Even With Insurance, Big Medical Bills Leave One Kentucky Patient Bankrupt

By Consumers For Quality Care, on September 30, 2020

Kaiser Health News reports on the experience of Matthew Fentress, who was forced to declare bankruptcy in his 20s after he couldn’t afford to pay his medical bills for a heart condition.

Fentress was just 25 when he was diagnosed with viral cardiomyopathy, a heart disease that developed after he had the flu. Just three years later, doctors put him in a medically induced coma and inserted a pacemaker and defibrillator after his condition worsened. Unable to pay his bills, the Kentucky hospital sued. He filed for bankruptcy.

“The curse of being sick in America is a lifetime of debt, which means you live a less-than-opportune life,” said Fentress, who still works for the senior facility, providing an essential service throughout the coronavirus pandemic. “The biggest crime you can commit in America is being sick.”

He needed another procedure this year but was assured by doctors that he wouldn’t have to pay more than $7,000 in medical expenses. While still a strain on his $30,000 annual salary, Fentress agreed to undergo the procedure. It wasn’t long until he was hit with another bill.

Like nearly half of all Americans with private insurance under the age of 65, Fentress has a high deductible. He tried to set up a payment plan to avoid going into bankruptcy again but was told by hospital representatives that he’d have to pay $500 per month – far outside his budget.

This precarious situation makes him “functionally uninsured,” said author Dave Chase, who defines this as having an insurance deductible greater than your savings. “It’s a lot more frequent than a lot of people realize,” said Chase, founder of Health Rosetta, a firm that advises large employers on health costs. “We’re the undisputed leaders in medical bankruptcy. It’s a sad state of affairs.”

Health care experts say that declaring bankruptcy destroys a person’s credit – especially a young person – and makes it difficult to recover financially. A recent survey found that over a quarter of adults between the ages of 19 and 64 who reported problems paying off medical bills or debt were unable to afford basic necessities, like rent or food.

Fentress was billed for just over $10,000, more than a third of what his insurer paid for the care. Since the bill covered services over two years, he owed more than his annual out-of-pocket maximum.

A hospital representative said that Fentress is responsible for all of his health care expenses up to his annual, in-network deductible. Once he reaches that, he’ll pay a percentage of health costs in “coinsurance” until he reaches his out-of-pocket maximum – leaving him on the hook for almost $8,000 of the bill.

Experts say that high-deductible plans may look appealing since they have low premiums, but warn that a patient will have to pay everything except preventative care until they’ve hit their deductible. They also advise patients with this kind of coverage to keep an eye on the calendar and try to plan expensive surgeries later in the year once they’ve chipped away at their deductible.

As always, experts also encourage those with big medical bills to ask about payment plans, financial assistance, or charity care.