,” she said.
While she was never threatened with having her bill sent to collections, she said she worried about that possibility when the same bills arrived in January, February, and March, with ominous warnings that “your balance is now past due.”
Mai said she first called the hospital billing office but that the representative could tell her only that the claim had been denied and didn’t know why. She called her insurer, and a representative there said the hospital didn’t adequately itemize its charges or include billing codes. She then called the hospital back and relayed exactly what her insurer said must be done to rectify the bill — and the name and number of the insurance employee to fax it to.
When her insurer told her a week or two later it hadn’t received a corrected bill, Mai said, she called the hospital again … and again.
“I said, ‘I’ve done your job for you — now can you please take it from here?'” she said.
Mai said a hospital staffer promised to fax over the corrected, itemized bill in two to three weeks. “How does it take that long to send a fax,” she wondered. She said she asked to speak with a supervisor and was told the person wasn’t available but would call her back. No one did.
After receiving another $139,000 bill in late February, Mai said, she checked back in with her insurer, but a representative said it had not yet received the revised bill.
Finally, she said, she told the hospital to “just send it to me and I’ll send it over.” This time, she forwarded the bill to her insurer herself. But in late March she got another bill demanding the full amount — and offering an $11,000-a-month payment plan.
Mai said she had met her out-of-pocket deductible and, with prior authorization in hand, expected the surgery to be fully covered.
SSM Health did not respond to multiple requests for comment about why it billed Mai.
“It’s outrageous that the patients end up umpiring the decisions,” said Elisabeth Ryden Benjamin, vice president of health initiatives at the Community Service Society of New York, an advocacy organization. “And it’s outrageous that providers are allowed to bill patients while they’re haggling with the insurer.”
Indeed, more and more patients are stuck with such bills as insurers and hospitals spend more and more time arguing in the trenches, data shows. A recent report by Crowe, an accounting firm that works with a large number of hospitals, found that more than 30% of claims submitted to commercial insurers early last year weren’t paid for more than 90 days — striking compared with the lower rates of such delays in Medicare, which were 12% for inpatient claims and 11% for outpatient claims.
The Crowe report found a particular justification for denying claims was cited at 12 times the rate by commercial insurers as by Medicare: that they needed more information before they would process the submission. Such a request allows insurers to sidestep laws in most states that require claims be paid in 30 to 40 days, automatically granting health plans the right to delay payment.
In a separate analysis, the American Hospital Association complained that increases in insurance denials and delays “strain hospital resources” and “inhibit medically necessary care.”
More from Bill of the Month
But perhaps no one is harmed as gravely as the patient, who is barraged with bills and believes they must pay up — particularly when the missives are stamped “past due” and contain offers of prompt-payment discounts or no-interest payment plans. “The stress and anxiety was huge,” Mai said.
Caroline Landree, a spokesperson for UnitedHealth Group, said the insurer could pay Mai’s claims only “after receiving a detailed bill from her provider.”
“We encourage our members to contact the number on their insurance cards for more information on the status of payments,” she added.
The Resolution: Mai estimated she spent at least 12 hours on the phone doing tasks that typically fall to someone working in a hospital billing department: making sure the bill was coded as needed and that the insurer had what it wanted to process the payment.
More than 90 days after her surgery, after Mai had received four terrifyingly huge bills, her insurance finally paid the claim. Mai owed nothing more.
She added: “I’ve never got that call back from a supervisor to this day.”
The Takeaway: It’s not uncommon for an insurer to delay paying a claim until it receives an itemized bill; providers sometimes get creative with billing codes to increase revenue, and studies show that more than half of hospital bills contain errors. But studies also suggest insurers are wont to drag their feet, niggling over coding and charges — and, in doing so, delaying reimbursement and holding on to the cash.
Medical billing experts say it may not seem right for patients to receive bills as this process plays out but that it’s probably legal.
“Laws say ‘hold the patient harmless,'” Benjamin said. “What we didn’t say is, ‘Don’t send them a bill.'” She said it is also unfair that patients may be forced to act as the go-between for providers and insurers who should be talking to each other.
What’s a patient to do? First step: Don’t pay the bill (aside from a copay or coinsurance) for care or services preapproved by insurance. Call the health care provider and explain they should take up their bill with the insurer.
Second, ask the provider to send an itemized bill with all billing codes used, then review it for errors. As the patient, you would know that you never had an MRI, for example. Your insurer wouldn’t.
If submissions to “Bill of the Month” are reflective of trends, many patients these days are finding themselves ping-ponging between representatives for providers and insurers to get bills resolved and paid.
“Bravo for Ms. Mai for having the energy to keep at it and get resolution,” Benjamin said.
Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!
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.
