Editor’s note: “Diagnosis: Debt” is a reporting partnership between KHN and NPR that explores the scale, impact, and causes of medical debt in America. This story has been updated with an audio postcard from KHN correspondent Aneri Pattani. She spoke with a woman who was dogged for years by a medical bill she shouldn’t have gotten in the first place.
I was being haunted by this zombie bill.
Edy Adams
Edy Adams, 31, Austin, Texas
Approximate Medical Debt: $131
Medical Issue: Sexual assault
What Happened: Edy Adams had just graduated from college when she was sexually assaulted in 2013.
She was living in Chicago, and believes she was drugged while at a bar.
Adams doesn’t remember what happened. When she woke up the next morning bruised and confused, she contacted the police and was directed to get an exam at a local hospital emergency room, which confirmed the assault.
Police never found the perpetrator. Then two years later, Adams started getting calls from debt collectors saying she owed $130.68.
At first, Adams was confused. The hospital had told her that Illinois law prohibited medical providers from charging rape victims for a medical exam.
“I thought someone didn’t put in the proper billing code or something,” said Adams, who is now a medical student in Texas.
She explained the situation to the debt collector, who said the company would put a note in her file.
Nevertheless, about six months later, another call came from another debt collector seeking the same $130.68.
Adams again explained the situation. A few months later, there was yet another call.
It kept on for years, as her small debt was passed from one collector to another.
Adams tried to contact the hospital, but the bill was not theirs. It had originated with a physicians’ practice that had closed.
Sometimes when the debt collectors called, Adams would break down in tears on the phone. “I was frantic,” she recalled.
With each call, Adams said, she was forced to relive the worst day of her life and explain her trauma to a disembodied voice in a call center somewhere in America.
“I was being haunted by this zombie bill,” she said. “I couldn’t make it stop.”
What’s Broken: Federal regulators and consumer advocates for years have documented widespread problems across the debt collection industry, calling out collectors for not doing enough to verify and document bills before pursuing consumers.
The problems are particularly acute in medical debt collection. From 2018 to 2021, people contacted about a medical debt complained most frequently to the Consumer Financial Protection Bureau about being hounded for a debt they did not owe, the agency found.
And in a nationwide poll conducted by KFF, a third of Americans who had been contacted by a collection agency because of a medical or dental bill said the debt was not theirs.
What’s Left: Adams found relief only after the last debt collector reported the bill to a credit reporting agency, which lowered her credit score.
Adams petitioned the agency to have the debt removed, which it quickly did.
Adams said she didn’t begrudge most of the people who called her over the years. “It seemed like they were only cogs in this giant debt machine,” she said.
About This Project
“Diagnosis: Debt” is a reporting partnership between KHN and NPR exploring the scale, impact, and causes of medical debt in America.
The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country.
Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KHN to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.
The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KHN on a survey of its clients to explore links between medical debt and housing instability.
KHN journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.
Reporters from KHN and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.
