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Upended: How Medical Debt Changed Their Lives
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Diagnosis: Debt


UPENDED: HOW MEDICAL DEBT CHANGED THEIR LIVES

By Noam N. Levey and Aneri Pattani and Yuki Noguchi, NPR News and Bram
Sable-Smith Updated January 10, 2023 Originally Published June 16, 2022

Republish This Story

Some lost their homes. Some emptied their retirement accounts. Some struggled to
feed and clothe their families. Medical debt now touches more than 100 million
people in America, as the U.S. health care system pushes patients into debt on a
mass scale. Debtors are from all walks of life and all corners of the country.
Here are their stories ― how they got into debt, what they’ve given up for it,
and how they’re living with the burden.

Related Story


100 MILLION PEOPLE IN AMERICA ARE SADDLED WITH HEALTH CARE DEBT 

The U.S. health system now produces debt on a mass scale, a new investigation
shows. Patients face gut-wrenching sacrifices.

Read More

--------------------------------------------------------------------------------

Samaria Bradford(Eamon Queeney for KHN and NPR)

An Air Force career held up because of debt owed for medical bills

By Aneri Pattani, KHN

Samaria Bradford, 27, Goldsboro, North Carolina

Approximate Medical Debt: $5,000

Medical Issue: Emergency room care

What Happened: In late August 2022, Samaria Bradford was prepared to leave for
basic training any day. She’d been in contact with an Air Force recruiter. Her
qualifying test score from two years earlier was still valid, and she’d lost
weight to meet the physical requirements. She felt so good about it that she
gave two weeks’ notice at her nursing home job.

Then the recruiter sent a text: “We got your credit check back you have multiple
accounts in collects.”

This story also ran on NPR. It can be republished for free.


TELL US ABOUT YOUR MEDICAL DEBT

Have you been forced into debt because of a medical or dental bill? Have you had
to make any changes in your life because of such debt? Have you been pursued by
debt collectors for a medical bill? We want to hear about it.

Share Your Story

Bradford had unpaid bills — mostly from hospitals and ambulance companies — that
had gone to collections. The recruiter said she needed to set up payment plans
to address the debts before she could enlist.

“I was very upset and surprised,” Bradford said. “I didn’t know your medical
debt could stop you from joining.”

Bradford had dreamed of enlisting in the Air Force for years. She took the
qualifying exam in 2020 but delayed her enlistment so she could stay close to
home and support her younger sister, who was in high school at the time.

She worked a variety of jobs to stay afloat — as a cashier, then as a cook and a
staff member at a bowling alley for a bit. Later, she took overnight shifts at a
hospital. The pay covered rent, utilities, and food, but she had little left
over.

Most of the jobs didn’t offer benefits, and since North Carolina had not
expanded Medicaid, Bradford did not qualify for the public insurance.

Over the years, when she landed in the emergency room without insurance, bills
racked up quickly. One time, she had a rash along her back that she feared was
an allergic reaction. Another time, she was dehydrated and had to be brought to
the hospital by ambulance. A car wreck led to another visit.

By 2022, when the Air Force recruiter looked into her finances, Bradford owed
roughly $5,000 spread across a half-dozen bills. In response to his text about
the debts, she wrote, “I’m guessing is doctor bills?”

What’s Broken: Several branches of the military check financial histories when
evaluating recruits. “Credit checks aid in determining recruit financial
responsibility while aiming to safeguard national security,” said Christine
Cuttita, an Air Force Recruiting Service spokesperson. Depending on the
particulars of the case, she confirmed, an individual can be disqualified from
enlisting because of debt.

Red flags on a credit report include late payments, long-term debts, or total
debt — including student loans, mortgages, and medical debt — that exceeds 40%
of the person’s income. There’s no strict disqualifier; rather, a squadron
commander evaluates each case and assesses it in the “best interest of the Air
Force,” Cuttita said.

Employers in other sectors also commonly use credit checks to evaluate
candidates.

However, research from the federal Consumer Financial Protection Bureau suggests
medical debts should be treated differently than other debts.

The CFPB found that unlike credit card debt, medical bills that have gone to
collections aren’t an accurate predictor of someone’s likelihood to pay bills.
In fact, the agency determined that people with “paid medical collections were
less likely to be delinquent than other consumers with the same credit score.”

The Biden administration this year advised federal lenders to no longer consider
medical debt when evaluating loan applications. VantageScore, one of the
companies that calculate consumers’ credit scores, has said it will stop using
medical collections in its formula.

But running credit checks on job candidates remains common. For those with
medical debt, that can mean being turned away from jobs because of the bills
they are trying to pay off.

What’s Left: After receiving the recruiter’s text, Bradford set out to make
payments on as many medical bills as she could. Using savings from the nursing
home job she had recently left, she closed out two accounts on which she owed a
few hundred dollars and made smaller payments toward bills of $1,000 or more.

But, it turned out, those were not the debts showing up on the Air Force credit
check.

“Of the five payments I made, only one of them was connected to what my
recruiter saw on his end,” Bradford said.

Medical debts can be difficult to track, especially once hospitals and doctors’
offices sell them to collection agencies. A given bill may be reported to one
credit agency but not another, meaning any single report cannot give a full
picture of someone’s debt.

Adding to the confusion, the credit check that Bradford’s recruiter shared with
her showed the amount of each debt but not to whom it was owed.

Bradford is now getting help to track down each debt from a friend who used to
work in hospital billing. She has also taken a new job to ensure she can pay
down those bills.

With the time that has passed, her previous score for the Air Force’s qualifying
test is no longer valid. She’s planning to retake the exam and try to enlist
next year.

“I’m trying to solve the problem now to go ahead,” Bradford said. But she still
questions why the Air Force would delay anyone’s enlistment for this kind of
debt.

“If you need people to be there for the country and to fight for the country,”
she said, “why would you hold them up for a medical bill?”

--------------------------------------------------------------------------------

Penelope Wingard(Aneri Pattani / KHN)

Her credit was ruined by medical debt. She’s been turned away from doctors,
jobs, and loans

By Aneri Pattani, KHN

Penelope Wingard, 58, Charlotte, North Carolina

Approximate Medical Debt: More than $50,000

Medical Issue: Breast cancer

What Happened: After a year of chemo and radiation, in 2014, Penelope Wingard
finally heard the news she’d been praying for: Her breast cancer was in
remission. But with relief immediately came worry about her finances.

Wingard had received Medicaid coverage through a temporary program for breast
cancer patients. When her treatment ended, she became uninsured.

Bills for follow-up appointments, blood tests, and scans quickly piled up. Soon,
her oncologist said he wouldn’t see her until she paid down the debt.

“My hair hadn’t even grown back from chemo,” Wingard said, “and I couldn’t see
my oncologist.”

It took about six months to find a doctor who would see her while unpaid bills
accrued.

Wingard was later diagnosed with an aneurysm that required brain surgery and,
separately, vision problems that prompted corneal transplants in both eyes.
Within a few years, she was buried under tens of thousands of dollars in medical
debt.

She learned to recognize the phone numbers of bill collectors and ignore the
past-due notices arriving in the mail. She wanted to pay them but had to
prioritize rent, utilities, and food. After taking care of those expenses, she
had little money left from her jobs as a covid-19 contact tracer and a driver
for ride-hailing services.

The unpaid medical bills began hitting her credit. Soon, she struggled to
qualify for loans. Applying for apartments and jobs became a nightmare.

“It’s like you’re being punished for being sick,” Wingard said.

What’s Broken: Unpaid medical bills can be reported to credit agencies and show
up as black marks on a person’s financial record, making it harder to qualify
for a car loan, rent an apartment, or get a job.

Earlier this year, three national credit agencies announced new policies that
would remove from credit reports paid medical debts and those that are less than
$500 even if they are unpaid.

The changes, slated to go into full effect in 2023, are expected to benefit an
estimated 16 million Americans.

But millions of Americans who owe far more than $500 may not benefit — 1 in 4
U.S. adults with health care debt owe more than $5,000, according to a KFF poll
conducted for this project; 1 in 8 owe more than $10,000.

A recent report by the Consumer Financial Protection Bureau also suggests that
the changes to credit reports may disproportionately benefit wealthier Americans
living in predominantly white neighborhoods. They’re more likely to have health
insurance, experts say, and collections under $500 often come from an unpaid
copay or coinsurance.

In contrast, people with the highest levels of medical debt tend to be Black or
Hispanic, have low incomes, and live in the South. According to the KFF poll,
56% of Black adults and 50% of Hispanic adults said they have debt because of
medical or dental bills, compared with 37% of white adults. And a study
published in 2021 found that medical debt was highest within low-income
communities and in Southern states that had not expanded Medicaid.

As an uninsured Black woman living in North Carolina, Wingard sits squarely
among the communities hit hardest by medical debt. Yet she will not benefit from
the credit agencies’ new policies.

What’s Left: Wingard has resigned herself to living with medical debt. That
means worrying that another doctor will turn her away because of unpaid bills
and having employers reject her from jobs because poor credit shows up as a red
flag on background checks.

Her fridge and stove have both been broken for over a year. She can’t qualify
for a loan to replace them, so instead of making baked chicken from her favorite
family recipe, she often settles for a can of soup or fast-food chicken wings.

But there are signs that help is on the way. The Biden administration has asked
the Consumer Financial Protection Bureau to investigate whether medical debt
should ever appear on credit reports, and some states — including North Carolina
— are considering strengthening protections against medical debt.

Wingard is hopeful she’ll get relief soon. “I’m hoping someone will listen and
say we need to focus more on health care for all Americans,” she said. “I don’t
know if they will, but it’s just a blind hope.”

--------------------------------------------------------------------------------

David Zipprich(Laura Buckman for KHN and NPR)

A retiree returns to work after a calamitous year of health emergencies

By Noam N. Levey, KHN

David Zipprich, 65, Fort Worth, Texas

Approximate Medical Debt: More than $200,000

Medical Issue: Diabetes and covid-19

What Happened: David Zipprich, a Fort Worth businessman and grandfather, was
forced out of retirement after a series of hospitalizations left him owing more
than $200,000.

Zipprich had spent a career in financial consulting. He owned a small bungalow
in a historical neighborhood near the Fort Worth rail yards. His daughters, both
teachers, and his four grandchildren lived nearby. He had health insurance and
some savings, and he’d paid off his mortgage.

In early 2020, though, Zipprich landed in the hospital. While he was driving,
his blood sugar dropped precipitously, and he blacked out and crashed his car.

Three months later, after he was diagnosed with diabetes, another complication
sent him back to the hospital. In December 2020, covid-19 put him there again.
“I look back at that year and feel lucky I even survived,” Zipprich said.

What’s Broken: Of the nation’s 20 most populous counties, none has a higher
prevalence of medical debt than Tarrant County, where Fort Worth is located.
Second is adjacent Dallas County, credit bureau data shows.

Nevertheless, Dallas-Fort Worth medical systems have been thriving. Though many
are exempt from taxes as nonprofit institutions, several notched double-digit
profit margins in recent years, outperforming many of the area’s Fortune 500
companies.

A KHN review of hospital finances in the country’s 306 hospital markets found
that several of the most profitable markets also have some of the highest levels
of patient debt.

Overall, about a third of the 100 million adults in the U.S. with health care
debt owe money for a hospitalization, according to a poll conducted by KFF for
this project. About a quarter of those owe $10,000 or more.

“The fact is, if you walk into a hospital today, chances are you are going to
walk out with debt, even if you have insurance,” said Allison Sesso, chief
executive of RIP Medical Debt, a nonprofit that buys debt from hospitals and
debt collectors so patients won’t have to pay it.

Overall in Tarrant County, 27% of residents with credit reports have medical
debt on their records, credit bureau data analyzed by KHN and the nonprofit
Urban Institute shows. In Dallas County, it’s 22.5%

What’s Left: Even with insurance, Zipprich was inundated with medical bills,
debt notices, and calls from collectors.

As he struggled to pay, his credit score plummeted below 600, and he had to
refinance his home. “My stress was off the charts,” he said, sitting in his tidy
living room with his Shih Tzu, Murphy.

Last year, Zipprich returned to work, taking a job in New Jersey that required
him to commute back and forth to Texas. He recently quit, citing the strain of
so much travel. He’s job-hunting again. “I never thought this would happen to
me,” he said.

--------------------------------------------------------------------------------

Monica Reed(Jamar Coach for KHN and NPR)

From her view in Knoxville, the health system is ‘not designed for poor people’

By Noam N. Levey, KHN

Monica Reed, 60, Knoxville, Tenn.

Approximate Medical Debt: $10,000

Medical Issue: Cancer

What Happened: Monica Reed considers herself luckier than most. Born in
Knoxville and raised by a single mother, Reed became the first in her family to
own a home, a small house built after the city demolished The Bottom, a once
thriving Black neighborhood that was systematically wiped out in a midcentury
urban renewal campaign. For the past 15 years, Reed has worked for a faith-based
nonprofit that assists low-income residents of Knoxville.

“It hasn’t always been easy,” Reed said. She raised her son by herself. And
though she’s always worked, her modest salary made saving difficult. “I just
tried to live a frugal kind of life,” she said. “And by the grace of God, I
didn’t become homeless.”

She couldn’t escape medical debt, though. Diagnosed with cancer five years ago,
Reed underwent surgery and chemotherapy. Although she had health insurance
through work, she was left with close to $10,000 in medical bills she couldn’t
pay.

What’s Broken: In and around Knoxville, residents of predominantly Black
neighborhoods are more than twice as likely as those in largely white
neighborhoods to owe money for medical bills, Urban Institute credit bureau data
shows. That is one of the widest racial disparities in the country.

Health care debt in the U.S. now affects more than 100 million people, according
to a nationwide KFF poll conducted for this project. The toll has been
especially high on Black communities: Fifty-six percent of Black adults owe
money for a medical or dental bill, compared with 37% of white adults.

The explanation for that startling disparity is deeply rooted. Decades of
discrimination in housing, employment, and health care blocked generations of
Black families from building wealth — savings and assets that are increasingly
critical to accessing America’s high-priced medical system.

Against that backdrop, patients suffer. People with debt avoid seeking care and
become sicker with treatable chronic conditions like diabetes or multiple
sclerosis. Worse still, hospitals and doctors sometimes won’t see patients with
medical debt — even those in the middle of treatment.

