Better Solutions for Healthcare

The Atlantic: What Happens When You Don’t Pay a Hospital Bill

As Americans sink under medical expenses, debt collectors go to great—and sometimes strange—lengths to collect.
On March 8, 2011, Joclyn Krevat, an occupational therapist in New York, was sitting at her computer when she received a most unusual LinkedIn request. The wording was the familiar: “I’d like to add you to my professional network.” The sender was familiar, too, but not for the reason Krevat expected. It was from a debt collector.Karen Pollack, the head of a debt-collections practice called KP Recovery Solutions, had been trying to collect on some medical bills Krevat had recently incurred for a heart transplant.
Krevat’s debts, which were reviewed by The Atlantic, made up plot points in the worst kind of American health-care horror story. In December 2009, Krevat, who was 32 at the time, thought she was coming down with the flu. Instead, she was admitted to the hospital and diagnosed with giant cell myocarditis, a severe inflammatory heart disease that can lead to heart failure.
After seven weeks on life support, a heart became available, and she had a transplant. For a year afterward, she wasn’t able to return to work. Krevat’s husband was a teacher, and Krevat had good insurance through him. But some of the doctors who treated her turned out to be out-of-network—a situation she couldn’t control, because she did not know when a new heart would become available.
She estimates that if she had paid every bill that was sent to her, the total would have been about $50,000.
The LinkedIn request was an extreme example of what happens when medical bills go unpaid. Even bills incurred in an emergency can be sent to debt collectors or sold to debt buyers, who will attempt to collect on them however they can—including, perhaps, through America’s largest professional social network. (Pollack claims the request was an error.)To Krevat, the LinkedIn request was almost funny, in the laugh-till-you-cry sense. She remembers thinking, Is this lady stalking me or does she really think we’d be good in each others’ professional networks? “It was just more evidence that I was in this bizarro world of receiving bills I shouldn’t be responsible for,” Krevat told me.Krevat’s bills were just a drop in the American medical-debt ocean.
About 43 million Americans have unpaid medical debt dinging their credit, and half of all overdue debt on Americans’ credit reports is from medical expenses, according to a Consumer Financial Protection Bureau study from 2014. The debt typically comes from out-of-network doctors who people thought were in-network, hospital stays, or ambulance rides. About one in six Americans received a surprise out-of-network medical bill in 2017 after being treated in a hospital, even though they had insurance, according to Kaiser Health News.In an emailed statement, the American Hospital Association told me, “Hospitals and health systems treat all patients who come through their doors, around the clock and regardless of their ability to pay.
They work closely with uninsured and low-income patients on their individual bills, including discussing financial-assistance options with them.”Krevat’s bills began to arrive while she was still being treated at Columbia University Irving Medical Center. One came from one of the hospital’s doctors, Mathew R. Williams, for $9,000. Another came from a doctor named Aziz Ghaly for $17,418. A few months later, a separate invoice from Weill Cornell Physicians said she owed $22,464.