Medical debt soars for consumers with hospital credit cards : Shots

Many hospitals are now partnering with financing companies to offer payment plans when patients and their families can’t afford their bills. The catch: the plans can come with interest that significantly increases a patient’s debt.

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Many hospitals are now partnering with financing companies to offer payment plans when patients and their families can’t afford their bills. The catch: the plans can come with interest that significantly increases a patient’s debt.

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Patients at North Carolina-based Atrium Health get what looks like an enticing pitch when they go to the nonprofit hospital system’s website: a payment plan from lender AccessOne. The plans offer “easy ways to make monthly payments” on medical bills, the website says. You don’t need good credit to get a loan. Everyone is approved. Nothing is reported to credit agencies.

In Minnesota, Allina Health encourages its patients to sign up for an account with MedCredit Financial Services to “consolidate your health expenses.” In Southern California, Chino Valley Medical Center, part of the Prime Healthcare chain, touts “promotional financing options with the CareCredit credit card to help you get the care you need, when you need it.”

As Americans are overwhelmed with medical bills, patient financing is now a multibillion-dollar business, with private equity and big banks lined up to cash in when patients and their families can’t pay for care. By one estimate from research firm IBISWorld, profit margins top 29% in the patient financing industry, seven times what is considered a solid hospital margin.

Hospitals and other providers, which historically put their patients in interest-free payment plans, have welcomed the financing, signing contracts with lenders and enrolling patients in financing plans with rosy promises about convenient bills and easy payments.

For patients, the payment plans often mean something more ominous: yet more debt.

Millions of people are paying interest on these plans, on top of what they owe for medical or dental care, an investigation by KHN and NPR shows. Even with lower rates than a traditional credit card, the interest can add hundreds, even thousands of dollars to medical bills and ratchet up financial strains when patients are most vulnerable.

Robin Milcowitz, a Florida woman who found herself enrolled in an AccessOne loan at a Tampa hospital in 2018 after having a hysterectomy for ovarian cancer, said she was appalled by the financing

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Mistaken identity leads to big hospital bill mix-up : Shots

In 2013, Grace E. Elliott spent a night in a hospital in Florida for a kidney infection that was treated with antibiotics. Eight years later, she got a large bill from the health system that bought the hospital. This bill was for an unrelated surgical procedure she didn’t need and never received. It was a case of mistaken identity, she knew, but proving that wasn’t easy.

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Shelby Knowles for KHN


In 2013, Grace E. Elliott spent a night in a hospital in Florida for a kidney infection that was treated with antibiotics. Eight years later, she got a large bill from the health system that bought the hospital. This bill was for an unrelated surgical procedure she didn’t need and never received. It was a case of mistaken identity, she knew, but proving that wasn’t easy.

Shelby Knowles for KHN

Earlier this year, Grace Elizabeth Elliott got a mysterious hospital bill for medical care she had never received.

She soon discovered how far a clerical error can reach — even across a continent — and how frustrating it can be to fix.

During a college break in 2013, Elliott, then 22, began to feel faint and feverish while visiting her parents in Venice, Fla., which is about an hour south of Tampa. Her mother, a nurse, drove her to a facility that locals knew simply as Venice Hospital.

In the emergency department, Elliott was diagnosed with a kidney infection and held overnight before being discharged with a prescription for antibiotics, a common treatment for the illness.

“My hospital bill was about $100, which I remember because that was a lot of money for me as an undergrad,” said Elliott, now 31.

She recovered and eventually moved to California to teach preschool. Venice Regional Medical Center was bought by Community Health Systems, based in Franklin, Tenn., in 2014 and eventually renamed ShorePoint Health Venice.

The kidney infection and overnight stay in the E.R. would have been little more than a memory for Elliott.

Then another bill came.

The Patients: Grace E. Elliott, 31, a preschool teacher living with her husband in San Francisco, and Grace A. Elliott, 81, a retiree in Venice, Fla.