Nationwide, Black adults who have had health care debt are twice as likely as
white adults with such debt to say they’ve been denied care because they owe
money, the KFF poll found. Many Black Americans also ration their care out of
fear of cost.

If Black patients go into debt, they face yet another challenge: a medical debt
collection industry that targets Black debtors more aggressively than their
white counterparts, particularly for smaller debts.

What’s Left: Reed has been pursued by debt collectors and even taken to court.
That has forced Reed to make difficult choices. “There’s always a sacrifice,”
she said. “You just do without some things to pay for other things.”

Reed said she cut back on trips to the grocery store: “I don’t buy a lot of
food. Just plain and simple.”

She has adjusted, she said. “You just do what you have to do.” What angers Reed,
though, is how she’s been treated by the cancer center where she goes for
periodic checkups to make sure the cancer remains in remission. When she
recently tried to make an appointment, a financial counselor told her she
couldn’t schedule it until she made a plan to pay her bills.

“I was so upset, I didn’t even find out how much I owed,” Reed said. “I mean, I
wasn’t calling about a little toothache. This is something that affects
someone’s life.”

Reed said she tries to stay upbeat. “I don’t sweat the small stuff,” she said.
“What am I going to do against this hospital?”

But, she said, she has realized one thing about the nation’s health care system:
“It’s not designed for poor people.”

--------------------------------------------------------------------------------

Kareen and Jeff King(Bram Sable-Smith / KHN)

A medical cost-sharing plan left pastor with most of the cost

By Bram Sable-Smith, KHN

Jeff King, 63, Lawrence, Kansas

Approximate Medical Debt: $160,000

Medical Issue: Heart ablation

What Happened: Kareen King calls it “the ultimate paradox”: The hospital that
saved her husband’s heart also broke it.

Jeff King needed his heart rhythm restored to normal with a procedure called an
ablation — sooner rather than later, his doctor said. Jeff asked the hospital
for a cost estimate but said he didn’t hear back before his scheduled surgery in
January 2021 at Stormont Vail Health in Topeka, Kansas.

The real pain came when the $160,000 bill arrived in the mail a few weeks later.
The Kings, who were uninsured at the time, were on the hook for nearly all of
it.



For health coverage, they’d joined a medical cost-sharing plan with a company
called Sedera, which describes its service as a “refreshing non-insurance
approach to managing large and unexpected healthcare costs.” With this
alternative to health insurance, members agree to share one another’s expenses.
The plans are often faith-based and have surged in popularity because they can
be cheaper than traditional insurance — the Kings said their plan cost $534 a
month, plus an additional $118 a month to join a direct primary care medical
practice.

But the sharing plans offer fewer protections than insurance and come with
provisos. The Kings said their plan did not fully cover preexisting conditions
like Jeff’s heart condition for the first two years of coverage — and he needed
the surgery after 16 months.

In a statement, a Sedera spokesperson said it’s important that members
understand the cost-sharing model and membership guidelines. “Sedera members
read and agree to these prior to joining,” the statement read.

The Kings have dabbled in all sorts of health coverage in their 42 years of
marriage. Jeff’s work as an evangelical pastor in his hometown of Osage City,
Kansas, almost never provided insurance for the couple or their five children,
all of whom are now grown. The exception came during Jeff’s most recent stint
leading a congregation, starting in 2015. Kareen remembered feeling “unworthy”
of the $1,800 a month the congregation paid for their insurance.

“We certainly had never come up with those kinds of premiums ourselves,” she
recalled.

But Jeff decided he had to leave that job in 2018. He said he felt forced out
over differences with some of his congregants on eternal damnation (“As a loving
parent, I could never punish my child forever”) and gay marriage (“Maybe God is
a whole lot more inclusive than we are”).

After Jeff resigned, the Kings briefly bought insurance through the Affordable
Care Act marketplace but later dropped it because they weren’t eligible for
subsidies and felt they couldn’t afford it.

That’s when they joined the Sedera plan. They knew the preexisting condition
clause was a gamble, but medication had managed Jeff’s heart condition for
years, and they didn’t expect he’d need medical procedures to address it.

What’s Broken: Without employer-sponsored insurance or federal subsidies to help
fund their coverage, the Kings felt priced out of traditional insurance. But
being uninsured left them exposed to hospital charges that ordinary patients
typically never see.

Hospital charges are generally understood by health economists to bear little
resemblance to the actual prices that are typically paid. Instead, they are more
of an opening salvo in the high-stakes negotiations between hospitals trying to
get as much money as they can for providing care and insurance companies trying
to pay as little as possible.

But patients lack the bargaining power of large insurers, which may cover
hundreds of thousands of patients in any given hospital’s catchment area. For
patients like Jeff, the main recourse is to go through a hospital’s financial
assistance program, although even with that help many patients can’t afford the
bills hospitals send them.

Stormont Vail’s assistance program eventually knocked about $107,000 off Jeff’s
original bill. Sedera provided a negotiator to help him haggle over costs.

Stormont Vail provided $19.5 million in financial assistance in tax year 2020
and wrote off about $13 million in bad debt, according to tax filings. Its net
revenue from patient services was $838.7 million.

Bill Lane, a Stormont Vail administrator, said that in addition to providing
financial assistance, the hospital works with patients facing high bills and
offers payment plans with zero interest. Payments are often in the range of 10%
of a person’s monthly income, Lane said. For some patients the hospital has a
“catastrophic discount” program that caps their balance at 30% of their gross
household income. The hospital also works with a local bank to provide loans to
patients to pay their bills. And the hospital sometimes sends patients’ balances
to debt collection agencies.

Lane said he generally recommends for patients to carry traditional insurance.
He also said the hospital now offers a “patient estimates module” and suggests
patients wait to schedule surgery, if possible, if they want an estimate “to
make an informed decision.”

What’s Left: Despite Sedera’s two-year waiting period to cover preexisting
conditions, the plan did give Jeff $15,000 to help with his bills. After Jeff
paid that to the hospital and then negotiated for several months, his final
balance was reduced to $37,859.34 in November 2021.

For his payment plan, Jeff said he was told the hospital would accept no less
than $500 per month — the equivalent of an additional mortgage payment for the
Kings. Jeff estimates it will take the family more than six years to pay it off.

“I never expected this to not cost me anything,” Jeff said, “but I wasn’t
expecting what it turned out to be either.”

The Kings are piecing together the funds to pay what they owe the hospital. A
few months after Jeff’s ablation, they sold their home in Osage City — where
they raised five children and where Jeff grew up — and bought a smaller house in
Lawrence. They had hoped to use that money to build their retirement account,
since Jeff’s decades of pastoral work didn’t include a pension or 401(k).

Instead, the home sale is helping pay Jeff’s medical debt. Kareen has part-time
jobs, and the couple leveraged their life insurance policy, as well.

Jeff began work as a hospice chaplain — for the extra income, but especially to
qualify the couple for health insurance. That meant less time for his passion
project, running a nonprofit called Transmuto through which he provides
spiritual guidance.

In February, Kareen checked again on whether the couple could afford Affordable
Care Act insurance so Jeff could get back to Transmuto full time. Her Google
searches for the federal government’s health insurance marketplace
(healthcare.gov) instead unwittingly landed her on websites that sell consumer
information to insurance brokers. Speaking to one of those brokers on the phone,
she bought what she said she was told was an Aetna plan. But it turned out to be
a membership in a cost-sharing plan with a company called Jericho Share, which
has received over 160 complaints on the Better Business Bureau website in the
past year.

Jericho Share spokesperson Mark Hubbard said in a statement that the
organization is “issuing full refunds when there is consumer confusion” and is
continuing to “evaluate and update our marketing efforts to increase
transparency and awareness.”

Hubbard also said Jericho Share is cooperating with regulators in California
and New Hampshire that have questioned whether the organization meets state
requirements of a health care sharing ministry. California is also questioning
whether Jericho Share has indeed received 501(c)(3) nonprofit status from the
IRS.

After canceling that plan and getting their money back, the Kings eventually did
sign up for an Affordable Care Act marketplace plan. Jeff has reduced his hours
as a chaplain, freeing up more time for Transmuto. All in all, the couple feels
pretty fortunate.

“It’s just so tragic the way our system is,” Jeff said. “It puts so many people
into impossible financial straits.”

--------------------------------------------------------------------------------

Allyson Ward(Taylor Glascock for KHN and NPR)

Double shifts, credit card debt, and family loans when twins were born early

By Noam N. Levey, KHN

Allyson Ward, 43, Chicago

Approximate Medical Debt: $80,000

Medical Issue: Childbirth

What Happened: There were times after her sons were born 10 years ago when
Allyson Ward wondered whether she and her family would lose their home.

On some days, she would tick through a list of friends and family, considering
who could take them in. “We had a plan that we were not going to be homeless,”
Ward recalled.

Ward is a nurse practitioner who works at a neonatal intensive care unit in
Chicago. Her husband, Marcus, runs a small nonprofit.

But when the couple’s boys, Milo and Theo, were born 10 weeks prematurely, their
lives were upended financially.

The twins were diagnosed with cerebral palsy. One required multiple surgeries to
fix a breathing disorder. The babies spent more than three months in a NICU.

Ward and her husband scrambled to get the boys the care they needed, including
years of physical and occupational therapy. The bills, which topped out at about
$80,000, overwhelmed them.

Much of it at first was from hospital care. Then their health plan denied
thousands of dollars in claims for the boys’ therapies, deeming some
unnecessary.

Desperate, Ward and her husband loaded up credit cards, borrowed from relatives,
and delayed repaying student loans. They moved back to the Midwest from Dallas
to be closer to family who could help them.

In Chicago, Ward took on extra nursing shifts, working day and night several
times a week. Her husband, who was finishing a master’s degree, watched the
babies.

“I wanted to be a mom,” she said. “But we had to have the money.”

What’s Broken: Ward and her husband had health insurance through her employer in
Texas.

But that’s often not enough to protect patients from a major medical event. Most
Americans who have medical debt had coverage, according to a KFF survey.

Even with health insurance, childbirth can be very expensive. One in 8 Americans
who have health care debt say it was at least partially caused by pregnancy and
childbirth.

Ward and her husband are also among tens of millions of Americans who end up
with medical debt because their health plan didn’t pay for something they
believed would be covered. Such insurance issues are the most common form of
billing problem cited by Americans with debt.

What’s Left: Since moving back to the Midwest, Ward and her husband have been
slowly paying down the debt.

They bought a small house in Chicago in 2016. And Milo and Theo have been able
to stay on grade level at school.

Although cerebral palsy can be severely disabling, the boys can run, ride bikes,
and go rock climbing, which Ward credits to the many therapists who have worked
with them.

Ten years later, though, the family is still paying off nearly $10,000 in
medical debt on their credit cards.

Ward said sometimes at work she looks sadly at new parents in the NICU, thinking
about their financial strains ahead. “They have no idea,” she said.

--------------------------------------------------------------------------------

Sherrie and Michael Foy(Carlos Bernate for KHN and NPR)

A surgery shatters retirement plans and leads to bankruptcy

By Noam N. Levey, KHN

Sherrie Foy, 63, Moneta, Virginia

Approximate Medical Debt: $850,000

Medical Issue: Colon surgery

What Happened: Sherrie and Michael Foy thought they’d made all the right
preparations when they moved to rural southwestern Virginia after Michael
retired from Consolidated Edison, New York’s largest utility.  

Sherrie Foy loved horses and had started to rescue unwanted animals. The couple
had diligently saved. And they had retiree health insurance through Con Edison.

“We were never rich,” Sherrie said. “But we had what we wanted.”

Then in 2016, Sherrie, who had lived for years with persistent bowel irritation,
had her colon removed. After the surgery, she contracted a dangerous infection
and barely survived.

The complications produced nearly $800,000 in bills from the University of
Virginia Health System for services that weren’t covered by the Foys’ health
insurance.  

When the couple couldn’t pay, the state sued Sherrie. The only way past it, the
Foys concluded, was to declare bankruptcy.

The nest egg they’d carefully built so her husband could retire early was wiped
out. They cashed in a life insurance policy to pay a lawyer and liquidated
savings accounts they’d set up for their grandchildren.

“They took everything we had,” Foy said. “Now we have nothing.”

What’s Broken: Foy fell victim to a gap in her husband’s retiree health
insurance plan that capped lifetime coverage at $1 million.

Such caps were more common before the 2010 Affordable Care Act, though some
plans with these caps were grandfathered in.

Relatively few patients with medical debt are sued, and some medical centers
have been forced to scale back the practice in recent years after news reports
about the lawsuits. (The University of Virginia Health System changed its
policies following a 2019 KHN investigation.)

But hospitals and other medical providers still rely on the courts to collect
from patients.

More broadly, bankruptcy caused directly or partially by medical debt remains a
significant problem.

A nationwide KFF poll conducted for this project found about 1 in 8 adults with
health care debt have been forced to declare bankruptcy.

What’s Left: Sherrie said her health has improved.

After the complications from her surgery in Virginia, she returned to New York
to seek care at a hospital she said saved her life. That hospital never billed
her, she said. She doesn’t know why, but she believes she may have qualified for
charity care.

The bankruptcy has been devastating. The Foys get by on Michael’s pension and
their Social Security checks.

The same year they declared bankruptcy, Michael also had a heart attack, and
their daughter was diagnosed with breast cancer.

“It was a disaster of a year,” Sherrie said. “No one should have to go through
this.”

Sherrie has no health insurance. She hopes there won’t be more major medical
bills before she turns 65 and qualifies for Medicare.

--------------------------------------------------------------------------------

Edy Adams(Julia Robinson for KHN and NPR)

A sexual assault and years of calls from debt collectors

By Noam N. Levey, KHN

Edy Adams, 31, Austin, Texas

Approximate Medical Debt: $131

Medical Issue: Sexual assault

What Happened: Edy Adams had just graduated from college when she was sexually
assaulted in 2013.

She was living in Chicago, and believes she was drugged while at a bar.

Adams doesn’t remember what happened. When she woke up the next morning bruised
and confused, she contacted the police and was directed to get an exam at a
local hospital emergency room, which confirmed the assault.