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Former Israeli hostages released in truce 1 year ago call for action to release those still held
Former Israeli hostages who were freed from Hamas captivity during a week-long humanitarian pause in fighting exactly one year ago Sunday called for immediate action to secure a deal for the release of those still held.
The only truce in the ongoing Israel-Hamas war on Nov. 24, 2023 – fewer than two months after fighting began – led to the release of 80 Israelis held by militants in Gaza. They were freed in exchange for 240 Palestinians detained in Israeli jails.
Repeated efforts since then by mediators from Qatar, Egypt and the United States to secure another truce and hostage release have failed. Qatar early this month said it was suspending its mediation role until the warring sides show “seriousness.”
Mostafa Alkharouf/Anadolu via Getty Images
Gabriella Leimberg was kidnapped during the Oct. 7, 2023, Hamas attack and was released along with her daughter, Mia, and sister Clara.
“For 53 days, the one thing that kept me going is that we, the people of Israel, the Jewish people, sanctify life — we don’t leave anyone behind,” she said.
Leimberg added: “Everything has already been said and now action is required. We don’t have any more time.”
Around 100 hostages are still in Gaza, and at least a third are believed to be dead.
“I survived and I was fortunate to get my entire family back,” Leimberg said. “I want and demand this for all the families of the hostages.”
Hamas wants Israel to end the war and withdraw all troops from Gaza. Israel has offered only to pause its offensive.
The Palestinian death toll from the war surpassed 44,000 this week, according to Gaza’s Health Ministry, which does not distinguish between civilians and combatants in its count.
Maya Alleruzzo / AP
Danielle Aloni, who was kidnapped with her five-year-old daughter, Emelia, and freed after 49 days, spoke at the ceremony of the “increasing danger” those still being held face every day.
She said those still in captivity “suffer physical, sexual, and psychological abuse, their identity and dignity crushed anew each day”.
“It took the Israeli government about two months to secure a deal for me and 80 other Israeli hostages. Why is it taking over a year to reach another deal to free them from this hell?” asked Aloni, whose brother-in-law, David Cunio, and his brother, Ariel Cunio, are still being held.
She emphasized that, even though she and the other hostages gained their freedom a year ago, “we haven’t really left the tunnels,” — referring to Hamas’ underground tunnels where many of the hostages were held.
“The feeling of suffocation, the terrible humidity, the stench — these sensations still envelop us,” Aloni said.
“If people could truly understand what it means to be held in subhuman conditions in tunnels, surrounded by terrorists for 54 days — there’s no way they would allow hostages to remain there for 415 days!” said Raz Ben Ami, who was released in the deal a year ago.
Her husband, Ohad, is still among those being held.
Ben Ami called for a ceasefire to “bring back all the hostages as quickly as possible”.
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Couple charged for allegedly stealing $1 million from Lululemon in convoluted retail theft scheme
A couple from Connecticut faces charges for allegedly taking part in an intricate retail theft operation targeting the apparel company Lululemon that may have amounted to $1 million worth of stolen items, according to a criminal complaint.
The couple, Jadion Anthony Richards, 44, and Akwele Nickeisha Lawes-Richards, 45, were arrested Nov. 14 in Woodbury, Minnesota, a suburb of Minneapolis-St. Paul. Richards and Lawes-Richards have been charged with one count each of organized retail theft, which is a felony, the Ramsey County Attorney’s Office said. They are from Danbury, Connecticut.
The alleged operation impacted Lululemon stores in multiple states, including Minnesota.
“Because of the outstanding work of the Roseville Police investigators — including their new Retail Crime Unit — as well as other law enforcement agencies, these individuals accused of this massive retail theft operation have been caught,” a spokesperson for the attorney’s office said in a statement on Nov. 18. “We will do everything in our power to hold these defendants accountable and continue to work with our law enforcement partners and retail merchants to put a stop to retail theft in our community.”
Both Richards and Lawes-Richards have posted bond as of Sunday and agreed to the terms of a court-ordered conditional release, according to the county attorney. For Richards, the court had set bail at $100,000 with conditional release, including weekly check-ins, or $600,000 with unconditional release. For Lawes-Richards, bail was set at $30,000 with conditional release and weekly check-ins or $200,000 with unconditional release. They are scheduled to appear again in court Dec. 16.
Prosecutors had asked for $1 million bond to be placed on each half of the couple, the attorney’s office said.
Richards and Lawes-Richards are accused by authorities of orchestrating a convoluted retail theft scheme that dates back to at least September. Their joint arrests came one day after the couple allegedly set off store alarms while trying to leave a Lululemon in Roseville, Minnesota, and an organized retail crime investigator, identified in charging documents by the initials R.P., recognized them.
