Since Chamberlin Edmonds was offering only to help her find government insurance, for which Lockett did not qualify, the company wasn’t able to reduce her hospital bill or work out a payment plan. Lockett assumed this meant she was at a dead end with her nearly $30,000 in hospital bills. “They were saying that there was nothing that they could do,” she told me. She decided to put the bills aside and try to get to them after she found a job.
A year later, Lockett attended a meeting with representatives of Georgia Watch, a nonprofit group, as part of her volunteer work. When one of the Georgia Watch representatives mentioned that the organization has a guide for people who wish to negotiate down their hospital bills, Lockett grabbed a copy. She called the hospital back. This time, she says, they told her her entire bill had been wiped away.
Emory Healthcare told me it could not comment on individual patients, but added, “Patients will sometimes receive two bills for the same date of service: one bill for services rendered by the physician; the other for a hospital stay, supplies, services, and equipment provided. Emory Healthcare’s customer-service department works with patients to establish a mutually acceptable agreement for paying inpatient or outpatient bills.”
Read: Even the insured often can’t afford their medical bills
“The reality is that medical costs are not objective, real costs,” says Berneta L. Haynes, the director of equity and access at Georgia Watch. One day, an MRI can cost $19,000. The next, it can cost nothing.
Though she was still responsible for her reduced ambulance bill, Lockett was lucky. Others aren’t. Dana Peterman, a physical therapist in Forsyth, Georgia, owed more than $4,000, after insurance, when her son was rushed to the hospital with an anaphylactic peanut-allergy reaction in 2017. She tried to negotiate down her bill, but she says the hospital, the ambulance company, and the ER doctors did not give her a discount. She paid in full, not wanting the bills to affect her credit.
To negotiate with a hospital, consumer advocates I spoke with recommended asking about financial assistance, including charity care for the uninsured. If that fails, patients can ask whether they can pay whatever the hospital would have charged someone who was on Medicare—typically a lower rate. Hospitals and even collections agencies will often agree to payment plans, or a discount in exchange for a lump-sum payment.
Still, the current system requires people to independently negotiate on their own behalf with giant corporations over tens of thousands of dollars, often while recovering from a major illness. For those who haven’t done it before, the process can be confounding. “Maybe I didn’t say the right thing before,” Lockett told me.
If the patient fails to pay, a medical debt might be sent to a debt collector. Some patient advocates say small medical debts are now getting sold to debt buyers, companies that try to collect as much as they can on long-past-due debts. “Now we are seeing small-time medical practices get involved in selling their bad debts to debt buyers for pennies on the dollar,” says Sandoval-Moshenberg, of the Legal Aid Justice Center. Rather than medical records or a patient history, these buyers rely on little more than a list of debts in a spreadsheet, making it harder, Sandoval-Moshenberg and others argue, for patients to negotiate a deal or expunge an error. But this practice makes financial sense for doctors, given how many people are unable to pay their bills.
When everything fails, and the person is at imminent risk of having wages garnished because they’ve been sued for medical debt, it might be time to file for bankruptcy, says Sandoval-Moshenberg. The people who do become the tip of a very big debt iceberg.