Police never found the perpetrator. Then two years later, Adams started getting
calls from debt collectors saying she owed $130.68.

At first, Adams was confused. The hospital had told her that Illinois law
prohibited medical providers from charging rape victims for a medical exam.

“I thought someone didn’t put in the proper billing code or something,” said
Adams, who is now a medical student in Texas.

She explained the situation to the debt collector, who said the company would
put a note in her file.

Nevertheless, about six months later, another call came from another debt
collector seeking the same $130.68.

Adams again explained the situation. A few months later, there was yet another
call.

It kept on for years, as her small debt was passed from one collector to
another.

Adams tried to contact the hospital, but the bill was not theirs. It had
originated with a physicians’ practice that had closed.

Sometimes when the debt collectors called, Adams would break down in tears on
the phone. “I was frantic,” she recalled.

With each call, Adams said, she was forced to relive the worst day of her life
and explain her trauma to a disembodied voice in a call center somewhere in
America.

“I was being haunted by this zombie bill,” she said. “I couldn’t make it stop.”

What’s Broken: Federal regulators and consumer advocates for years have
documented widespread problems across the debt collection industry, calling out
collectors for not doing enough to verify and document bills before pursuing
consumers.

The problems are particularly acute in medical debt collection. From 2018 to
2021, people contacted about a medical debt complained most frequently to the
Consumer Financial Protection Bureau about being hounded for a debt they did not
owe, the agency found.

And in a nationwide poll conducted by KFF, a third of Americans who had been
contacted by a collection agency because of a medical or dental bill said the
debt was not theirs.

What’s Left: Adams found relief only after the last debt collector reported the
bill to a credit reporting agency, which lowered her credit score.

Adams petitioned the agency to have the debt removed, which it quickly did.

Adams said she didn’t begrudge most of the people who called her over the years.
“It seemed like they were only cogs in this giant debt machine,” she said.

--------------------------------------------------------------------------------

Elizabeth and Nick Woodruff(Heather Ainsworth for KHN and NPR)

Hospital lawsuits and garnished wages on top of diabetes

By Noam N. Levey, KHN

Nick Woodruff, 37, Binghamton, New York

Approximate Medical Debt: $20,000

Medical Issue: Diabetes

What Happened: Nick Woodruff’s wages were garnished for the first time in 2016.

Woodruff, who was diagnosed with diabetes in his 20s, had a good job. He worked
for a truck dealership in this small city 175 miles northwest of New York while
his wife, Elizabeth, completed her degree in social work. His job had health
benefits. The couple had recently bought a home.

But a small infection on Nick’s foot related to the diabetes set off a cascade
of medical emergencies and financial struggles that the Woodruffs are still
laboring to put behind them.

First Nick’s infection spread to the bone and threatened to overwhelm his immune
system. He was hospitalized and suffered damage to his heart and kidneys.

More complications followed. Nick slipped going down the stairs, shattering his
foot. Doctors later had to amputate it.

Then came thousands of dollars of medical bills, followed by debt collectors.

“We were drowning in medical debt, and he was not doing well,” Elizabeth
recalled. 

The bills were overwhelming and often incomprehensible. “There’s a lot that we
owe that we don’t even know,” Elizabeth said.

The Woodruffs withdrew money from their retirement accounts. Their siblings
kicked in to pay off some bills.

Elizabeth got a job as a social worker at the hospital, Our Lady of Lourdes
Memorial Hospital, a Catholic institution that is now part of the Ascension
chain. But that did little to forestall the debt collectors.

The hospital sued Nick, and he was ordered to pay an additional $9,391 before
Elizabeth persuaded the hospital to lower the bill by several thousand dollars.

What’s Broken: The Woodruffs’ struggles with debt are a common experience for
Americans who have chronic illnesses such as diabetes, heart disease, and
cancer.

These people are more likely to end up with medical debt than those who are
healthy, a nationwide poll conducted by KFF found.

In fact, illness is the strongest predictor of medical debt, according to an
analysis by the Urban Institute, which looked at county-level debt and disease
data across the country.

In the 100 U.S. counties with the highest levels of chronic disease, nearly a
quarter of adults have medical debt on their credit records. By contrast, in the
healthiest counties fewer than 1 in 10 have debt.

What’s Left: The Woodruffs have managed to pay down some of their debt, and Nick
is on disability benefits because he’s no longer able to work.

Elizabeth has a new job, so she doesn’t have to work for the hospital that sued
them.

They said they feel lucky to have been able to pay many of their bills. “I feel
sorry for the people who don’t have the resources that we did,” Nick said.

But the couple remains shocked by the aggressive debt collections.

“This hospital boasts Catholic values and states they take pride in their
charity work,” Elizabeth said, “but I am taken aback by how callous they have
been.”

--------------------------------------------------------------------------------

Ariane Buck(Ash Ponders for KHN and NPR)

Denied care for a dangerous infection because of past-due bills

By Noam N. Levey, KHN

Ariane Buck, 30, Peoria, Arizona

Approximate Medical Debt: $50,000

Medical Issue: Infection

What Happened: Ariane Buck knew it was important to stay on top of his health
care.

The young father, who lives with his wife and three children outside Phoenix,
had survived cancer when he was a child.

But making ends meet hasn’t always been easy for Ariane, who sells health
insurance, and his wife, Samantha, a therapist who cares for people with autism.

At times the family has fallen behind on medical bills. Still, they never
expected to be denied care.

Just before Father’s Day in 2016, Ariane grew very sick. He couldn’t hold down
food without vomiting. There was blood in his stool.

Samantha called the family’s primary care doctor seeking an appointment. But the
office turned the Bucks away.

“They said they wouldn’t see him because of past due bills,” Samantha said,
estimating they owed a few hundred dollars.

Ariane’s only choice was to go to a hospital emergency room. There he was
diagnosed with a serious intestinal infection that required intravenous fluids
and antibiotics.

The Bucks were also hit with thousands of dollars of additional bills they
couldn’t pay.

What’s Broken: Hospitals for decades have been required by federal law to
provide emergency medical care to any patients who need it, regardless of their
ability to pay.

But many medical providers, including physicians, have policies that allow them
to turn away patients with past-due bills for nonurgent care.

The practice is surprisingly common. Nationwide, 1 in 7 Americans with health
care debt say they have been denied care because of money they owe, a poll
conducted by KFF found.

On top of that, tens of millions of Americans ration their care. About
two-thirds of U.S. adults with debt from medical or dental bills say they or a
member of their household have put off getting care they needed because of
costs.

What’s Left: Buck recovered from the infection and is now in good health. But
the family’s medical debt has swelled to more than $50,000, from Ariane’s bills
and Samantha’s.

Samantha went to the emergency room twice in the past several years with painful
cases of endometriosis.

The Bucks have taken out loans, loaded up their credit cards, and sought help
from charities.

“We’ve all had to cut back on everything,” Buck said. The kids wear
hand-me-downs. They scrimp on school supplies and rely on family for Christmas
gifts. A dinner out for chili is an extravagance. 

“It pains me when my kids ask to go somewhere, and I can’t,” Buck said. “I feel
as if I’ve failed as a parent.”

The couple is preparing to file for bankruptcy.

--------------------------------------------------------------------------------

Cindy and Jim Powers(Olivia Sun for KHN and NPR)

Nineteen surgeries over five years. Then they lost their house.

By Noam N. Levey, KHN

Cindy Powers, 52, Greeley, Colorado

Approximate Medical Debt: $250,000

Medical Issue: Twisted intestine

What Happened: Cindy Powers was 34 when doctors discovered she had a twisted
intestine, a potentially life-threatening condition that doctors told her
required immediate surgery.

She and her husband, Jim, were living outside Dallas at the time, where Jim had
a job with a school district.

They had health insurance. But it couldn’t protect them from the flood of
medical bills that swamped them after Cindy’s diagnosis.

Cindy’s first surgery, which lasted nine hours, would be followed by 18 more
operations at hospitals across the Dallas-Fort Worth area. “Nobody was able to
come up with a solution,” Jim said.

Cindy had recurring infections and hernias. Persistent pain left her addicted to
the opioids she’d been prescribed.

“It was five years of hell,” Jim said of his wife’s medical ordeal.

By the time a surgeon finally repaired Cindy’s intestines in 2009, the couple
had some $250,000 in medical debt. They declared bankruptcy.

The Powers also ended up losing their home when their mortgage was sold and the
new lender rejected the payment plan set up through the bankruptcy. 

A few years later, their adult daughter died. And in 2017, Cindy and Jim moved
back to Colorado, where Cindy was from.

What’s Broken: How much medical debt contributes to housing insecurity is
difficult to measure, as many people forced out of their homes face a mix of
financial challenges.

But a recent nationwide poll by KFF suggests that the debt from health care is
forcing millions of people from their homes.

About 1 in 12 Americans with health care debt say they have lost their home to
eviction or foreclosure at least in part because of what they owed, the survey
found.

And about 1 in 5 say they or someone in their household have moved in with
family or friends or made some other change in their living arrangement because
of health care debt.

What’s Left: After the bankruptcy and the move, the couple slowly got back on
their feet financially.

Jim began work at an animal welfare group. Cindy, whose health has improved, got
a job as well. The couple adopted their daughter’s girl, who’s now in sixth
grade.

Then Jim needed prostate surgery. As he worked to scrape together the $1,100 he
owed, he was sued by a debt collector.

“Things have got to change,” Jim said.

--------------------------------------------------------------------------------

Joe Pitzo(Darren Hauck for KHN and NPR)

Damaged credit delays the dream of buying a home

By Aneri Pattani, KHN

Joe Pitzo, 42, Brookfield, Wisconsin

Approximate Medical Debt: $350,000

Medical Issue: Cancer

What Happened: Joe Pitzo and his wife, Amanda, had been married only five months
when Joe was diagnosed with brain cancer in 2018. He would need brain surgery
and extensive rehab.

They’d been planning to buy a house for their blended family of five children.
Instead, they shifted their attention to doctor’s visits, insurance paperwork,
and hospital bills. And their finances fell apart.

“This just took a major toll on my credit,” Joe said. “It went down to next to
nothing.”

Joe had insurance through his employer. Prior to his brain surgery, the couple
confirmed that the surgeon and hospital were in their insurer’s network. But
around 4 p.m. the day before the procedure, their insurer said a device the
surgeons planned to use was medically unnecessary. It was not covered.

Joe and Amanda proceeded with the surgery, figuring they could deal with the
bills later.

The bills, it turned out, topped $350,000.

Joe said the debt dragged down his credit score by several hundred points. 

Their best hope for a home loan became Amanda, who didn’t have much credit, she
said. She’d never taken out a mortgage or a car loan.

What’s Broken: Difficulties with health insurance are a common feature of
medical debt in the U.S.

Two-thirds of Americans with health care debt say they haven’t fully paid a bill
because they were expecting their health plan to cover it, according to a
nationwide survey conducted by KFF. 

But health insurance rules and restrictions are often so complex that even
diligent patients struggle to make sense of them. 

It’s also not uncommon for medical debts to hurt patients’ credit scores.
There’s growing pressure to change that.  

This spring, the three leading credit agencies announced they would stop using
small past-due medical bills in credit score calculations. And the federal
Consumer Financial Protection Bureau plans to investigate whether any health
care bills should be counted.  

What’s Left: The Pitzos managed to get the hospital to reduce their charges to
about $30,000.

They worked to build Amanda’s credit so she could apply for the loan and were
finally able to buy a house in spring 2022.

They’re still making payments on about $19,000 in medical bills.

“It makes me sick about medical costs and how this whole thing is done,” Amanda
said.

--------------------------------------------------------------------------------

Terri Logan (Juan Diego Reyes for KHN and NPR)

Haunted for 13 years by debt from childbirth, then rescued by a nonprofit

By Yuki Noguchi, NPR

Terri Logan, 42, Spartanburg, South Carolina

Approximate Medical Debt: $1,400, now $0

Medical Issue: Premature childbirth

What Happened: Two months ahead of her due date with her second daughter, Terri
Logan felt weighed down by stress. She was a high school math teacher in Union
City, Georgia, and was ending her relationship with the baby’s father.

One day the baby stopped moving. Logan went to the hospital, where her blood
pressure spiked, her head throbbed, and she blacked out. Hours later, her
daughter was born by cesarean section, weighing only 3 pounds. Logan had health
insurance through work, but she was responsible for out-of-pocket charges. She
and her baby were in a health crisis, so the issue of money didn’t come up:
“That conversation just wasn’t had in that moment.”

About two weeks after her daughter was discharged, Logan was hit with a bill.
She couldn’t bring herself to take a close look at the total. “It was one of
those moments when you see … commas,” she said. She never opened the bills that
arrived after that, knowing she couldn’t pay them or handle the stress. “I just
avoided it like the plague.”

Other bills followed. Eventually, they were sent to collections.

The debt piled on to other stressors for the single mom. She developed
debilitating anxiety, which brought on more headaches. She had to give up her
full-time teaching job. “The weight of all of that medical debt — oh, man, it
was tough,” she said. “Every day was tough. Every day, I’m thinking about what I
owe, how am I going to get out of this.”

What’s Broken: Logan is among a growing number of working people who are
considered under-insured; that is, they have an employer-sponsored plan but it
pushes a lot of costs — in the form of copays, coinsurance, and deductibles —
onto the patient.

This cost sharing, as it’s called, has increased steadily over the past two
decades. Last year, the average annual deductible for a single worker with
job-based coverage topped $1,669, which is 68% higher than a decade ago,
according to an annual employer survey by KFF. Family deductibles can top
$10,000.

At the same time, millions of Americans have next to no savings. A nationwide
poll conducted by KFF for this project found that half of U.S. adults don’t have
the cash to cover an unexpected $500 health care bill.

That makes debt almost inevitable for anyone with a large expense like the birth
of a child, even if they have health insurance. Indeed, most Americans who have
medical debt had coverage, according to the KFF poll.

With her older daughter, Logan said, she never saw a bill. It was an
uncomplicated birth with no out-of-pocket charges. So she assumed her insurance
would provide similar coverage for the second birth.

What’s Left: Nearly 13 years after her second daughter’s birth, Logan received
yellow envelopes by mail and braced herself to open them. She was finally able
to work again, whenever her health permitted. It was time to start tackling the
problem that had dogged her.