The couple were allowed to leave the Roseville store. But the investigator later told an officer who responded to the incident that Richards and Lawes-Richards were seasoned shoplifters, who apparently stole close to $5,000 worth of Lululemon items just that day and were potentially “responsible for hundreds of thousands of dollars in loss to the store across the country,” according to the complaint. That number was eventually estimated by an investigator for the brand to be even higher, with the criminal complaint placing it at as much as $1 million.
Richards and Lawes-Richards allegedly involved other individuals in their shoplifting pursuits, but none were identified by name in the complaint. Authorities said they were able to successfully pull off the thefts by distracting store employees and later committing fraudulent returns with the stolen items at different Lululemon stores.
“Between October 29, 2024 and October 30, 2024, RP documented eight theft incidents in Colorado involving Richards and Lawes-Richards and an unidentified woman,” authorities wrote in the complaint, describing an example of how the operation would allegedly unfold.
“The group worked together using specific organized retail crime tactics such as blocking and distraction of associates to commit large thefts,” the complaint said. “They selected coats and jackets and held them up as if they were looking at them in a manner that blocked the view of staff and other guests while they selected and concealed items. They removed security sensors using a tool of some sort at multiple stores.”
CBS News contacted Lululemon for comment but did not receive an immediate reply.
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Former Trump national security adviser says next couple months are “really critical” for Ukraine
Washington — Lt. Gen. H.R. McMaster, a former national security adviser to Donald Trump, said Sunday that the upcoming months will be “really critical” in determining the “next phase” of the war in Ukraine as the president-elect is expected to work to force a negotiated settlement when he enters office.
McMaster, a CBS News contributor, said on “Face the Nation with Margaret Brennan” that Russia and Ukraine are both incentivized to make “as many gains on the battlefield as they can before the new Trump administration comes in” as the two countries seek leverage in negotiations.
With an eye toward strengthening Ukraine’s standing before President-elect Donald Trump returns to office in the new year, the Biden administration agreed in recent days to provide anti-personnel land mines for use, while lifting restrictions on Ukraine’s use of U.S.-made longer range missiles to strike within Russian territory. The moves come as Ukraine marked more than 1,000 days since Russia’s invasion in February 2022.
Meanwhile, many of Trump’s key selection for top posts in his administration — Rep. Mike Waltz for national security adviser and Sens. Marco Rubio for secretary of state and JD Vance for Vice President — haven’t been supportive of providing continued assistance to Ukraine, or have advocated for a negotiated end to the war.
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McMaster said the dynamic is “a real problem” and delivers a “psychological blow to the Ukrainians.”
“Ukrainians are struggling to generate the manpower that they need and to sustain their defensive efforts, and it’s important that they get the weapons they need and the training that they need, but also they have to have the confidence that they can prevail,” he said. “And any sort of messages that we might reduce our aid are quite damaging to them from a moral perspective.”
McMaster said he’s hopeful that Trump’s picks, and the president-elect himself, will “begin to see the quite obvious connections between the war in Ukraine and this axis of aggressors that are doing everything they can to tear down the existing international order.” He cited the North Korean soldiers fighting on European soil in the first major war in Europe since World War II, the efforts China is taking to “sustain Russia’s war-making machine,” and the drones and missiles Iran has provided as part of the broader picture.
“So I think what’s happened is so many people have taken such a myopic view of Ukraine, and they’ve misunderstood Putin’s intentions and how consequential the war is to our interests across the world,” McMaster said.
On Trump’s selections for top national security and defense posts, McMaster stressed the importance of the Senate’s advice and consent role in making sure “the best people are in those positions.”
McMaster outlined that based on his experience, Trump listens to advice and learns from those around him. And he argued that the nominees for director of national intelligence and defense secretary should be asked key questions like how they will “reconcile peace through strength,” and what they think “motivates, drives and constrains” Russian President Vladimir Putin.
Trump has tapped former Rep. Tulsi Gabbard to be director of national intelligence, who has been criticized for her views on Russia and other U.S. adversaries. McMaster said Sunday that Gabbard has a “fundamental misunderstanding” about what motivates Putin.
More broadly, McMaster said he “can’t understand” the Republicans who “tend to parrot Vladimir Putin’s talking points,” saying “they’ve got to disabuse themselves of this strange affection for Vladimir Putin.”
Meanwhile, when asked about Trump’s recent selection of Sebastian Gorka as senior director for counterterrorism and deputy assistant to the president, McMaster said he doesn’t think Gorka is a good person to advise the president-elect on national security. But he noted that “the president, others who are working with him, will probably determine that pretty quickly.”
Former Israeli hostages released in truce 1 year ago call for action to release those still held
Couple charged for allegedly stealing $1 million from Lululemon in convoluted retail theft scheme
Former Trump national security adviser says next couple months are “really critical” for Ukraine
Former Israeli hostages released in truce 1 year ago call for action to release those still held
Couple charged for allegedly stealing $1 million from Lululemon in convoluted retail theft scheme