Medical Services: For Grace E., an emergency department visit and overnight stay, plus antibiotics to treat a kidney infection in 2013. For Grace A., a shoulder replacement and rehabilitation services

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To prevent medical debt, the U.S. could learn from Germany’s health care system : Shots

Dr. Eckart Rolshoven examines a patient at his clinic in Püttlingen, a small town in Germany’s Saarland region. Although Germany has a largely private health care system, patients pay nothing out-of-pocket when they come to see him.

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Dr. Eckart Rolshoven examines a patient at his clinic in Püttlingen, a small town in Germany’s Saarland region. Although Germany has a largely private health care system, patients pay nothing out-of-pocket when they come to see him.

Pasquale D’Angiolillo for KHN

PÜTTLINGEN, Germany — Almost every day, Dr. Eckart Rolshoven sees the long shadow of coal mining in his clinic near the big brownstone church that dominates this small town in Germany’s Saarland.

The region’s last-operating coal shaft, just a few miles away, closed a decade ago, ending centuries of mining in the Saarland, a mostly rural state tucked between the Rhine River and the French border. But the mines left a difficult legacy, as they have in coal regions in the United States, including West Virginia.

Many of Rolshoven’s patients battle lung diseases and chronic pain from years of work underground. “We had an industry with a lot of illnesses,” said Rolshoven, a genial primary care physician who at 71 is nearing the end of a long career.

The Saarland’s residents are sicker than elsewhere in Germany. And like West Virginia, the region faces economic hurdles. For decades, German politicians, business leaders and unions have labored to adjust to the mining industry’s slow demise.

But this is a healthier place than West Virginia in many respects. The region’s residents are less likely to die prematurely, data shows. And on average, they live four years longer than West Virginians.

There is another important difference between this former coal territory and its Appalachian counterpart: West Virginia’s economic struggles have been compounded by medical debt, a burden that affects about 100 million people in the U.S. — in no state more than West Virginia.

In the Saarland, medical debt is practically nonexistent. It’s so rare in Germany that the federal government’s statistical office doesn’t even track it.

The reason isn’t government health care. Germany, like the U.S., has a largely private health care system that relies on private doctors and private insurers. Like Americans, many Germans enroll in a health plan through work, splitting the cost with their employer.

But Germany has

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States look to regulate weed alternatives like delta-8 : Shots

Delta-8 products are set for testing at Virginia Commonwealth University’s forensic science lab. These products come in different forms and packaging, many of which are designed to look like candies or cereal.

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Delta-8 products are set for testing at Virginia Commonwealth University’s forensic science lab. These products come in different forms and packaging, many of which are designed to look like candies or cereal.

Crixell Matthews/VPM News

Michelle Peace will sometimes dip into a convenience store and emerge with a handful of hemp products like delta-8. They come in gummies, tinctures, vape cartridges and joints and they’re designed to get you high.

Despite knowing glances from cashiers, Peace isn’t headed to a party. She’s the director of the laboratory for forensic toxicology research at Virginia Commonwealth University, and she’s bringing her collection to the lab to see what’s inside. In some cases, no one else is checking.

Hemp products that can get you high have proliferated online and at corner stores, even in places where marijuana remains illegal. The products, marketed under names like delta-8 and delta-10, have been a lifeline for the struggling hemp industry. Even critics of the products acknowledge some companies maintain high standards for their products, with credible lab testing and careful quality control.

Dr. Peace shows off one of the delta-8 products, highlighting the specific aspects of the packaging that have the potential to confuse consumers.

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Dr. Peace shows off one of the delta-8 products, highlighting the specific aspects of the packaging that have the potential to confuse consumers.

Crixell Matthews/VPM News

But federal regulators aren’t monitoring what’s in the products. Peace and other researchers have found problems ranging from irregular dosing to heavy metals. Some edibles have packaging and labels that mimic common candy or cereal (“Stony Patch THC Gummies” or “Fruity Pebblez”), and there’s been a spike in calls to poison control centers related to delta-8. Newer products, like THC-O, can be even more potent, according to Peace.

“Delta-8 is like, ‘Look at me, look at me,’ and there’s a monster behind the bush,” Peace said.

