It makes me sick about medical costs and how this whole thing is done.Amanda Pitzo
Joe Pitzo, 42, Brookfield, Wisconsin
Approximate medical debt: $350,000
Medical Issue: Cancer
What Happened: Joe Pitzo and his wife, Amanda, had been married only five months when Joe was diagnosed with brain cancer in 2018. He would need brain surgery and extensive rehab.
They’d been planning to buy a house for their blended family of five children. Instead, they shifted their attention to doctor’s visits, insurance paperwork, and hospital bills. And their finances fell apart.
“This just took a major toll on my credit,” Joe said. “It went down to next to nothing.”
Joe had insurance through his employer. Prior to his brain surgery, the couple confirmed that the surgeon and hospital were in their insurer’s network. But around 4 p.m. the day before the procedure, their insurer said a device the surgeons planned to use was medically unnecessary. It was not covered.
Joe and Amanda proceeded with the surgery, figuring they could deal with the bills later.
The bills, it turned out, topped $350,000.
Joe said the debt dragged down his credit score by several hundred points.
Their best hope for a home loan became Amanda, who didn’t have much credit, she said. She’d never taken out a mortgage or a car loan.
What’s Broken: Difficulties with health insurance are a common feature of medical debt in the U.S.
Two-thirds of Americans with health care debt say they haven’t fully paid a bill because they were expecting their health plan to cover it, according to a nationwide survey conducted by KFF.
But health insurance rules and restrictions are often so complex that even diligent patients struggle to make sense of them.
It’s also not uncommon for medical debts to hurt patients’ credit scores. There’s growing pressure to change that.
This spring, the three leading credit agencies announced they would stop using small past-due medical bills in credit score calculations. And the federal Consumer Financial Protection Bureau plans to investigate whether any health care bills should be counted.
What’s Left: The Pitzos managed to get the hospital to reduce their charges to about $30,000.
They worked to build Amanda’s credit so she could apply for the loan and were finally able to buy a house in spring 2022.
They’re still making payments on about $19,000 in medical bills.
“It makes me sick about medical costs and how this whole thing is done,” Amanda 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.