As she put it: “It was like, ‘OK, even if you can’t pay it, you need to know who
you owe. At some point, you gotta start, because you gotta take care of this to
get into a better situation.’”

To her surprise, the envelopes did not contain bills, but rather a notice from
RIP Medical Debt, a nonprofit, saying it had bought her unpaid medical debts and
forgiven them on her behalf. She was shocked: “Wait: What? Who does that?”

Logan reread the letter and cried, absorbing the unexpected gift. “It definitely
gives you a sense of, ‘You know what? There’s still good in this world,’” she
said.

RIP Medical Debt uses donated funds to buy unpaid medical debt, directly from
hospitals or on the secondary market, for about 1% of the original value. It
selects unpaid bills held by lower-income patients — those making up to four
times the federal poverty level — and instead of trying to collect on those
loans, simply forgives them.

Through the pandemic, donations have skyrocketed, enabling the group to
accelerate its purchase of hospital debts. To date, it has forgiven $6.7 billion
in medical debt, helping 3.6 million people.

The lifting of her own debt burden, Logan said, has freed her to pursue
long-dormant interests. A lover of the stage, she planned her first singing
performance this month.

--------------------------------------------------------------------------------

Jeni Rae Peters(Dawnee LeBeau for KHN and NPR)

Sleepless nights over her children’s future as debts pile up

By Noam N. Levey, KHN

Jeni Rae Peters, 44, Rapid City, South Dakota

Approximate Medical Debt: More than $30,000

Medical Issue: Breast cancer

What Happened: Jeni Rae Peters’ budget has always been tight. But Peters, a
single mom and mental health counselor, has worked to provide opportunities for
her children, including two girls she adopted and a succession of foster
children. One of her daughters had been homeless.

Then two years ago, Peters was diagnosed with stage 2 breast cancer.

Multiple surgeries, radiation, and chemotherapy controlled the disease. But,
despite having insurance, Peters was left with more than $30,000 of debt and
mounting threats from bill collectors.

One collection call came as Peters was lying in the recovery room after her
double mastectomy. “I was kind of delirious, and I thought it was my kids,” she
said. “It was someone asking me to pay a medical bill.”

Through the surgeries and treatments, Peters kept working so she would not lose
her insurance. She took on extra work to pay some of the bills. Five days a
week, she works back-to-back shifts at both a mental health crisis center and a
clinic where she counsels teenagers, some of whom are suicidal. Last year, three
friends on the East Coast paid off some of the debt.

But Peters’ credit score has tumbled below 600. And she worries constantly about
how she will provide for her children.

Peters said she could drop car insurance for her teenage daughter, who just got
her license. Canceling ice skating for another daughter would yield an extra $60
a month. But Peters is reluctant. “Do you know what it feels like to be a foster
kid and get a gold medal in ice skating? Do you know what kind of citizen they
could become if they know they’re special?” she said.

Peters added: “My doctor saved my life, but my medical bills are stealing from
my children’s lives.”

What’s Broken: Despite many advances in cancer treatments, millions of Americans
end up in debt after being diagnosed with the disease.

That’s in part because medications and treatments are now so expensive. It’s
also because health plans typically require patients to pay thousands of dollars
out-of-pocket in deductibles and other cost sharing.

One study found that cancer patients were 71% more likely than Americans without
the disease to have bills in collections or to have a credit account closed for
nonpayment.

The debt forces many to make difficult sacrifices. Two-thirds of U.S. adults
who’ve incurred health care debt who’ve had cancer themselves or in their family
have cut spending on food, clothing, or other household basics, according to a
poll conducted by KFF for this project. One in 4 have declared bankruptcy or
lost their home.

The financial stress from debt can hinder cancer patients’ recovery and even
hasten death, researchers have found.

What’s Left: Peters’ cancer is in remission, and her health has improved. She
said she’s excited about adopting two more of her foster children.

But the threats from debt collectors keep coming. She recently received a new
collection notice for $13,000, warning her that she would soon face legal
action.

Peters said she has no way of paying off all her debts. She recently told one
bill collector that she was prepared to go to court and ask the judge to decide
which of her children should miss out on after-school activities to pay off
debt.

She asked another debt collector whether he had kids. “He told me that it had
been my choice to get the surgery,” Peters recalled. “And I said, ‘Yeah, I guess
I chose not to be dead.’”

--------------------------------------------------------------------------------

Lucille Brooks(Heather Ainsworth for KHN)

Her brother landed in a nursing home. She was sued over his bill.

By Noam N. Levey, KHN

Lucille Brooks, 74, Pittsford, New York

Approximate Medical Debt: $8,000

Medical Issue: None. She was billed for her brother’s care.

What Happened: Lucille Brooks was stunned to discover a nursing home in Monroe
County, New York, was suing her. She had never been a patient there. Nor had her
husband. “I thought this was crazy,” she said, figuring it had to be a mistake.

The bill was for care her brother, James Lawson, received in summer 2019. He’d
been hospitalized for complications from a diabetes medication. The hospital
released him to the county-run nursing home, where Brooks had visited him a few
times. No one ever talked to her about billing, she said. And she was never
asked to sign anything.

Brooks and Lawson were part of a big family that moved north from Mississippi to
escape segregation in the 1960s. Lawson had a career at the Rochester Parks and
Recreation Department. Brooks worked in insurance. They lived on opposite sides
of the city. “My brother always took care of his own business,” she said.

Lawson spent two months in the nursing home. A year later, Brooks was sued.

The county alleged that Brooks should have used her brother’s assets to pay his
bills and that she was therefore personally responsible for his debt. Attached
to the suit was an admissions agreement with what looked like Brooks’ signature.

What’s Broken: Admissions agreements often designate whoever signs as a
“responsible party” who will help the nursing home collect payments or enroll
the resident in Medicaid, the government safety-net program.

Consumer advocates say nursing homes slip the agreements into papers that family
members sign when an older parent or sick friend is admitted. Sometimes people
are told they must sign, a violation of federal law. “They are given a stack of
forms and told, ‘Sign here, sign there. Click here, click there,” said Miriam
Sheline, managing attorney at Pro Seniors, a nonprofit law firm in Cincinnati.

Litigation is a frequent byproduct of America’s medical debt crisis, which a
KHN-NPR investigation found has touched more than half of all U.S. adults in the
past five years.

About 1 in 7 adults who have had health care debt say they’ve been threatened
with a lawsuit or arrest, according to a nationwide KFF poll. Five percent say
they’ve been sued.

The nursing home industry has quietly developed what consumer attorneys and
patient advocates say is a pernicious strategy of pursuing family and friends of
patients despite federal law that was enacted to protect them from debt
collection.

In Monroe County, 24 federally licensed nursing homes filed 238 debt collections
cases from 2018 to 2021 seeking almost $7.6 million, KHN found. Nearly
two-thirds of the cases targeted a friend or relative.

Many were accused — often without documentation — of hiding residents’ assets.
The practice can intimidate people with means into paying debts they do not owe,
said Anna Anderson, an attorney at the nonprofit Legal Assistance of Western New
York. “People see that on a lawsuit and they think they’re being accused of
stealing,” she said. “It’s chilling.”

What’s Left: When the bill came, Brooks was so worried that she didn’t tell her
husband. “People like us live on a fixed income,” she said. “We don’t have money
to throw around, especially when you don’t see it coming.”

Brooks turned to Legal Assistance of Western New York, a nonprofit, which has
represented defendants in such cases. In time, Monroe County dropped its case
against her. Brooks said she thinks the signature on the admissions agreement
was forged from the nursing home’s visitor log, the only thing she signed.

Now she tells anyone with a friend or relative in a nursing home not to sign
anything. “It’s ridiculous,” she said. “But why would you ever think they would
be coming after you?”

--------------------------------------------------------------------------------

ABOUT THIS PROJECT

“Diagnosis: Debt” is a reporting partnership between KHN and NPR exploring the
scale, impact, and causes of medical debt in America.

The series draws on original polling by KFF, court records, federal data on
hospital finances, contracts obtained through public records requests, data on
international health systems, and a yearlong investigation into the financial
assistance and collection policies of more than 500 hospitals across the
country. 

Additional research was conducted by the Urban Institute, which analyzed credit
bureau and other demographic data on poverty, race, and health status for KHN to
explore where medical debt is concentrated in the U.S. and what factors are
associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit
card holders to look at how customers’ balances may be affected by major medical
expenses. And the CED Project, a Denver nonprofit, worked with KHN on a survey
of its clients to explore links between medical debt and housing instability. 

KHN journalists worked with KFF public opinion researchers to design and analyze
the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through
March 20, 2022, online and via telephone, in English and Spanish, among a
nationally representative sample of 2,375 U.S. adults, including 1,292 adults
with current health care debt and 382 adults who had health care debt in the
past five years. The margin of sampling error is plus or minus 3 percentage
points for the full sample and 3 percentage points for those with current debt.
For results based on subgroups, the margin of sampling error may be higher.

Reporters from KHN and NPR also conducted hundreds of interviews with patients
across the country; spoke with physicians, health industry leaders, consumer
advocates, debt lawyers, and researchers; and reviewed scores of studies and
surveys about medical debt.

Noam N. Levey: nlevey@kff.org, @NoamLevey

Aneri Pattani: apattani@kff.org, @aneripattani

Bram Sable-Smith: brams@kff.org, @besables


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UPENDED: HOW MEDICAL DEBT CHANGED THEIR LIVES

By Noam N. Levey and Aneri Pattani and Yuki Noguchi, NPR News and Bram
Sable-Smith Updated January 10, 2023 Originally Published June 16, 2022

