By Consumers For Quality Care, on October 30, 2019
As consumers face surprise bills, insurance denials, high premiums and deductibles, medical debt continues to be a growing issue. Across the country, consumers have experienced aggressive debt collection practices for unpaid medical bills, including the use of wage garnishing and liens. In Coffeyville, Kansas, a small city of 9,000, the tactics can be even more intense, according to ProPublica. The city, which has a poverty rate twice the national average and is in the least healthy county in the state, houses the only hospital within a 40-mile radius.
When consumers wind up with unpaid bills, they often find themselves in front of Judge David Casement, who presides over the monthly medical debt collections hearings. Though Casement plays an important role in these cases, he does not have a law degree and in fact has never taken a course in law. In Kansas and some other states, judges do not need law degrees to preside over these cases. Casemate began hearing the cases in 1987, after passing a self-study exam.
These meetings are referred to as a “debtor’s exam,” where consumers have to come to court to explain the medical debt they’ve incurred and what income they have “to testify, quite often, to their poverty.” From there, lawyers representing the providers – often hospitals, physicians, and ambulance services – try to determine how they will proceed, including payment plans, wage or bank account garnishment, or property liens.
If a debtor missed an exam, the judge typically issued a citation of contempt, a charge for disobeying an order of the court, which in this case was to appear. If the debtor missed a hearing on contempt, [Attorney Michael] Hassenplug would ask the judge for a bench warrant. As long as the defendant had been properly served, the judge’s answer was always yes. In practice, this system has made Hassenplug and other collectors the real arbiters of who gets arrested and who is shown mercy. If debtors can post bail, the judge almost always applies the money to the debt. Hassenplug, like any collector working on commission, gets a cut of the cash he brings in.
Courts like Coffeyville’s, with loose restrictions and cooperative judges, end up giving debt collectors unchecked power to turn the legal system into “a government-sanctioned shakedown of the uninsured and underinsured, where the leverage is the debtors’ liberty.” Collectors automatically win when debtors fail to appeal or contest the charges, which happens in roughly 90 percent of the cases nationally. Hassenplug says that the court’s ability to hold individuals in contempt is his strongest tool to get consumers to come to court.
Thousands of individuals are arrested each year nationally for failing to appear in court over debt issues. Over half of the debt in collections is medical debt. The country’s most ill patients are also the most indebted. They have no special protection from arrest.
Tres Biggs knows this process all too well. He has been arrested for his family’s outstanding medical debt more than once. Biggs’ troubles began after his son Lane, then only six, was diagnosed with leukemia and continued when his wife began having seizures. At the time of his first arrest in 2006, Biggs was working two jobs to support their family of five, but neither job provided health insurance. Coffeyville Regional Medical Center had sued him for more than $2,000 after an emergency room visit for his wife.
In the shuffle of 70-hour workweeks and Lane’s chemotherapy, he had missed two consecutive court dates. He was fingerprinted, photographed, made to strip and told to brace himself for a tub of delousing liquid. His bail was set at $500 cash; he had about $50 to his name.
After a friend helped Biggs post bail, the judge granted the bail money to the hospital. Biggs still owed the rest of the bill, which was growing with a 12 percent annual interest rate. As Biggs tried to support his family, and as his son’s and wife’s health remained in flux, providers garnished his paychecks and savings, including money the family had raised for Lane’s cancer treatments. Despite living on $25,000 a year and qualifying for food stamps, the family did not qualify for Medicaid. The Biggs family, like millions of Americans, found themselves falling into the coverage gap – not making enough to afford private insurance but too much for government programs.
By 2012, the Biggs family had accrued more than $70,000 in medical debt, which it owed to Coffeyville Regional Medical Center and other hospitals, pediatricians and neurologists. Some forgave it; others set up lenient payment plans. Coffeyville’s was the only hospital that sued.
Bigg was arrested a second time over a $380 radiologist’s bill. The family’s experience with medical debt has touched nearly every part of their lives. The family has filed for bankruptcy and lost their home. Biggs now has a job that includes health insurance, but the family has to meet a $5,00 deductible before the coverage kicks in. Biggs received yet another court summons after chest pains and vomiting brought him to hospital.
“I haven’t received a bill,” he told me, slouched over his turquoise shorts. “The only thing I received was this summons.” Around noon, he finally sat down with an ARSI representative, who explained that the underlying bill had been garnished from his wages, but he still owed $328 in interest and court fees. He had another couple thousand dollars in collections for separate bills he hadn’t paid, for which he hadn’t yet been sued. He said the most he could afford to pay, every two weeks, was $12.50.