The healthcare system is one of the only transactions you make without knowing the price of your purchase. Whether you have health insurance or not, most Americans are dealing with or have dealt with some kind of medical debt.  

It’s estimated that more than 100 million Americans have medical debt. And it doesn’t take much to end up with a bill you can’t pay. One infection, a fall, or an accident and you can be stuck with thousands of dollars of medical bills. 

To no surprise, Black folks, according to a KFF Health News poll, are 50% more likely to owe money for care. As a result, many Americans will avoid an ambulance ride, steer clear of the hospital, or seek out home remedies when sick. But, you can’t always avoid care. 

Tenaya Taylor, the executive director of nonprofit accountability group, went in for a routine dental filing in Sept. 2022. After drilling in their tooth, dentists told them they needed a root canal. Before continuing with the procedure, dental staff demanded $2,000 for the root canal. 

If Taylor didn’t pay, the Connecticut-based dental staff said they would leave the tooth exposed. More than 30-minutes passed, and the numbness was starting to wear off. Eventually the dentist did the root canal, even though Taylor refused to pay.  

After the procedure, they ended up paying about $400 of the $2,500 bill. With state covered insurance, they were told a root canal would not be covered. And Taylor has no idea if their balance of $2,100 is still owed. 

Prior to sitting in the dental chair that day, Taylor says they were never given a treatment plan and costs should have been clearer. A year has passed, and they say the procedure wasn’t done right. They still feel pain in their tooth and have been told it needs to be redone. 

Courtesy of Tenaya Taylor.

“I was so traumatized,” they say. “I felt mad out of wack after that. I just felt like that was such medical malpractice and racism. If I was white, they would have just finished.” 

As a result, Taylor switched to a different dentist.  

Many Black folks like Taylor go in for routine dental care and during treatment are hit with an unexpected bill. Even with insurance, the cost for certain dental procedures is not always covered because of an annual cap, or only a percentage of major procedures is covered. 

“Dental healthcare needs to be seen as healthcare because they separate the two, but we are learning that oral health care is directly linked to heart and lung health,” they say.  

Haphazard Protections, Dangerous Consequences 

In a new report by The Commonwealth Fund, researchers looked at the varying state protections against medical debt. Federal medical debt protections are vague and rarely enforced, the report states. And about 40% of Americans are in debt because of past-due payments directly owed to a health care provider, or because of ongoing payment plans, credit card debt from medical bills, money owed to a bank or collections agency that has been assigned or sold the debt, and money borrowed from loved ones to pay for bills. 

Do not pay the bill straight up.

Maanasa kona, assistant research professor

The list is long and exhaustive. As much as 60% of adults with debt have cut back on food and clothing and use their savings to pay for their medical debt. The dangerous effect medical debt has on folks has caused mental and physical harm — and is correlated with an increased risk of suicide.  

Courtesy of Maanasa Kona.

Maanasa Kona, assistant research professor and co-author of the report, says when it comes to regulating hospital debt collections, states are new to that space. Federal and state regulators have traditionally left hospitals to manage their own finances.  

As a result, most hospitals in the country have no preconditions before they send a bill to collectors. 37 states have no regulation, and the states that have preconditions range from giving a patient prior notification to offering a reasonable payment plan to screening for financial assistance.  

When hospitals sell old unpaid debt to third-party debt buyers, their efforts to collect can be aggressive. According the report, that includes collectors taking patients to court, ruining a patient’s credit score, and foreclosing a patient’s home.  

New Mexico, Connecticut, New Jersey, and Massachusetts are the only states with prohibitions on sending a bill for low-income patients to collections. But even defining low-income patients varies by state.  

The first thing Kona recommends to patients who receive a bill is to assess their options. Before making any kind of payment, call and ask for an itemized receipt of the bill. Sometimes you might not need to pay the bill if you qualify for financial assistance. And she encourages people to reach out to local legal aid or nonprofit organizations to discuss your options.  

“Do not pay the bill straight up,” Kona says. “Make sure insurance and the hospital is doing what it’s supposed to. And if they’re not reach out to the department of insurance … or the regulator of the hospital.” 

$2,292 for a Few Vials of Blood 

After wrapping up interviews for this story, I realized I’ve been avoiding a medical bill I was hit with over the summer. I have health insurance coverage through my job. In the last two to three years, I’ve had to visit a few different physicians. Over the summer, I saw my primary care doctor for a routine physical.  

I told her I was concerned I may be anemic. She ordered some blood tests. The results never came. And Kaiser Permanente charged $2,292 for a few vials of blood. With insurance coverage I’m left to pay $305 for results that have yet to be explained to me. 

Courtesy of Anissa Durham.

I avoided calling Kaiser for months, but finally I called this week. I was told I could apply for financial assistance that takes about a month to process. If I don’t pay the bill, it would be sent to collections or sold to a third-party debt collector.  

To say I’m anything short of frustrated is an understatement. Although I will continue to figure out how to get out of paying the bill, I can’t help but think about the lives that get destroyed because of the way healthcare runs in the U.S. 

The healthcare system is supposed to be a place you go when you need treatment and help maintaining a healthy lifestyle. But what is the price of life when folks are stuck with bills they can’t afford?