When you go to the doctor, do you get one simple bill for the health care you received? Many patients, like John Ingram, are caught in our fragmented health care system and left drowning in a sea of medical bills. Or as John put it, New Yorkers are being “slaughtered on all sides.” Patients are hit with bill after bill from the facility, the doctor, the imaging services, and debt collectors if they are late on payments. John came to us because he wants our health care system to change: he calls for One Visit, One Bill.
John Ingram, a 75-year old New Yorker struggling with medical debt.
How do you afford insurance with little financial security?
John worked for the Archdiocese of New York for 13 years until he was forced to retire at age 70, despite not having resources. John’s annual income is only $24,648 from Social Security and $13,872 from a small pension. John is insured through Medicare. However, he cannot afford the nearly $800 spenddown he would have to enroll in Medicaid. John has no family who can help him, no 401k, and no additional resources. He currently has 39 cents in his bank account.
The beginning of a long and difficult medical journey.
John’s struggle with medical debt began when he was diagnosed with Charcot foot, a condition that hurts John so much, it limits his mobility. John underwent two surgeries to treat his foot – one at Mount Sinai and one at New York Presbyterian Hospital. After each surgery, John was discharged to a different nursing home where he stayed for several weeks. Medicare covered 80% of the costs, but his 20% co-insurance quickly amounted to several thousands of dollars.
He gained hospital financial assistance to cover the outstanding hospital bills but the two nursing homes do not offer financial assistance and continue to bill him. They will not offer him a reduction based on financial hardship and will only accept a monthly payment plan, which is going to take him years to pay off. Additionally, John received seven at-home infusions for his foot by CVS Coram. The infusions ranged from a few hundred to over a thousand dollars each. He could not afford the 20% co-insurance and he was soon turned over to collections.
John suffered a heart attack that required surgery. He was hospitalized at Northwell Health and referred for follow-up at NYU Langone. During this time his partner was very ill, and John forgot about his hospital bills. Northwell did not inform John about hospital financial assistance and instead sent him to collections. He worked with CHA to apply for assistance and renegotiated his payment plan with Northwell from $1000 per month to a more affordable amount.
2018 – Now
John was diagnosed with colon cancer. He grew very ill and was hospitalized at New York Presbyterian multiple times. John received hospital financial assistance to cover his New York Presbyterian hospital bills. However, the physicians at NY Presbyterian bill separately for services through Weill Cornell Medical College. Therefore, the hospital’s financial assistance policy does not apply to the physician bills. John then received dozens of pages of confusing Weill Cornell physician bills, including separate bills for imaging services, that amounted to nearly $4,000. John couldn’t afford these bills and he was sent to collections.
Most heartbreaking, in March 2018, while he was in the hospital, his lifelong partner died from complications of AIDS. John was so ill that he was not informed about his partner’s passing until May 2018 and he never had the chance to say goodbye.
John’s medical debt caused a ripple effect.
Mr. Ingram’s unsurmountable medical debt has devastated his life and caused him a great deal of stress. As a result of his numerous hospital stays, John fell behind on paying his $1655 monthly rent. He was sued by his landlord for $13,000 in back rent. An elder care organization helped him to cover most of the back rent and CHA secured a NYTimes Neediest Cases grant to pay the rest and avoid eviction. However, now he cannot afford to properly furnish his apartment, including purchasing a special chair needed for his foot. He postpones doctor visits because he can’t afford cab fare and his foot condition does not allow him to use public transportation. Sadly, John now worries about how he will afford his follow-up visits with his oncologist and his doctors are worried about the toll that all this stress is having on his health.
UPDATE: After this interview, John reached out to let us know his cancer had returned and was at an advanced stage. He continued to pay his medical debt, but felt incredibly overwhelmed and sad that the last few years of his life would be spent on a unlivable budget, paying off his ongoing medical bills. In August 2019, we learned that John had passed away.