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How one bill can pursue you for months
A new journalist on her first experience in the healthcare system.
On February 13, 2020, I woke up with a horrible pain in my abdomen that wrapped around my back whenever I took deep breaths, and feeling like I had to pee. It was 7:30 a.m—the latest I could wake up and still make it to my 8 a.m public speaking class if I ran from my off-campus apartment to the English building and skipped grabbing coffee. As I bent down to put pants on, the pain worsened, like someone was punching me from the inside. Scared, confused, and wondering how many participation points I’d lose if I skipped class that day, I did what any college kid would do: I called my mom.
“Well, it’s probably a UTI,” she said. “You should go to the doctor if you’re in that much pain.”
“What if I drank cranberry juice?” I asked. “I don’t want to have to go to the doctor. I have class, and midterms are next week.”
“Victoria,” Mom said, pointedly. 15 minutes later, I was at the urgent care on Tallahassee Memorial Hospital’s campus, where a nurse pressed on my abdomen, saw me wince, and sent me to their ER across the street without even collecting a urine sample.
My mom was right: It was a UTI, and the reason why it hurt so badly was that the infection was trying to spread to my kidneys. Once I was in the ER and admitted, they took a urine sample, drew blood, and hooked me up to an IV drip with antibiotics and pain medication. I laid in a hospital bed for a few hours and watched Netflix on my laptop; a nurse kindly took it out of my backpack and plugged its charger into the wall for me. I was discharged at 1 p.m., with a few prescriptions waiting for me at the campus CVS and a note exempting me from class.
This one morning has followed me for over 18 months, and potentially will for several more years. It showed me how our healthcare system forces patients to be financially responsible for health issues totally out of their control, without displaying any of that same level of responsibility with the power it has to ruin those patients’ financial lives.
A couple of weeks later, I got my bills from the urgent care and hospital in the mail. They totaled about $3,000, because of my insurance deductible (I was still part of my parents’ plan). I panicked and brought the bills with me when I visited home for spring break (and eventually never returned to campus due to the pandemic). My parents, who are thankfully very financially stable, paid for it. I felt terrible springing it on them, but they told me not to worry.
Cut to August 2021.
I got a call from a phone number that’s called me before. I had assumed it was just telemarketing, but this time, I picked it up.
“Is this Victoria?” the woman on the other end said.
“Yes, that’s me.”
“Hello ma’am, my name’s [name], and I’m calling from Gulf Coast Collection Bureau. We’ve been trying to reach you regarding…”
Here’s what happened: Those bills that I got in the mail that my parents paid for me? Those weren’t the last of them. There was one bill left that was charged separately from the rest—a doctor’s administration bill for about $800. I moved out of my student apartment in the spring of 2020, and never saw the last bill; my apartment complex also never notified me that I’d received anything else at that address or offered to forward the mail to my parents’ house. The hospital also never attempted to contact me any other way; I had no way to know that the bills were piling up there. Apparently, hospitals have not heard of the concepts of “dormitories,” “college students,” or “moving.”
I hung up on the representative and immediately Googled the name of the debt collector to check if it was a scam. It wasn’t. I called the hospital’s billing and they confirmed that Gulf Coast is a collector they send unpaid bills to, and also explained to me that doctor’s fees are billed separately from any other hospital bills. I sighed, called back the familiar phone number, and paid up. A single, simple UTI had ultimately cost my family and me $3,800. Is it any wonder that so many people avoid healthcare they need?
But even that wasn’t the end of this stray bill’s impact on my life. I just graduated a few months ago, and because of deductibles, confusing hospital billing, and a pandemic that sent me home for my last 3 semesters of college, my credit has already taken a hit before I even opened up my first credit card on my own. It might not be enough to ruin my life, but it’s certainly not the start you want to have as you enter the adult world. You can make payments responsibly and on time, have parents who are able to support you financially, and one bill can still fall through the cracks and mess things up as you’re starting your life. Meanwhile, a hospital can send you to collections without any basic due diligence to establish whether you even knew you had another bill to pay. I’m lucky enough that when I moved out of my parents’ place and in with my partner, our new place is under his name and my credit wasn’t the one being checked. But credit scores, unaccountable and impenetrable as they are, can follow you for a long time.
As awful as this experience was, it’s given me the wisdom to be wary of hospital billing and to stay on top of things like changes of addresses. An administrative mistake shouldn’t cost anyone so dearly, but it’s the reality we live with. I recently broke my ankle and needed surgery. Thankfully, I had just read Elizabeth Rosenthal’s An American Sickness, in which Rosenthal details the breakdown of billing for surgeries and what things are billed together and separate, usually in three or four different parts. It goes something like this:
You get surgery.
There is a bill for the surgery (as in, the literal procedure) itself.
There is a bill for the anesthesiologist. This becomes extra fun if your hospital and surgeon are in-network for your insurance, but your anesthesiologist is not. Yes, this sometimes happens. No, it is not in your control!
There is a general administrative bill for the hospital or surgery center.
There is another, separate bill for the doctor who performed surgery on you.
If it wasn’t for the impeccable timing of me reading this book just before my injury, I wouldn’t have known the ins and outs of surgery billing. (Of course, no one at the hospital explained it to me either.) I wouldn’t have known that I could ask for a breakdown of the bills I would receive, which doctors they would be from, or when to expect them—which certainly helped to reduce my anxiety that a situation like last time would occur. Chances are, I would have just paid for the surgery bill, not asked for an itemized list of what needed to be paid for, and gone on with my life like I did last spring. No one should have to read a particular book just to get by in our healthcare system, but I’m sure glad I did (and you should, too).
With the way our healthcare, as well as our punitive credit score systems, are set up, it’s not a matter of if something goes wrong or falls by the wayside—it’s when. It pays to be prepared.
Victoria Dominguez is a journalist and radio producer based in North Carolina. Currently, she’s an incoming Audio Fellow at Vox.