<h1>Upended: How Medical Debt Changed Their Lives</h1> <span class="byline">Noam
N. Levey and Aneri Pattani and Yuki Noguchi, NPR News and Bram
Sable-Smith</span> <p> Loading… </p> <p>Some lost their homes. Some emptied
their retirement accounts. Some struggled to feed and clothe their families.
Medical debt now touches more than 100 million people in America, as the U.S.
health care system pushes patients into debt on a mass scale. Debtors are from
all walks of life and all corners of the country. Here are their stories ― how
they got into debt, what they’ve given up for it, and how they’re living with
the burden.</p> <p><strong>An Air Force career held up because of debt owed for
medical bills</strong></p> <p><em>By Aneri Pattani, KHN</em></p>
<p><strong>Samaria Bradford</strong>, 27, Goldsboro, North Carolina</p>
<p><strong>Approximate Medical Debt:</strong> $5,000</p> <p><strong>Medical
Issue: </strong>Emergency room care</p> <p><strong>What Happened:</strong> In
late August 2022, Samaria Bradford was prepared to leave for basic training any
day. She’d been in contact with an Air Force recruiter. Her qualifying test
score from two years earlier was still valid, and she’d lost weight to meet the
physical requirements. She felt so good about it that she gave two weeks’ notice
at her nursing home job.</p> <p>Then the recruiter sent a text: “We got your
credit check back you have multiple accounts in collects.”</p> <p>Bradford had
unpaid bills — mostly from hospitals and ambulance companies — that had gone to
collections. The recruiter said she needed to set up payment plans to address
the debts before she could enlist.</p> <p>“I was very upset and surprised,”
Bradford said. “I didn’t know your medical debt could stop you from
joining.”</p> <p>Bradford had dreamed of enlisting in the Air Force for years.
She took the qualifying exam in 2020 but delayed her enlistment so she could
stay close to home and support her younger sister, who was in high school at the
time.</p> <p>She worked a variety of jobs to stay afloat — as a cashier, then as
a cook and a staff member at a bowling alley for a bit. Later, she took
overnight shifts at a hospital. The pay covered rent, utilities, and food, but
she had little left over.</p> <p>Most of the jobs didn’t offer benefits, and
since North Carolina had not expanded Medicaid, Bradford did not qualify for the
public insurance.</p> <p>Over the years, when she landed in the emergency room
without insurance, bills racked up quickly. One time, she had a rash along her
back that she feared was an allergic reaction. Another time, she was dehydrated
and had to be brought to the hospital by ambulance. A car wreck led to another
visit.</p> <p>By 2022, when the Air Force recruiter looked into her finances,
Bradford owed roughly $5,000 spread across a half-dozen bills. In response to
his text about the debts, she wrote, “I’m guessing is doctor bills?”</p>
<p><strong>What’s Broken: </strong>Several branches of the military check
financial histories when evaluating recruits. “Credit checks aid in determining
recruit financial responsibility while aiming to safeguard national security,”
said Christine Cuttita, an Air Force Recruiting Service spokesperson. Depending
on the particulars of the case, she confirmed, an individual can be disqualified
from enlisting because of debt.</p> <p>Red flags on a credit report include late
payments, long-term debts, or total debt — including student loans, mortgages,
and medical debt — that exceeds 40% of the person’s income. There’s no strict
disqualifier; rather, a squadron commander evaluates each case and assesses it
in the “best interest of the Air Force,” Cuttita said.</p> <p>Employers in other
sectors also commonly use credit checks to evaluate candidates.</p> <p>However,
<a
href="https://files.consumerfinance.gov/f/201405_cfpb_report_data-point_medical-debt-credit-scores.pdf">research
from the federal Consumer Financial Protection Bureau suggests</a> medical debts
should be treated differently than other debts.</p> <p>The CFPB found that
unlike credit card debt, medical bills that have gone to collections aren’t an
accurate predictor of someone’s likelihood to pay bills. In fact, the agency
determined that people with “paid medical collections were less likely to be
delinquent than other consumers with the same credit score.”</p> <p>The Biden
administration this year advised federal lenders to <a
href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/04/11/fact-sheet-the-biden-administration-announces-new-actions-to-lessen-the-burden-of-medical-debt-and-increase-consumer-protection/">no
longer consider medical debt</a> when evaluating loan applications.
VantageScore, one of the companies that calculate consumers’ credit scores, has
said it will <a
href="https://www.investopedia.com/vantagescore-excluding-medical-bills-from-credit-scores-6386300">stop
using medical collections</a> in its formula.</p> <p>But running credit checks
on job candidates remains common. For those with medical debt, that can mean
being turned away from jobs because of the bills they are trying to pay off.</p>
<p><strong>What’s Left: </strong>After receiving the recruiter’s text, Bradford
set out to make payments on as many medical bills as she could. Using savings
from the nursing home job she had recently left, she closed out two accounts on
which she owed a few hundred dollars and made smaller payments toward bills of
$1,000 or more.</p> <p>But, it turned out, those were not the debts showing up
on the Air Force credit check.</p> <p>“Of the five payments I made, only one of
them was connected to what my recruiter saw on his end,” Bradford said.</p>
<p>Medical debts can be difficult to track, especially once hospitals and
doctors’ offices sell them to collection agencies. A given bill may be reported
to one credit agency but not another, meaning any single report cannot give a
full picture of someone’s debt.</p> <p>Adding to the confusion, the credit check
that Bradford’s recruiter shared with her showed the amount of each debt but not
to whom it was owed.</p> <p>Bradford is now getting help to track down each debt
from a friend who used to work in hospital billing. She has also taken a new job
to ensure she can pay down those bills.</p> <p>With the time that has passed,
her previous score for the Air Force’s qualifying test is no longer valid. She’s
planning to retake the exam and try to enlist next year.</p> <p>“I’m trying to
solve the problem now to go ahead,” Bradford said. But she still questions why
the Air Force would delay anyone’s enlistment for this kind of debt.</p> <p>“If
you need people to be there for the country and to fight for the country,” she
said, “why would you hold them up for a medical bill?”</p> <p><strong>Her credit
was ruined by medical debt. She’s been turned away from doctors, jobs, and
loans</strong></p> <p><em>By Aneri Pattani, KHN</em></p> <p><strong>Penelope
Wingard</strong>, 58, Charlotte, North Carolina</p> <p><strong>Approximate
Medical Debt:</strong> More than $50,000</p> <p><strong>Medical Issue:
</strong>Breast cancer</p> <p><strong>What Happened:</strong> After a year of
chemo and radiation, in 2014, Penelope Wingard finally heard the news she’d been
praying for: Her breast cancer was in remission. But with relief immediately
came worry about her finances.</p> <p>Wingard had received Medicaid coverage
through a temporary program for breast cancer patients. When her treatment
ended, she became uninsured.</p> <p>Bills for follow-up appointments, blood
tests, and scans quickly piled up. Soon, her oncologist said he wouldn’t see her
until she paid down the debt.</p> <p>“My hair hadn’t even grown back from
chemo,” Wingard said, “and I couldn’t see my oncologist.”</p> <p>It took about
six months to find a doctor who would see her while unpaid bills accrued.</p>
<p>Wingard was later diagnosed with an aneurysm that required brain surgery and,
separately, vision problems that prompted corneal transplants in both eyes.
Within a few years, she was buried under tens of thousands of dollars in medical
debt.</p> <p>She learned to recognize the phone numbers of bill collectors and
ignore the past-due notices arriving in the mail. She wanted to pay them but had
to prioritize rent, utilities, and food. After taking care of those expenses,
she had little money left from her jobs as a covid-19 contact tracer and a
driver for ride-hailing services.</p> <p>The unpaid medical bills began hitting
her credit. Soon, she struggled to qualify for loans. Applying for apartments
and jobs became a nightmare.</p> <p>“It’s like you’re being punished for being
sick,” Wingard said.</p> <p><strong>What’s Broken: </strong>Unpaid medical bills
can be reported to credit agencies and show up as black marks on a person’s
financial record, making it harder to qualify for a car loan, rent an apartment,
or get a job.</p> <p>Earlier this year, three national credit agencies <a
href="https://www.washingtonpost.com/business/2022/03/18/medical-debt-removed-from-credit-reports/">announced
new policies</a> that would remove from credit reports paid medical debts and
those that are less than $500 even if they are unpaid.</p> <p>The changes,
slated to go into full effect in 2023, are expected to benefit an estimated 16
million Americans.</p> <p>But millions of Americans who owe far more than $500
may not benefit — 1 in 4 U.S. adults with health care debt owe more than $5,000,
according to <a
href="https://www.kff.org/health-costs/report/kff-health-care-debt-survey/">a
KFF poll</a> conducted for this project; 1 in 8 owe more than $10,000.</p> <p>A
<a
href="https://www.consumerfinance.gov/data-research/research-reports/paid-and-low-balance-medical-collections-on-consumer-credit-reports/">recent
report</a> by the Consumer Financial Protection Bureau also suggests that the
changes to credit reports may disproportionately benefit wealthier Americans
living in predominantly white neighborhoods. They’re more likely to have health
insurance, experts say, and collections under $500 often come from an unpaid
copay or coinsurance.</p> <p>In contrast, people with the highest levels of
medical debt tend to be Black or Hispanic, have low incomes, and live in the
South. According to the KFF poll, 56% of Black adults and 50% of Hispanic adults
said they have debt because of medical or dental bills, compared with 37% of
white adults. And a <a
href="https://jamanetwork.com/journals/jama/article-abstract/2782187">study
published in 2021</a> found that medical debt was highest within low-income
communities and in Southern states that had not expanded Medicaid.</p> <p>As an
uninsured Black woman living in North Carolina, Wingard sits squarely among the
communities hit hardest by medical debt. Yet she will not benefit from the
credit agencies’ new policies.</p> <p><strong>What’s Left: </strong>Wingard has
resigned herself to living with medical debt. That means worrying that another
doctor will turn her away because of unpaid bills and having employers reject
her from jobs because poor credit shows up as a red flag on background
checks.</p> <p>Her fridge and stove have both been broken for over a year. She
can’t qualify for a loan to replace them, so instead of making baked chicken
from her favorite family recipe, she often settles for a can of soup or
fast-food chicken wings.</p> <p>But there are signs that help is on the way. The
Biden administration <a
href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/04/11/fact-sheet-the-biden-administration-announces-new-actions-to-lessen-the-burden-of-medical-debt-and-increase-consumer-protection/">has
asked</a> the Consumer Financial Protection Bureau to investigate whether
medical debt should ever appear on credit reports, and some states — including
North Carolina — are considering <a
href="https://kffhealthnews.org/news/article/medical-bills-can-shatter-lives-north-carolina-may-act-to-de-weaponize-that-debt/">strengthening
protections against medical debt</a>.</p> <p>Wingard is hopeful she’ll get
relief soon. “I’m hoping someone will listen and say we need to focus more on
health care for all Americans,” she said. “I don’t know if they will, but it’s
just a blind hope.”</p> <p><strong>A retiree returns to work after a calamitous
year of health emergencies</strong></p> <p><em>By Noam N. Levey, KHN</em></p>
<p><strong>David Zipprich, </strong>65, Fort Worth, Texas</p>
<p><strong>Approximate Medical Debt:</strong> More than $200,000</p>
<p><strong>Medical Issue:</strong> Diabetes and covid-19</p> <p><strong>What
Happened: </strong>David Zipprich, a Fort Worth businessman and grandfather, was
forced out of retirement after a series of hospitalizations left him owing more
than $200,000.</p> <p>Zipprich had spent a career in financial consulting. He
owned a small bungalow in a historical neighborhood near the Fort Worth rail
yards. His daughters, both teachers, and his four grandchildren lived nearby. He
had health insurance and some savings, and he’d paid off his mortgage.</p> <p>In
early 2020, though, Zipprich landed in the hospital. While he was driving, his
blood sugar dropped precipitously, and he blacked out and crashed his car.</p>
<p>Three months later, after he was diagnosed with diabetes, another
complication sent him back to the hospital. In December 2020, covid-19 put him
there again. “I look back at that year and feel lucky I even survived,” Zipprich
said.</p> <p><strong>What’s Broken: </strong>Of the nation’s 20 most populous
counties, none has a higher prevalence of medical debt than Tarrant County,
where Fort Worth is located. Second is adjacent Dallas County, credit bureau
data shows.</p> <p>Nevertheless, Dallas-Fort Worth medical systems have been
thriving. Though many are exempt from taxes as nonprofit institutions, several
notched double-digit profit margins in recent years, outperforming many of the
area’s Fortune 500 companies.</p> <p>A KHN review of hospital finances in the
country’s 306 hospital markets found that several of the most profitable markets
also have some of the highest levels of patient debt.</p> <p>Overall, about a
third of the 100 million adults in the U.S. with health care debt owe money for
a hospitalization, according to <a
href="https://www.kff.org/health-costs/report/kff-health-care-debt-survey/">a
poll conducted by KFF for this project</a>. About a quarter of those owe $10,000
or more.</p> <p>“The fact is, if you walk into a hospital today, chances are you
are going to walk out with debt, even if you have insurance,” said Allison
Sesso, chief executive of RIP Medical Debt, a nonprofit that buys debt from
hospitals and debt collectors so patients won’t have to pay it.</p> <p>Overall
in Tarrant County, 27% of residents with credit reports have medical debt on
their records, credit bureau data analyzed by KHN and the nonprofit Urban
Institute shows. In Dallas County, it’s 22.5%</p> <p><strong>What’s Left:
</strong>Even with insurance, Zipprich was inundated with medical bills, debt
notices, and calls from collectors.</p> <p>As he struggled to pay, his credit
score plummeted below 600, and he had to refinance his home. “My stress was off
the charts,” he said, sitting in his tidy living room with his Shih Tzu,
Murphy.</p> <p>Last year, Zipprich returned to work, taking a job in New Jersey
that required him to commute back and forth to Texas. He recently quit, citing
the strain of so much travel. He’s job-hunting again. “I never thought this
would happen to me,” he said.</p> <p><strong>From her view in Knoxville, the
health system is ‘not designed for poor people’</strong></p> <p><em>By Noam N.
Levey, KHN</em></p> <p><strong>Monica Reed, </strong>60, Knoxville, Tenn.</p>
<p><strong>Approximate Medical Debt:</strong> $10,000</p> <p><strong>Medical
Issue:</strong> Cancer</p> <p><strong>What Happened: </strong>Monica Reed
considers herself luckier than most. Born in Knoxville and raised by a single
mother, Reed became the first in her family to own a home, a small house built
after the city demolished The Bottom, a once thriving Black neighborhood that
was systematically wiped out in a midcentury urban renewal campaign. For the
past 15 years, Reed has worked for a faith-based nonprofit that assists
low-income residents of Knoxville.</p> <p>“It hasn’t always been easy,” Reed
said. She raised her son by herself. And though she’s always worked, her modest
salary made saving difficult. “I just tried to live a frugal kind of life,” she
said. “And by the grace of God, I didn’t become homeless.”</p> <p>She couldn’t
escape medical debt, though. Diagnosed with cancer five years ago, Reed
underwent surgery and chemotherapy. Although she had health insurance through
work, she was left with close to $10,000 in medical bills she couldn’t pay.</p>
<p><strong>What’s Broken: </strong>In and around Knoxville, residents of
predominantly Black neighborhoods are more than twice as likely as those in
