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Consumer Stories

Nicki Pogue

In August 2018, the same week as her 50th birthday, Nicki Pogue ran a high-altitude race with a chest cold. After returning home, it got much worse. Her doctor diagnosed her with bronchitis and prescribed her antibiotics and a decongestant. Nicki followed her doctor’s advice, taking her medication and lying down for a nap.

When she woke up, Nicki immediately knew something was wrong. Her ears were ringing, her heart was pounding, her hands and feet were tingling, and she was dizzy. Nicki’s neighbor rushed her to the closest hospital where they ran multiple tests—an EKG, chest x-rays, and blood tests – but could not pinpoint Nicki’s condition. By the end of the night, her heart rate stabilized, and she was sent home with a diagnosis of “viral syndrome.” A month later, Nicki received a shocking $13,000 bill from the hospital. The biggest charge on her bill was a line item for a “Level V” Emergency with a fee of more than $11,000. Nicki spent the next five months researching and speaking with health advocates and attorneys about her outrageous bill. Nicki’s visit to the ER required multiple tests, as well as an urgency and intellectual acuity from doctors that is normally categorized by her hospital as a Level III emergency, and carries a fee of around $3,000. Instead, the hospital chose to bill her at the highest possible price with a different emergency designation, without providing any transparency. These billing tactics happen all the time and drive up costs on individuals at their most vulnerable moments. In Nicki’s case, she was able to advocate for herself and urge her insurance company to cover the full cost of her visit. For many others however, these unfair billing practices can lead to mountains of medical debt that are nearly impossible to overcome.

Linda Ragusa

Linda Ragusa had a tumor on her optic nerve. She had surgery to remove part of the tumor, and in 2016, Linda began 6 weeks of radiation therapy to shrink the tumor and allow her to live a more normal, pain-free life. When it came to her insurance coverage, Linda did everything right. She spoke to her insurance company in advance about her radiation treatment and confirmed that her chosen provider would be fully covered. But soon after she started therapy, Linda began receiving out-of-network notices and bills for the full cost of the radiation treatment.

Linda found out that her radiation therapy provider, who was listed on her insurance company’s website as “in-network,” actually had two different locations in the same area. The two locations contract with different insurance companies and charge patients different rates for care, despite offering the exact same services and being – on paper – the same radiation therapy provider.

After learning this, Linda asked if she should switch locations for her last few appointments, but was told it didn’t matter, and that her treatment would be covered, but it wasn’t. Linda’s bills added up to more than $30,000 and she is still in the courts trying to get her debts settled.

Linda was caught in the crossfire between an insurance company refusing to pay whatever they can get out of, and her provider trying to charge whatever price they can get away with.

Debra Smith

Debra is a former state employee of Tennessee, she has several degrees and has worked as a microbiologist and as a phlebotomist. For most of her life, she was able to get insurance through employers. Then, Debra needed hip replacement surgery, and unfortunately, as a result of the surgery she developed a severe infection, through no fault of her own.

Debra was forced to leave her job and transferred to COBRA to help cover her medical bills. Her hip infection started a multi-year cycle of illness, and the infection spread from her hips into her vertebrae and disks. Debra estimated that she’s had ten extensive back surgeries and has spent much of the last few years bedridden. At times, she was in a drug-induced coma. It got to the point where, in 2016, she was at risk of a complete spinal collapse – again through no fault of her own, but because of an infection that she contracted following surgery at her hospital.

To pay for her care, which included home health care aides, Debra had no choice but to spend down her savings. She considers herself fortunate to have qualified for a plan with a tax credit subsidy in both the first and second Affordable Care Act Open Enrollment periods before she eventually transferred onto Medicare Disability.

“I had about two million dollars in surgery, plus a bunch of other expenses,” she says. One such expense was an intravenous antibiotic that she says was around $850/day.

“Before this, I had a brand-new house. I had a new car. The car was repossessed and I almost went into foreclosure,” she says. She talks about how she was sitting in the hospital “when the repo papers came.” The program Save My Tennessee Home was able to help her keep her house. “When you’re down South and you talk about being on any kind of program, they put you in the same bucket,” she says. She also talks about her time as a phlebotomist and says that people without insurance are just treated differently.

Debra continues, “I planned my life 20 years ago and I didn’t expect this to happen. It hit me so hard and it took everything. I worked for over 30 years and this isn’t what I thought would happen to me.” Hospitals should be places you go when something is broken, not places you go and come out broke. But Debra went to the hospital for a simple hip replacement surgery, and left with an infection that took everything from her, and a mountain of medical bills that she will be paying for the rest of her life.

Tamara Hamilton

Tamara Hamilton lives in Mancos, Colorado, a town of around a thousand people. When her 1-year-old grandson, Tucker, fell ill, there were two hospitals nearby as options.

The first, closer hospital, Tamara knew she had to avoid. Not only does the hospital have a horrible reputation in the community, but Tamara’s own experiences there have been enough for her. 15 years ago, she took her son there, and they diagnosed him with strep throat. Knowing something else was wrong, Tamara took him the extra 7 hour drive to a children’s hospital in Denver, where he was diagnosed with and treated for cancer.

Tamara and her daughter Lillian decided to take Tucker to the other hospital nearby, but that was only the beginning of their issues. Tucker’s pediatrician had diagnosed him with COVID via a telehealth appointment, but the hospital refused to listen to the pediatrician’s advice. Tamara and her daughter felt trapped; with Tucker extremely dehydrated and with low oxygen levels, it would be risky to take the 7 hour trip to Denver. Lillian had to threaten the hospital they were at that she would take him to Denver for the hospital to give him oxygen. Eventually, Tucker recovered.

Tamara faces other issues living in a rural area. In her corner of Colorado, insurance premiums are higher than anywhere else in the state. Every doctor in the county is on the same network, so there is no competition. Medical appointments are hugely backlogged in her area, and often can only be booked four months out. Tamara has even told a receptionist trying to book her not to bother, because “that far from now, I’ll either be better, or I’ll be dead.”

Ola Ojewumi

At age nine, Ola was diagnosed with a severe heart condition. Two years later, she received a heart and kidney transplant. At the time, Ola’s surgeries cost hundred of thousands of dollars, and her parents had no idea what the cost was until they received the bill.

Now, as an adult on her own private insurance, Ola has to deal with the cost of her own care and struggles with the lack of price transparency. In addition to being a double transplant recipient, Ola is also a cancer survivor. Managing her health after all of these obstacles is difficult and extremely expensive, even with great insurance. Ola is constantly worried about the next hospital visit, or the next procedure, and how much it will cost her.

With more transparency, Ola argues, patients like her and so many others would be able to shop around and plan for procedures, and wouldn’t have to worry about being forced into dire financial straits after a huge, unexpected medical bill.