With worsening COVID-19 pandemic, a growing concern about medical debt

North Carolina news

RALEIGH, N.C. (WNCN) — Bev Veals found herself in the middle of two fights at the same time — one against cancer, the other against the creditors trying to collect money for her treatment.

The mother and artist from Carolina Beach wound up in medical bankruptcy a decade and a half ago after accumulating more than $180,000 in medical debt during multiple fights with cancer.

“You’re fighting the disease all while fighting the system in all probability you’re not going to win with, because it’s not set up for the average consumer to win this battle,” Veals told CBS 17. “Somehow, someway, very few have come out of this without having to lose something that we’ve worked hard for a long period of time.”

And medical debt has become even more of a concern now during the COVID-19 pandemic, with the public health crisis leading to more people in hospitals and high unemployment.

An uninsured COVID-19 patient, or an insured one seeing an out-of-network provider with a plan without an out-of-network benefit, who requires a hospital stay faces an average charge of $73,300, according to Fairhealth.org.

And according to the most recent figures from the Urban Institute, nearly a quarter of people in North Carolina have medical debt now in collections with a median amount of $698.

“When you’re in treatment for some kind of condition or a disease and you’re really fighting for your life, the thought processes that go through your head is not like you’re trying to buy a home or you’re trying to buy a car, you’re trying to finance something,” Veals said. “You’re financing, basically, your life. And you don’t have the funds to pay for your medical debt. You’re financing your survival.”

Patient advocates and state Attorney General Josh Stein are watching closely. Stein told CBS 17 that his office has yet to hear many complaints.

“But obviously, for someone who’s experienced COVID, many of whom have lost their jobs, they don’t have the resources to pay,” Stein said. “Any hospital that would initiate collections efforts against those people is really doing the wrong thing.”

Hospitals in other states have even gone as far as to sue their former patients over outstanding payments, investigations from ProPublica and a number of other news organizations have uncovered.

Cynthia Charles of the North Carolina Healthcare Association said her group is unaware of any hospitals here doing that.

“Health systems and hospitals know that this is a difficult time for many people because of the economic downturn and COVID-19 and want to hear from patients who have concerns about bills so they can work with them to resolve the situation,” she said.

Officials with three of the most prominent health care systems in the Triangle — UNC Health, UNC REX, and Duke Health — all said they don’t bring lawsuits against their patients over bills anymore.

Leslie Pegram, the public records officer at UNC Health, said that between March 1 and Sept. 30, UNC Hospitals placed 49,416 accounts for collection agency referrals, with those accounts having an average age of 207 days from the date of service. That represents less than 3 percent of charges for patients seen during that time period, spokesman Phil Bridges said.

UNC REX Healthcare had 21,000 accounts placed into bad debt, which accounts for 2.18 percent of the total — a slight year-over-year reduction, hospital spokesman Alan Wolf said.

UNC Health only places an account into bad debt if a patient has not been approved for financial aid, a payment plan, or paying off the outstanding balance after more than 140 days, Bridges said, adding that the complexity of bad debt makes it difficult to attribute changes in bad debt to COVID-19 or any other factor.

“Even before COVID, UNC Health had put into place a number of policies and programs to support and assist our most financially vulnerable of patients including a generous charity care policy and dedicated financial assistance resources to help patients identify and apply for financial support programs,” he said.

Duke Health officials say they decided three years ago that their “pursuit of unpaid medical bills would no longer include filing lawsuits or liens, or seeking wage garnishment,” they said in a statement. They added that as of this year, consumers’ credit agencies will not receive “adverse reports” due to their bill collection processes.

And FirstHealth spokeswoman Gretchen Kelly said her not-for-profit system “does not include lawsuits against patients,” pointing out a “very robust” financial assistance program for patients who are underinsured, uninsured, or meet federal poverty guidelines for assistance.

Officials at several other local health care providers — including WakeMed, Cape Fear Valley and Harnett Health — did not respond to CBS 17 inquiries about their practices.

“If you have debt that you owe to a hospital, it’s the same as a debt you would owe to someone else,” Stein said. “The difference is, a lot of hospitals are nonprofits and therefore they have a charitable mission involved, and they have a charity care policy. So that’s why it’s really important that you as a customer reach out to the hospital and ask what can they do for you if you’re having trouble paying your bills.”

So what should you do if you’re facing a debt collector over a medical bill?

Stein says the first step is to “engage the hospital” and ask about its charity care policy to determine whether you qualify for it, or if you can work out a payment plan with them.

He advises people “really being harassed by a debt collector, whether it’s by a hospital or anyone else” to call his office toll-free at 877-5-NO-SCAM.

Veals — who said one medical provider told her she was required to pay 100 percent of the cost of chemotherapy treatment before she could receive another one — echoed that advice.

“Be in constant contact with the business office (for) the doctor or hospital that you’re working with, and try to negotiate with them ways to keep it out of the creditors’ hands,” she said. “Because once it goes to the creditors’ hands, the niceties go away.”

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