largely white neighborhoods to owe money for medical bills, Urban Institute <a
href="https://apps.urban.org/features/debt-interactive-map/?type=medical&variable=medcoll&state=47&county=47093">credit
bureau data</a> shows. That is one of the widest racial disparities in the
country.</p> <p>Health care debt in the U.S. now affects more than 100 million
people, according to <a
href="https://www.kff.org/health-costs/report/kff-health-care-debt-survey/">a
nationwide KFF poll</a> conducted for this project. The toll has been especially
high on Black communities: Fifty-six percent of Black adults owe money for a
medical or dental bill, compared with 37% of white adults.</p> <p>The
explanation for that startling disparity is deeply rooted. Decades of
discrimination in housing, employment, and health care blocked generations of
Black families from building wealth — savings and assets that are increasingly
critical to accessing America’s high-priced medical system.</p> <p>Against that
backdrop, patients suffer. People with debt avoid seeking care and become sicker
with treatable chronic conditions like diabetes or multiple sclerosis. Worse
still, hospitals and doctors sometimes won’t see patients with medical debt —
even those in the middle of treatment.</p> <p>Nationwide, Black adults who have
had health care debt are twice as likely as white adults with such debt to say
they’ve been denied care because they owe money, the KFF poll found. Many Black
Americans also ration their care out of fear of cost.</p> <p>If Black patients
go into debt, they face yet another challenge: a medical debt collection
industry that <a
href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3465203">targets Black
debtors</a> more aggressively than their white counterparts, particularly for
smaller debts.</p> <p><strong>What’s Left: </strong>Reed has been pursued by
debt collectors and even taken to court. That has forced Reed to make difficult
choices. “There’s always a sacrifice,” she said. “You just do without some
things to pay for other things.”</p> <p>Reed said she cut back on trips to the
grocery store: “I don’t buy a lot of food. Just plain and simple.”</p> <p>She
has adjusted, she said. “You just do what you have to do.” What angers Reed,
though, is how she’s been treated by the cancer center where she goes for
periodic checkups to make sure the cancer remains in remission. When she
recently tried to make an appointment, a financial counselor told her she
couldn’t schedule it until she made a plan to pay her bills.</p> <p>“I was so
upset, I didn’t even find out how much I owed,” Reed said. “I mean, I wasn’t
calling about a little toothache. This is something that affects someone’s
life.”</p> <p>Reed said she tries to stay upbeat. “I don’t sweat the small
stuff,” she said. “What am I going to do against this hospital?”</p> <p>But, she
said, she has realized one thing about the nation’s health care system: “It’s
not designed for poor people.”</p> <p><strong>A medical cost-sharing plan left
pastor with most of the cost</strong></p> <p><em>By Bram Sable-Smith,
KHN</em></p> <p><strong>Jeff King</strong>, 63, Lawrence, Kansas</p>
<p><strong>Approximate Medical Debt</strong>: $160,000</p> <p><strong>Medical
Issue:</strong> Heart ablation</p> <p><strong>What Happened: </strong>Kareen
King calls it “the ultimate paradox”: The hospital that saved her husband’s
heart also broke it.</p> <p>Jeff King needed his heart rhythm restored to normal
with a procedure called an ablation — sooner rather than later, his doctor said.
Jeff asked the hospital for a cost estimate but said he didn’t hear back before
his scheduled surgery in January 2021 at Stormont Vail Health in Topeka,
Kansas.</p> <p>The real pain came when the $160,000 bill arrived in the mail a
few weeks later. The Kings, who were uninsured at the time, were on the hook for
nearly all of it.</p> <p>For health coverage, they’d joined a medical
cost-sharing plan with a company called Sedera, which describes its service as a
“refreshing non-insurance approach to managing large and unexpected healthcare
costs.” With this <a
href="https://kffhealthnews.org/news/leap-of-faith-will-health-care-ministries-cover-your-costs/">alternative
to health insurance</a>, members agree to share one another’s expenses. The
plans are often faith-based and have surged in popularity because they can be
cheaper than traditional insurance — the Kings said their plan cost $534 a
month, plus an additional $118 a month to join a <a
href="https://kffhealthnews.org/news/fueled-by-health-law-concierge-medicine-reaches-new-markets/">direct
</a><a
href="https://kffhealthnews.org/news/fueled-by-health-law-concierge-medicine-reaches-new-markets/">primary</a><a
href="https://kffhealthnews.org/news/fueled-by-health-law-concierge-medicine-reaches-new-markets/">
care</a> medical practice.</p> <p>But the sharing plans <a
href="https://kffhealthnews.org/morning-breakout/new-york-subpoenas-business-that-markets-christian-cost-sharing-ministry-as-substitute-for-health-coverage/">offer
fewer protections</a> than insurance and come with provisos. The Kings said
their plan did not fully cover preexisting conditions like Jeff’s heart
condition for the first two years of coverage — and he needed the surgery after
16 months.</p> <p>In a statement, a Sedera spokesperson said it’s important that
members understand the cost-sharing model and membership guidelines. “Sedera
members read and agree to these prior to joining,” the statement read.</p>
<p>The Kings have dabbled in all sorts of health coverage in their 42 years of
marriage. Jeff’s work as an evangelical pastor in his hometown of Osage City,
Kansas, almost never provided insurance for the couple or their five children,
all of whom are now grown. The exception came during Jeff’s most recent stint
leading a congregation, starting in 2015. Kareen remembered feeling “unworthy”
of the $1,800 a month the congregation paid for their insurance.</p> <p>“We
certainly had never come up with those kinds of premiums ourselves,” she
recalled.</p> <p>But Jeff decided he had to leave that job in 2018. He said he
felt forced out over differences with some of his congregants on eternal
damnation (“As a loving parent, I could never punish my child forever”) and gay
marriage (“Maybe God is a whole lot more inclusive than we are”).</p> <p>After
Jeff resigned, the Kings briefly bought insurance through the Affordable Care
Act marketplace but later dropped it because they weren’t eligible for subsidies
and felt they couldn’t afford it.</p> <p>That’s when they joined the Sedera
plan. They knew the preexisting condition clause was a gamble, but medication
had managed Jeff’s heart condition for years, and they didn’t expect he’d need
medical procedures to address it.</p> <p><strong>What’s Broken: </strong>Without
employer-sponsored insurance or federal subsidies to help fund their coverage,
the Kings felt priced out of traditional insurance. But being uninsured left
them exposed to hospital charges that ordinary patients typically never see.</p>
<p>Hospital charges are generally understood by health economists to <a
href="https://journalofethics.ama-assn.org/article/challenge-understanding-health-care-costs-and-charges/2015-11">bear
little resemblance</a> to the actual <a
href="https://www.aha.org/system/files/2018-01/factsheet-hospital-billing-explained-9-2017.pdf">prices
that are typically paid</a>. Instead, they are more of an opening salvo in the
high-stakes negotiations between hospitals trying to get as much money as they
can for providing care and insurance companies trying to pay as little as
possible.</p> <p>But patients lack the bargaining power of large insurers, which
may cover hundreds of thousands of patients in any given hospital’s catchment
area. For patients like Jeff, the main recourse is to go through a hospital’s
financial assistance program, although even with that help many patients can’t
afford the bills hospitals send them.</p> <p>Stormont Vail’s assistance program
eventually knocked about $107,000 off Jeff’s original bill. Sedera provided a
negotiator to help him haggle over costs.</p> <p>Stormont Vail provided $19.5
million in financial assistance in tax year 2020 and wrote off about $13 million
in bad debt, according to tax filings. Its net revenue from patient services was
$838.7 million.</p> <p>Bill Lane, a Stormont Vail administrator, said that in
addition to providing financial assistance, the hospital works with patients
facing high bills and offers payment plans with zero interest. Payments are
often in the range of 10% of a person’s monthly income, Lane said. For some
patients the hospital has a “catastrophic discount” program that caps their
balance at 30% of their gross household income. The hospital also works with a
local bank to provide loans to patients to pay their bills. And the hospital
sometimes sends patients’ balances to debt collection agencies.</p> <p>Lane said
he generally recommends for patients to carry traditional insurance. He also
said the hospital now offers a “patient estimates module” and suggests patients
wait to schedule surgery, if possible, if they want an estimate “to make an
informed decision.”</p> <p><strong>What’s Left:</strong> Despite Sedera’s
two-year waiting period to cover preexisting conditions, the plan did give Jeff
$15,000 to help with his bills. After Jeff paid that to the hospital and then
negotiated for several months, his final balance was reduced to $37,859.34 in
November 2021.</p> <p>For his payment plan, Jeff said he was told the hospital
would accept no less than $500 per month — the equivalent of an additional
mortgage payment for the Kings. Jeff estimates it will take the family more than
six years to pay it off.</p> <p>“I never expected this to not cost me anything,”
Jeff said, “but I wasn’t expecting what it turned out to be either.”</p> <p>The
Kings are piecing together the funds to pay what they owe the hospital. A few
months after Jeff’s ablation, they sold their home in Osage City — where they
raised five children and where Jeff grew up — and bought a smaller house in
Lawrence. They had hoped to use that money to build their retirement account,
since Jeff’s decades of pastoral work didn’t include a pension or 401(k).</p>
<p>Instead, the home sale is helping pay Jeff’s medical debt. Kareen has
part-time jobs, and the couple leveraged their life insurance policy, as
well.</p> <p>Jeff began work as a hospice chaplain — for the extra income, but
especially to qualify the couple for health insurance. That meant less time for
his passion project, running a <a href="https://www.transmuto.org/">nonprofit
called Transmuto</a> through which he provides spiritual guidance.</p> <p>In
February, Kareen checked again on whether the couple could afford Affordable
Care Act insurance so Jeff could get back to Transmuto full time. Her Google
searches for the federal government’s health insurance marketplace
(healthcare.gov) instead unwittingly landed her on websites that sell consumer
information to insurance brokers. Speaking to one of those brokers on the phone,
she bought what she said she was told was an Aetna plan. But it turned out to be
a membership in a cost-sharing plan with a <a
href="https://kffhealthnews.org/news/article/health-care-sharing-ministry-insurance-complaints-jericho-share/">company
called Jericho Share</a>, which has received <a
href="https://www.bbb.org/us/tx/houston/profile/churches/jericho-share-0915-90064242">over
160 complaints</a> on the Better Business Bureau website in the past year.</p>
<p>Jericho Share spokesperson Mark Hubbard said in a statement that the
organization is “issuing full refunds when there is consumer confusion” and is
continuing to “evaluate and update our marketing efforts to increase
transparency and awareness.”</p> <p>Hubbard also said Jericho Share is
cooperating with regulators in California and <a
href="https://www.nh.gov/insurance/legal/enforcement/documents/2022-06-15-jericho-share-otsc-and-notice-of-hearing.pdf">New
Hampshire</a> that have questioned whether the organization meets state
requirements of a health care sharing ministry. California is also questioning
whether Jericho Share has indeed received 501(c)(3) nonprofit status from the
IRS.</p> <p>After canceling that plan and getting their money back, the Kings
eventually did sign up for an Affordable Care Act marketplace plan. Jeff has
reduced his hours as a chaplain, freeing up more time for Transmuto. All in all,
the couple feels pretty fortunate.</p> <p>“It’s just so tragic the way our
system is,” Jeff said. “It puts so many people into impossible financial
straits.”</p> <p><strong>Double shifts, credit card debt, and family loans when
twins were born early </strong></p> <p><em>By Noam N. Levey, KHN</em></p>
<p><strong>Allyson Ward</strong>, 43, Chicago</p> <p><strong>Approximate Medical
Debt:</strong> $80,000</p> <p><strong>Medical Issue:</strong> Childbirth</p>
<p><strong>What Happened:</strong> There were times after her sons were born 10
years ago when Allyson Ward wondered whether she and her family would lose their
home.</p> <p>On some days, she would tick through a list of friends and family,
considering who could take them in. “We had a plan that we were not going to be
homeless,” Ward recalled.</p> <p>Ward is a nurse practitioner who works at a
neonatal intensive care unit in Chicago. Her husband, Marcus, runs a small
nonprofit.</p> <p>But when the couple’s boys, Milo and Theo, were born 10 weeks
prematurely, their lives were upended financially.</p> <p>The twins were
diagnosed with cerebral palsy. One required multiple surgeries to fix a
breathing disorder. The babies spent more than three months in a NICU.</p>
<p>Ward and her husband scrambled to get the boys the care they needed,
including years of physical and occupational therapy. The bills, which topped
out at about $80,000, overwhelmed them.</p> <p>Much of it at first was from
hospital care. Then their health plan denied thousands of dollars in claims for
the boys’ therapies, deeming some unnecessary.</p> <p>Desperate, Ward and her
husband loaded up credit cards, borrowed from relatives, and delayed repaying
student loans. They moved back to the Midwest from Dallas to be closer to family
who could help them.</p> <p>In Chicago, Ward took on extra nursing shifts,
working day and night several times a week. Her husband, who was finishing a
master’s degree, watched the babies.</p> <p>“I wanted to be a mom,” she said.
“But we had to have the money.”</p> <p><strong>What’s Broken:</strong> Ward and
her husband had health insurance through her employer in Texas.</p> <p>But
that’s often not enough to protect patients from a major medical event. Most
Americans who have medical debt had coverage, according to a <a
href="https://www.kff.org/health-costs/report/kff-health-care-debt-survey/">KFF
survey</a>.</p> <p>Even with health insurance, childbirth can be very expensive.
One in 8 Americans who have health care debt say it was at least partially
caused by pregnancy and childbirth.</p> <p>Ward and her husband are also among
tens of millions of Americans who end up with medical debt because their health
plan didn’t pay for something they believed would be covered. Such insurance
issues are the most common form of billing problem cited by Americans with
debt.</p> <p><strong>What’s Left:</strong> Since moving back to the Midwest,
Ward and her husband have been slowly paying down the debt.</p> <p>They bought a
small house in Chicago in 2016. And Milo and Theo have been able to stay on
grade level at school.</p> <p>Although cerebral palsy can be severely disabling,
the boys can run, ride bikes, and go rock climbing, which Ward credits to the
many therapists who have worked with them.</p> <p>Ten years later, though, the
family is still paying off nearly $10,000 in medical debt on their credit
cards.</p> <p>Ward said sometimes at work she looks sadly at new parents in the
NICU, thinking about their financial strains ahead. “They have no idea,” she
said.</p> <p><strong>A surgery shatters retirement plans and leads to bankruptcy
</strong></p> <p><em>By Noam N. Levey, KHN</em></p> <p><strong>Sherrie
Foy</strong>, 63, Moneta, Virginia</p> <p><strong>Approximate Medical
Debt:</strong> $850,000</p> <p><strong>Medical Issue:</strong> Colon surgery</p>
<p><strong>What Happened:</strong> Sherrie and Michael Foy thought they’d made
all the right preparations when they moved to rural southwestern Virginia after
Michael retired from Consolidated Edison, New York’s largest utility.  </p>
<p>Sherrie Foy loved horses and had started to rescue unwanted animals. The
couple had diligently saved. And they had retiree health insurance through Con
Edison.</p> <p>“We were never rich,” Sherrie said. “But we had what we
wanted.”</p> <p>Then in 2016, Sherrie, who had lived for years with persistent
