Denied care for a dangerous infection because of past-due bills

Ariane Buck, 30, Peoria, Arizona

Approximate Medical Debt: $50,000

Medical Issue: Infection

What Happened: Ariane Buck knew it was important to stay on top of his health care.

The young father, who lives with his wife and three children outside Phoenix, had survived cancer when he was a child.

But making ends meet hasn't always been easy for Ariane, who sells health insurance, and his wife, Samantha, a therapist who cares for people with autism.

At times the family has fallen behind on medical bills. Still, they never expected to be denied care.

Just before Father's Day in 2016, Ariane grew very sick. He couldn't hold down food without vomiting. There was blood in his stool.

Samantha called the family's primary care doctor seeking an appointment. But the office turned the Bucks away.

"They said they wouldn't see him because of past due bills," Samantha said, estimating they owed a few hundred dollars.

Ariane's only choice was to go to a hospital emergency room. There he was diagnosed with a serious intestinal infection that required intravenous fluids and antibiotics.

The Bucks were also hit with thousands of dollars of additional bills they couldn't pay.

What's Broken: Hospitals for decades have been required by federal law to provide emergency medical care to any patients who need it, regardless of their ability to pay.

But many medical providers, including physicians, have policies that allow them to turn away patients with past-due bills for nonurgent care.

The practice is surprisingly common. Nationwide, 1 in 7 Americans with health care debt say they have been denied care because of money they owe, a poll conducted by KFF found.

On top of that, tens of millions of Americans ration their care. About two-thirds of U.S. adults with debt from medical or dental bills say they or a member of their household have put off getting care they needed because of costs.

What's Left: Buck recovered from the infection and is now in good health. But the family's medical debt has swelled to more than $50,000, from Ariane's bills and Samantha's.

Samantha went to the emergency room twice in the past several years with painful cases of endometriosis.

The Bucks have taken out loans, loaded up their credit cards, and sought help from charities.

"We've all had to cut back on everything," Buck said. The kids wear hand-me-downs. They scrimp on school supplies and rely on family for Christmas gifts. A dinner out for chili is an extravagance.

"It pains me when my kids ask to go somewhere, and I can't," Buck said. "I feel as if I've failed as a parent."

The couple is preparing to file for bankruptcy.

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 the "KFF Health Care Debt Survey," a poll designed and analyzed by public opinion researchers at KFF in collaboration with KHN journalists and editors. 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.

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status 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.

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.