Still, a recent federal appeals court verdict appeared to uphold the legality of delta-8 products on the federal level. In the absence of clear federal regulations or guidance, lawmakers in states like Colorado and Oregon have

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Nursing homes use lawsuits to demand friends and family pay off medical debts : Shots

Lucille Brooks, a retiree who lives in Pittsford, New York, was sued in 2020 for nearly $8,000 by a nursing home that had taken care of her brother. The nursing home dropped the case after she showed she had no control over his money or authority to make decisions for him.

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Heather Ainsworth for KHN


Lucille Brooks, a retiree who lives in Pittsford, New York, was sued in 2020 for nearly $8,000 by a nursing home that had taken care of her brother. The nursing home dropped the case after she showed she had no control over his money or authority to make decisions for him.

Heather Ainsworth for KHN

ROCHESTER, N.Y. — Lucille Brooks was stunned when she picked up the phone before Christmas two years ago and learned a nursing home was suing her.

“I thought this was crazy,” recalled Brooks, 74, a retiree who lives with her husband in a modest home in the Rochester suburbs. Brooks’ brother had been a resident of the nursing home. But she had no control over his money or authority to make decisions for him. She wondered how she could be on the hook for his nearly $8,000 bill.

Brooks would learn she wasn’t alone. Pursuing unpaid bills, nursing homes across this industrial city have been routinely suing not only residents but their friends and family, a KHN review of court records reveals. The practice has ensnared scores of children, grandchildren, neighbors, and others, many with nearly no financial ties to residents or legal responsibility for their debts.

The lawsuits illuminate a dark corner of America’s larger medical debt crisis, which a KHN-NPR investigation found has touched more than half of all U.S. adults in the past five years.

Litigation is a frequent byproduct. About 1 in 7 adults who have had health care debt say they’ve been threatened with a lawsuit or arrest, according to a nationwide KFF poll conducted for this project. Five percent say they’ve been sued.

The nursing home industry has quietly developed what consumer attorneys and patient advocates say is a pernicious strategy of pursuing family and friends of patients despite federal law that was enacted to protect them from debt collection. “The level of aggression that nursing homes are using to collect unpaid debt is severely increasing,” said Lisa Neeley, a Massachusetts elder law attorney.

In Monroe

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Emergency contraception pills are safe, but not always available : Shots

The 2021 study found that 32% of pharmacies did not have levonorgestrel, a hormone that can prevent pregnancy after unprotected sex, in stock at all, and of the pharmacies that did have it on the shelf, 70% of them kept it in a locked box.

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The 2021 study found that 32% of pharmacies did not have levonorgestrel, a hormone that can prevent pregnancy after unprotected sex, in stock at all, and of the pharmacies that did have it on the shelf, 70% of them kept it in a locked box.

Seth Herald/AFP via Getty Images

Imagine this scenario that untold numbers of women find themselves in each year. Maybe you had unprotected intercourse, or the condom broke, or maybe you accidentally missed taking a birth control pill or two. You don’t want to get pregnant, so you rush to the pharmacy for emergency contraception. All the while, the clock is ticking.

“These medications are incredibly time sensitive,” says Dr. Sonya Borrero, a professor of medicine at the University of Pittsburgh who focuses on reproductive health equity. She says emergency contraception pills need to be taken within five days after unprotected sex — “but the sooner, the better.”

Surveys show that roughly a quarter of American women have, at some point in their lives, used emergency contraception pills to prevent an unintended pregnancy. This type of contraception is effective, safe and legal throughout the United States. And yet researchers are finding it’s not always available when people need it.

Take, for example, levonorgestrel, a form of emergency contraception better known under the brand name Plan B, although it’s also available in generic versions with names including My Way, Take Action and My Choice, to name a few. Borrero says Plan B is supposed to be available over the counter, on the shelf, stocked for all ages.

But when Borrero sent a team of medical students to pharmacies across western Pennsylvania to see what these stores actually had on hand, they found a third of pharmacies didn’t stock Plan B at all. And when they did have it, “most of the time it wasn’t really on the shelf. It was either behind the counter or in one of those locked boxes,” which means a customer would have to ask someone to hand them the emergency contraception. She says

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