bowel irritation, had her colon removed. After the surgery, she contracted a
dangerous infection and barely survived.</p> <p>The complications produced
nearly $800,000 in bills from the University of Virginia Health System for
services that weren’t covered by the Foys’ health insurance.  </p> <p>When the
couple couldn’t pay, the state sued Sherrie. The only way past it, the Foys
concluded, was to declare bankruptcy.</p> <p>The nest egg they’d carefully built
so her husband could retire early was wiped out. They cashed in a life insurance
policy to pay a lawyer and liquidated savings accounts they’d set up for their
grandchildren.</p> <p>“They took everything we had,” Foy said. “Now we have
nothing.”</p> <p><strong>What’s Broken:</strong> Foy fell victim to a gap in her
husband’s retiree health insurance plan that capped lifetime coverage at $1
million.</p> <p>Such caps were more common before the 2010 Affordable Care Act,
though some plans with these caps were grandfathered in.</p> <p>Relatively few
patients with medical debt are sued, and some medical centers have been forced
to scale back the practice in recent years after news reports about the
lawsuits. (The University of Virginia Health System changed its policies
following <a href="https://kffhealthnews.org/news/tag/uva-lawsuits/">a 2019 KHN
investigation</a>.)</p> <p>But hospitals and other medical providers still rely
on the courts to collect from patients.</p> <p>More broadly, bankruptcy caused
directly or partially by medical debt remains a significant problem.</p> <p>A <a
href="https://www.kff.org/health-costs/report/kff-health-care-debt-survey/">nationwide
KFF poll</a> conducted for this project found about 1 in 8 adults with health
care debt have been forced to declare bankruptcy.</p> <p><strong>What’s
Left:</strong> Sherrie said her health has improved.</p> <p>After the
complications from her surgery in Virginia, she returned to New York to seek
care at a hospital she said saved her life. That hospital never billed her, she
said. She doesn’t know why, but she believes she may have qualified for charity
care.</p> <p>The bankruptcy has been devastating. The Foys get by on Michael’s
pension and their Social Security checks.</p> <p>The same year they declared
bankruptcy, Michael also had a heart attack, and their daughter was diagnosed
with breast cancer.</p> <p>“It was a disaster of a year,” Sherrie said. “No one
should have to go through this.”</p> <p>Sherrie has no health insurance. She
hopes there won’t be more major medical bills before she turns 65 and qualifies
for Medicare.</p> <p><strong>A sexual assault and years of calls from debt
collectors </strong></p> <p><em>By Noam N. Levey, KHN</em></p> <p><strong>Edy
Adams</strong>, 31, Austin, Texas</p> <p><strong>Approximate Medical
Debt:</strong> $131</p> <p><strong>Medical Issue:</strong> Sexual assault</p>
<p><strong>What Happened:</strong> Edy Adams had just graduated from college
when she was sexually assaulted in 2013.</p> <p>She was living in Chicago, and
believes she was drugged while at a bar.</p> <p>Adams doesn’t remember what
happened. When she woke up the next morning bruised and confused, she contacted
the police and was directed to get an exam at a local hospital emergency room,
which confirmed the assault.</p> <p>Police never found the perpetrator. Then two
years later, Adams started getting calls from debt collectors saying she owed
$130.68.</p> <p>At first, Adams was confused. The hospital had told her that
Illinois law prohibited medical providers from charging rape victims for a
medical exam.</p> <p>“I thought someone didn’t put in the proper billing code or
something,” said Adams, who is now a medical student in Texas.</p> <p>She
explained the situation to the debt collector, who said the company would put a
note in her file.</p> <p>Nevertheless, about six months later, another call came
from another debt collector seeking the same $130.68.</p> <p>Adams again
explained the situation. A few months later, there was yet another call.</p>
<p>It kept on for years, as her small debt was passed from one collector to
another.</p> <p>Adams tried to contact the hospital, but the bill was not
theirs. It had originated with a physicians’ practice that had closed.</p>
<p>Sometimes when the debt collectors called, Adams would break down in tears on
the phone. “I was frantic,” she recalled.</p> <p>With each call, Adams said, she
was forced to relive the worst day of her life and explain her trauma to a
disembodied voice in a call center somewhere in America.</p> <p>“I was being
haunted by this zombie bill,” she said. “I couldn’t make it stop.”</p>
<p><strong>What’s Broken:</strong> Federal regulators and consumer advocates for
years have documented widespread problems across the debt collection industry,
calling out collectors for not doing enough to verify and document bills before
pursuing consumers.</p> <p>The problems are particularly acute in medical debt
collection. From 2018 to 2021, people contacted about a medical debt complained
most frequently to the Consumer Financial Protection Bureau about being hounded
for a debt they did not owe, <a
href="https://files.consumerfinance.gov/f/documents/cfpb_medical-debt-burden-in-the-united-states_report_2022-03.pdf">the
agency found</a>.</p> <p>And in a <a
href="https://www.kff.org/health-costs/report/kff-health-care-debt-survey/">nationwide
poll conducted by KFF</a>, a third of Americans who had been contacted by a
collection agency because of a medical or dental bill said the debt was not
theirs.</p> <p><strong>What’s Left:</strong> Adams found relief only after the
last debt collector reported the bill to a credit reporting agency, which
lowered her credit score.</p> <p>Adams petitioned the agency to have the debt
removed, which it quickly did.</p> <p>Adams said she didn’t begrudge most of the
people who called her over the years. “It seemed like they were only cogs in
this giant debt machine,” she said.</p> <p><strong>Hospital lawsuits and
garnished wages on top of diabetes </strong></p> <p><em>By Noam N. Levey,
KHN</em></p> <p><strong>Nick Woodruff</strong>, 37, Binghamton, New York</p>
<p><strong>Approximate Medical Debt:</strong> $20,000</p> <p><strong>Medical
Issue:</strong> Diabetes</p> <p><strong>What Happened:</strong> Nick Woodruff’s
wages were garnished for the first time in 2016.</p> <p>Woodruff, who was
diagnosed with diabetes in his 20s, had a good job. He worked for a truck
dealership in this small city 175 miles northwest of New York while his wife,
Elizabeth, completed her degree in social work. His job had health benefits. The
couple had recently bought a home.</p> <p>But a small infection on Nick’s foot
related to the diabetes set off a cascade of medical emergencies and financial
struggles that the Woodruffs are still laboring to put behind them.</p> <p>First
Nick’s infection spread to the bone and threatened to overwhelm his immune
system. He was hospitalized and suffered damage to his heart and kidneys.</p>
<p>More complications followed. Nick slipped going down the stairs, shattering
his foot. Doctors later had to amputate it.</p> <p>Then came thousands of
dollars of medical bills, followed by debt collectors.</p> <p>“We were drowning
in medical debt, and he was not doing well,” Elizabeth recalled. </p> <p>The
bills were overwhelming and often incomprehensible. “There’s a lot that we owe
that we don’t even know,” Elizabeth said.</p> <p>The Woodruffs withdrew money
from their retirement accounts. Their siblings kicked in to pay off some
bills.</p> <p>Elizabeth got a job as a social worker at the hospital, Our Lady
of Lourdes Memorial Hospital, a Catholic institution that is now part of the
Ascension chain. But that did little to forestall the debt collectors.</p>
<p>The hospital sued Nick, and he was ordered to pay an additional $9,391 before
Elizabeth persuaded the hospital to lower the bill by several thousand
dollars.</p> <p><strong>What’s Broken:</strong> The Woodruffs’ struggles with
debt are a common experience for Americans who have chronic illnesses such as
diabetes, heart disease, and cancer.</p> <p>These people are more likely to end
up with medical debt than those who are healthy, a <a
href="https://www.kff.org/health-costs/report/kff-health-care-debt-survey/">nationwide
poll conducted by KFF</a> found.</p> <p>In fact, illness is the strongest
predictor of medical debt, according to an analysis by the Urban Institute,
which looked at county-level debt and disease data across the country.</p> <p>In
the 100 U.S. counties with the highest levels of chronic disease, nearly a
quarter of adults have medical debt on their credit records. By contrast, in the
healthiest counties fewer than 1 in 10 have debt.</p> <p><strong>What’s
Left:</strong> The Woodruffs have managed to pay down some of their debt, and
Nick is on disability benefits because he’s no longer able to work.</p>
<p>Elizabeth has a new job, so she doesn’t have to work for the hospital that
sued them.</p> <p>They said they feel lucky to have been able to pay many of
their bills. “I feel sorry for the people who don’t have the resources that we
did,” Nick said.</p> <p>But the couple remains shocked by the aggressive debt
collections.</p> <p>“This hospital boasts Catholic values and states they take
pride in their charity work,” Elizabeth said, “but I am taken aback by how
callous they have been.”</p> <p><strong>Denied care for a dangerous infection
because of past-due bills </strong></p> <p><em>By Noam N. Levey, KHN</em></p>
<p><strong>Ariane Buck</strong>, 30, Peoria, Arizona</p> <p><strong>Approximate
Medical Debt:</strong> $50,000</p> <p><strong>Medical Issue:</strong>
Infection</p> <p><strong>What Happened:</strong> Ariane Buck knew it was
important to stay on top of his health care.</p> <p>The young father, who lives
with his wife and three children outside Phoenix, had survived cancer when he
was a child.</p> <p>But making ends meet hasn’t always been easy for Ariane, who
sells health insurance, and his wife, Samantha, a therapist who cares for people
with autism.</p> <p>At times the family has fallen behind on medical bills.
Still, they never expected to be denied care.</p> <p>Just before Father’s Day in
2016, Ariane grew very sick. He couldn’t hold down food without vomiting. There
was blood in his stool.</p> <p>Samantha called the family’s primary care doctor
seeking an appointment. But the office turned the Bucks away.</p> <p>“They said
they wouldn’t see him because of past due bills,” Samantha said, estimating they
owed a few hundred dollars.</p> <p>Ariane’s only choice was to go to a hospital
emergency room. There he was diagnosed with a serious intestinal infection that
required intravenous fluids and antibiotics.</p> <p>The Bucks were also hit with
thousands of dollars of additional bills they couldn’t pay.</p>
<p><strong>What’s Broken:</strong> Hospitals for decades have been required by
federal law to provide emergency medical care to any patients who need it,
regardless of their ability to pay.</p> <p>But many medical providers, including
physicians, have policies that allow them to turn away patients with past-due
bills for nonurgent care.</p> <p>The practice is surprisingly common.
Nationwide, 1 in 7 Americans with health care debt say they have been denied
care because of money they owe, a <a
href="https://www.kff.org/health-costs/report/kff-health-care-debt-survey/">poll
conducted by KFF</a> found.</p> <p>On top of that, tens of millions of Americans
ration their care. About two-thirds of U.S. adults with debt from medical or
dental bills say they or a member of their household have put off getting care
they needed because of costs.</p> <p><strong>What’s Left:</strong> Buck
recovered from the infection and is now in good health. But the family’s medical
debt has swelled to more than $50,000, from Ariane’s bills and Samantha’s.</p>
<p>Samantha went to the emergency room twice in the past several years with
painful cases of endometriosis.</p> <p>The Bucks have taken out loans, loaded up
their credit cards, and sought help from charities.</p> <p>“We’ve all had to cut
back on everything,” Buck said. The kids wear hand-me-downs. They scrimp on
school supplies and rely on family for Christmas gifts. A dinner out for chili
is an extravagance. </p> <p>“It pains me when my kids ask to go somewhere, and I
can’t,” Buck said. “I feel as if I’ve failed as a parent.”</p> <p>The couple is
preparing to file for bankruptcy.</p> <p><strong>Nineteen surgeries over five
years. Then they lost their house. </strong></p> <p><em>By Noam N. Levey,
KHN</em></p> <p><strong>Cindy Powers</strong>, 52, Greeley, Colorado</p>
<p><strong>Approximate Medical Debt:</strong> $250,000</p> <p><strong>Medical
Issue:</strong> Twisted intestine</p> <p><strong>What Happened</strong>: Cindy
Powers was 34 when doctors discovered she had a twisted intestine, a potentially
life-threatening condition that doctors told her required immediate surgery.</p>
<p>She and her husband, Jim, were living outside Dallas at the time, where Jim
had a job with a school district.</p> <p>They had health insurance. But it
couldn’t protect them from the flood of medical bills that swamped them after
Cindy’s diagnosis.</p> <p>Cindy’s first surgery, which lasted nine hours, would
be followed by 18 more operations at hospitals across the Dallas-Fort Worth
area. “Nobody was able to come up with a solution,” Jim said.</p> <p>Cindy had
recurring infections and hernias. Persistent pain left her addicted to the
opioids she’d been prescribed.</p> <p>“It was five years of hell,” Jim said of
his wife’s medical ordeal.</p> <p>By the time a surgeon finally repaired Cindy’s
intestines in 2009, the couple had some $250,000 in medical debt. They declared
bankruptcy.</p> <p>The Powers also ended up losing their home when their
mortgage was sold and the new lender rejected the payment plan set up through
the bankruptcy. </p> <p>A few years later, their adult daughter died. And in
2017, Cindy and Jim moved back to Colorado, where Cindy was from.</p>
<p><strong>What’s Broken:</strong> How much medical debt contributes to housing
insecurity is difficult to measure, as many people forced out of their homes
face a mix of financial challenges.</p> <p>But a recent <a
href="https://www.kff.org/health-costs/report/kff-health-care-debt-survey/">nationwide
poll by KFF</a> suggests that the debt from health care is forcing millions of
people from their homes.</p> <p>About 1 in 12 Americans with health care debt
say they have lost their home to eviction or foreclosure at least in part
because of what they owed, the survey found.</p> <p>And about 1 in 5 say they or
someone in their household have moved in with family or friends or made some
other change in their living arrangement because of health care debt.</p>
<p><strong>What’s Left:</strong> After the bankruptcy and the move, the couple
slowly got back on their feet financially.</p> <p>Jim began work at an animal
welfare group. Cindy, whose health has improved, got a job as well. The couple
adopted their daughter’s girl, who’s now in sixth grade.</p> <p>Then Jim needed
prostate surgery. As he worked to scrape together the $1,100 he owed, he was
sued by a debt collector.</p> <p>“Things have got to change,” Jim said.</p>
<p><strong>Damaged credit delays the dream of buying a home</strong></p>
<p><em>By Aneri Pattani, KHN</em></p> <p><strong>Joe Pitzo,</strong> 42,
Brookfield, Wisconsin</p> <p><strong>Approximate Medical Debt:</strong>
$350,000</p> <p><strong>Medical Issue: </strong>Cancer</p> <p><strong>What
Happened:</strong> Joe Pitzo and his wife, Amanda, had been married only five
months when Joe was diagnosed with brain cancer in 2018. He would need brain
surgery and extensive rehab.</p> <p>They’d been planning to buy a house for
their blended family of five children. Instead, they shifted their attention to
doctor’s visits, insurance paperwork, and hospital bills. And their finances
fell apart.</p> <p>“This just took a major toll on my credit,” Joe said. “It
went down to next to nothing.”</p> <p>Joe had insurance through his employer.
Prior to his brain surgery, the couple confirmed that the surgeon and hospital
were in their insurer’s network. But around 4 p.m. the day before the procedure,
their insurer said a device the surgeons planned to use was medically
unnecessary. It was not covered.</p> <p>Joe and Amanda proceeded with the
surgery, figuring they could deal with the bills later.</p> <p>The bills, it
turned out, topped $350,000.</p> <p>Joe said the debt dragged down his credit
score by several hundred points. </p> <p>Their best hope for a home loan became
Amanda, who didn’t have much credit, she said. She’d never taken out a mortgage
or a car loan.</p> <p><strong>What’s Broken:</strong> Difficulties with health
insurance are a common feature of medical debt in the U.S.</p> <p>Two-thirds of
Americans with health care debt say they haven’t fully paid a bill because they
were expecting their health plan to cover it, according to a <a
href="https://www.kff.org/health-costs/report/kff-health-care-debt-survey/">nationwide
survey conducted by KFF</a>. </p> <p>But health insurance rules and restrictions
are often so complex that even diligent patients struggle to make sense of
them. </p> <p>It’s also not uncommon for medical debts to hurt patients’ credit
scores. There’s growing pressure to change that.  </p> <p>This spring, the three
leading credit agencies announced they would <a
href="https://www.cnbc.com/select/medical-debt-credit-report/">stop using</a>
small past-due medical bills in credit score calculations. And the federal
Consumer Financial Protection Bureau <a
href="https://files.consumerfinance.gov/f/documents/cfpb_medical-debt-burden-in-the-united-states_report_2022-03.pdf">plans
to investigate</a> whether any health care bills should be counted.  </p>
<p><strong>What’s Left:</strong> The Pitzos managed to get the hospital to
reduce their charges to about $30,000.</p> <p>They worked to build Amanda’s
credit so she could apply for the loan and were finally able to buy a house in
spring 2022.</p> <p>They’re still making payments on about $19,000 in medical
bills.</p> <p>“It makes me sick about medical costs and how this whole thing is
done,” Amanda said.</p> <p><strong>Haunted for 13 years by debt from childbirth,
then rescued by a nonprofit</strong></p> <p><em>By Yuki Noguchi, NPR</em></p>
<p><strong>Terri Logan, </strong>42, Spartanburg, South Carolina</p>
<p><strong>Approximate Medical Debt:</strong> $1,400, now $0</p>
<p><strong>Medical Issue:</strong> Premature childbirth</p> <p><strong>What
Happened:</strong> Two months ahead of her due date with her second daughter,
Terri Logan felt weighed down by stress. She was a high school math teacher in
Union City, Georgia, and was ending her relationship with the baby’s father.</p>
<p>One day the baby stopped moving. Logan went to the hospital, where her blood
pressure spiked, her head throbbed, and she blacked out. Hours later, her
daughter was born by cesarean section, weighing only 3 pounds. Logan had health
insurance through work, but she was responsible for out-of-pocket charges. She
and her baby were in a health crisis, so the issue of money didn’t come up:
“That conversation just wasn’t had in that moment.”</p> <p>About two weeks after
her daughter was discharged, Logan was hit with a bill. She couldn’t bring
herself to take a close look at the total. “It was one of those moments when you
see … commas,” she said. She never opened the bills that arrived after that,
knowing she couldn’t pay them or handle the stress. “I just avoided it like the
plague.”</p> <p>Other bills followed. Eventually, they were sent to
collections.</p> <p>The debt piled on to other stressors for the single mom. She
developed debilitating anxiety, which brought on more headaches. She had to give
up her full-time teaching job. “The weight of all of that medical debt — oh,
man, it was tough,” she said. “Every day was tough. Every day, I’m thinking
about what I owe, how am I going to get out of this.”</p> <p><strong>What’s
Broken: </strong>Logan is among a growing number of working people who are
considered <em>under</em>-insured; that is, they have an employer-sponsored plan
but it pushes a lot of costs — in the form of copays, coinsurance, and
deductibles — onto the patient.</p> <p>This cost sharing, as it’s called, has
increased steadily over the past two decades. Last year, the average annual
deductible for a single worker with job-based coverage topped $1,669, which is
68% higher than a decade ago, according <a
href="https://www.kff.org/report-section/ehbs-2021-section-7-employee-cost-sharing/">to
an annual employer survey by KFF</a>. Family deductibles can top $10,000.</p>
<p>At the same time, millions of Americans have next to no savings. A nationwide
poll conducted by KFF for this project found that half of U.S. adults don’t have
the cash to cover an unexpected $500 health care bill.</p> <p>That makes debt
almost inevitable for anyone with a large expense like the birth of a child,
even if they have health insurance. Indeed, most Americans who have medical debt
had coverage, according to the KFF poll.</p> <p>With her older daughter, Logan
said, she never saw a bill. It was an uncomplicated birth with no out-of-pocket
charges. So she assumed her insurance would provide similar coverage for the
second birth.</p> <p><strong>What’s Left:</strong> Nearly 13 years after her
second daughter’s birth, Logan received yellow envelopes by mail and braced
herself to open them. She was finally able to work again, whenever her health
permitted. It was time to start tackling the problem that had dogged her.</p>
<p>As she put it: “It was like, ‘OK, even if you can’t pay it, you need to know
who you owe. At some point, you gotta start, because you gotta take care of this
to get into a better situation.’”</p> <p>To her surprise, the envelopes did not
contain bills, but rather a notice from RIP Medical Debt, a nonprofit, saying it
had bought her unpaid medical debts and forgiven them on her behalf. She was
shocked: “Wait: What? Who does that?”</p> <p>Logan reread the letter and cried,
absorbing the unexpected gift. “It definitely gives you a sense of, ‘You know
what? There’s still good in this world,’” she said.</p> <p>RIP Medical Debt uses
donated funds to buy unpaid medical debt, directly from hospitals or on the
secondary market, for about 1% of the original value. It selects unpaid bills
held by lower-income patients — those making up to four times the federal
poverty level — and instead of trying to collect on those loans, simply forgives
them.</p> <p>Through the pandemic, donations have skyrocketed, enabling the
group to accelerate its purchase of hospital debts. To date, it has forgiven
$6.7 billion in medical debt, helping 3.6 million people.</p> <p>The lifting of
her own debt burden, Logan said, has freed her to pursue long-dormant interests.
A lover of the stage, she planned her first singing performance this month.</p>
<p><strong>Sleepless nights over her children’s future as debts pile
up</strong></p> <p><em>By Noam N. Levey, KHN</em></p> <p><strong>Jeni Rae
Peters</strong>, 44, Rapid City, South Dakota</p> <p><strong>Approximate Medical
Debt:</strong> More than $30,000</p> <p><strong>Medical Issue:</strong> Breast
cancer</p> <p><strong>What Happened</strong>: Jeni Rae Peters’ budget has always
been tight. But Peters, a single mom and mental health counselor, has worked to
provide opportunities for her children, including two girls she adopted and a
succession of foster children. One of her daughters had been homeless.</p>
<p>Then two years ago, Peters was diagnosed with stage 2 breast cancer.</p>
<p>Multiple surgeries, radiation, and chemotherapy controlled the disease. But,
despite having insurance, Peters was left with more than $30,000 of debt and
mounting threats from bill collectors.</p> <p>One collection call came as Peters
was lying in the recovery room after her double mastectomy. “I was kind of
delirious, and I thought it was my kids,” she said. “It was someone asking me to
pay a medical bill.”</p> <p>Through the surgeries and treatments, Peters kept
working so she would not lose her insurance. She took on extra work to pay some
of the bills. Five days a week, she works back-to-back shifts at both a mental
health crisis center and a clinic where she counsels teenagers, some of whom are
suicidal. Last year, three friends on the East Coast paid off some of the
debt.</p> <p>But Peters’ credit score has tumbled below 600. And she worries
constantly about how she will provide for her children.</p> <p>Peters said she
could drop car insurance for her teenage daughter, who just got her license.
Canceling ice skating for another daughter would yield an extra $60 a month. But
Peters is reluctant. “Do you know what it feels like to be a foster kid and get
a gold medal in ice skating? Do you know what kind of citizen they could become
if they know they’re special?” she said.</p> <p>Peters added: “My doctor saved
my life, but my medical bills are stealing from my children’s lives.”</p>
<p><strong>What’s Broken:</strong> Despite many advances in cancer treatments,
millions of Americans end up in debt after being diagnosed with the disease.</p>
<p>That’s in part because medications and treatments are now so expensive. It’s
also because health plans typically require patients to pay thousands of dollars
out-of-pocket in deductibles and other cost sharing.</p> <p>One study found that
cancer patients were 71% more likely than Americans without the disease to have
bills in collections or to have a credit account closed for nonpayment.</p>
<p>The debt forces many to make difficult sacrifices. Two-thirds of U.S. adults
who’ve incurred health care debt who’ve had cancer themselves or in their family
have cut spending on food, clothing, or other household basics, according to a
poll conducted by KFF for this project. One in 4 have declared bankruptcy or
lost their home.</p> <p>The financial stress from debt can hinder cancer
patients’ recovery and even hasten death, researchers have found.</p>
<p><strong>What’s Left:</strong> Peters’ cancer is in remission, and her health
has improved. She said she’s excited about adopting two more of her foster
children.</p> <p>But the threats from debt collectors keep coming. She recently
received a new collection notice for $13,000, warning her that she would soon
face legal action.</p> <p>Peters said she has no way of paying off all her
debts. She recently told one bill collector that she was prepared to go to court
and ask the judge to decide which of her children should miss out on
after-school activities to pay off debt.</p> <p>She asked another debt collector
whether he had kids. “He told me that it had been my choice to get the surgery,”
Peters recalled. “And I said, ‘Yeah, I guess I chose not to be dead.’”</p>
<p><strong>Her brother landed in a nursing home. She was sued over his
bill.</strong></p> <p><em>By Noam N. Levey, KHN</em></p> <p><strong>Lucille
Brooks, </strong>74, Pittsford, New York</p> <p><strong>Approximate Medical
Debt:</strong> $8,000</p> <p><strong>Medical Issue:</strong> None. She was
billed for her brother’s care.</p> <p><strong>What Happened:</strong> Lucille
Brooks was stunned to discover a nursing home in Monroe County, New York, was
suing her. She had never been a patient there. Nor had her husband. “I thought
this was crazy,” she said, figuring it had to be a mistake.</p> <p>The bill was
for care her brother, James Lawson, received in summer 2019. He’d been
hospitalized for complications from a diabetes medication. The hospital released
him to the county-run nursing home, where Brooks had visited him a few times. No
one ever talked to her about billing, she said. And she was never asked to sign
anything.</p> <p>Brooks and Lawson were part of a big family that moved north
from Mississippi to escape segregation in the 1960s. Lawson had a career at the
Rochester Parks and Recreation Department. Brooks worked in insurance. They
lived on opposite sides of the city. “My brother always took care of his own
business,” she said.</p> <p>Lawson spent two months in the nursing home. A year
later, <a
href="https://iapps.courts.state.ny.us/nyscef/DocumentList?docketId=ASPjnNo6sqC957Zx/GhTig==&display=all&courtType=Monroe%20County%20Supreme%20Court&resultsPageNum=2">Brooks
was sued</a>.</p> <p>The county alleged that Brooks should have used her
brother’s assets to pay his bills and that she was therefore personally
responsible for his debt. Attached to the suit was an admissions agreement with
what looked like Brooks’ signature.</p> <p><strong>What’s Broken:</strong>
Admissions agreements often designate whoever signs as a “responsible party” who
will help the nursing home collect payments or enroll the resident in Medicaid,
the government safety-net program.</p> <p>Consumer advocates say nursing homes
slip the agreements into papers that family members sign when an older parent or
sick friend is admitted. Sometimes people are told they must sign, a violation
of federal law. “They are given a stack of forms and told, ‘Sign here, sign
there. Click here, click there,” said Miriam Sheline, managing attorney at Pro
Seniors, a nonprofit law firm in Cincinnati.</p> <p>Litigation is a frequent
byproduct of America’s medical debt crisis, <a
href="https://kffhealthnews.org/news/article/diagnosis-debt-investigation-100-million-americans-hidden-medical-debt/">which
a KHN-NPR investigation found</a> has touched more than half of all U.S. adults
in the past five years.</p> <p>About 1 in 7 adults who have had health care debt
say they’ve been threatened with a lawsuit or arrest, according to a <a
href="https://www.kff.org/health-costs/report/kff-health-care-debt-survey/">nationwide
KFF poll</a>. Five percent say they’ve been sued.</p> <p>The nursing home
industry has quietly developed what consumer attorneys and patient advocates say
is a pernicious strategy of pursuing family and friends of patients despite
federal law that was enacted to protect them from debt collection.</p> <p>In
Monroe County, 24 federally licensed nursing homes filed 238 debt collections
cases from 2018 to 2021 seeking almost $7.6 million, KHN found. Nearly
two-thirds of the cases targeted a friend or relative.</p> <p>Many were accused
— often without documentation — of hiding residents’ assets. The practice can
intimidate people with means into paying debts they do not owe, said Anna
Anderson, an attorney at the nonprofit Legal Assistance of Western New York.
“People see that on a lawsuit and they think they’re being accused of stealing,”
she said. “It’s chilling.”</p> <p><strong>What’s Left:</strong> When the bill
came, Brooks was so worried that she didn’t tell her husband. “People like us
live on a fixed income,” she said. “We don’t have money to throw around,
especially when you don’t see it coming.”</p> <p>Brooks turned to Legal
Assistance of Western New York, a nonprofit, which has represented defendants in
such cases. In time, Monroe County dropped its case against her. Brooks said she
thinks the signature on the admissions agreement was forged from the nursing
home’s visitor log, the only thing she signed.</p> <p>Now she tells anyone with
a friend or relative in a nursing home not to sign anything. “It’s ridiculous,”
she said. “But why would you ever think they would be coming after you?”</p>
<h4>About This Project</h4><p>“Diagnosis: Debt” is a reporting partnership
between KHN and NPR exploring the scale, impact, and causes of medical debt in
America.</p><p>The series draws on original polling by KFF, court records,
federal data on hospital finances, contracts obtained through public records
requests, data on international health systems, and a yearlong investigation
into the financial assistance and collection policies of more than 500 hospitals
across the country. </p><p>Additional research was <a
href="https://www.urban.org/research/publication/which-county-characteristics-predict-medical-debt">conducted
by the Urban Institute</a>, which analyzed credit bureau and other demographic
data on poverty, race, and health status for KHN to explore where medical debt
is concentrated in the U.S. and what factors are associated with high debt
levels.</p><p>The JPMorgan Chase Institute <a
href="https://www.jpmorganchase.com/institute/research/healthcare/spending-during-the-pandemic">analyzed
records</a> from a sampling of Chase credit card holders to look at how
customers’ balances may be affected by major medical expenses. And the CED
Project, a Denver nonprofit, worked with KHN on a survey of its clients to
explore links between medical debt and housing instability. </p><p>KHN
journalists worked with KFF public opinion researchers to design and analyze the
“<a
href="https://www.kff.org/health-costs/report/kff-health-care-debt-survey/">KFF
Health Care Debt Survey</a>.” The survey was conducted Feb. 25 through March 20,
2022, online and via telephone, in English and Spanish, among a nationally
representative sample of 2,375 U.S. adults, including 1,292 adults with current
health care debt and 382 adults who had health care debt in the past five years.
The margin of sampling error is plus or minus 3 percentage points for the full
sample and 3 percentage points for those with current debt. For results based on
subgroups, the margin of sampling error may be higher.</p><p>Reporters from KHN
and NPR also conducted hundreds of interviews with patients across the country;
spoke with physicians, health industry leaders, consumer advocates, debt
lawyers, and researchers; and reviewed scores of studies and surveys about
medical debt.</p> Copy HTML

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