PORT RICHEY — When Ryan Naylor hurt his ankle during kickball practice in May, he did what many would do: He Googled it.
Ice and an Epsom salts bath didn’t work. Turns out there is no surefire home remedy for a ruptured Achilles tendon.
Naylor, 26, didn’t have health insurance. So he stayed home for 36 hours until he couldn’t take the pain anymore.
His fiance, Brittany Nolan, took him to the emergency room at HCA Florida Trinity Hospital where doctors wrapped his ankle in a splint. They told him to see a specialist. The hospital bill and the one for surgery came out to $14,000.
The couple, who were saving for a fall wedding, were devastated. They had no way of knowing that Naylor was days away from a medical emergency that would almost claim his life and leave them $170,000 in debt.
“I’m trying to do the right thing but at the same time I feel there’s no way out,” he said. “I feel like I’m financially broken.”
Medical debt common
Some 100 million Americans — including 41% of US adults — are saddled with medical debt, according to a nationwide poll published in June by the Kaiser Family Foundation. In one quarter of cases, the debt is more than $5,000.
The survey found that medical debt is often hidden in credit card debt, loans from family or friends and payment plans to hospitals and clinics.
Medical debt also remains the largest single cause of bankruptcy in America, according to the National Consumer Law Center. An estimated 530,000 Americans cite medical debt in bankruptcy court filings every year.
The situation may be worse in Florida, one of 13 states that continue to reject a provision of the Affordable Care Act that would expand Medicaid eligibility to over 400,000 low-income residents. The state ranked 47th for access to health care and affordability of treatment in a national analysis released last month by the Commonwealth Fund, a New York foundation that supports independent research on health.
After his May 13 surgery, Naylor followed his surgeon’s orders to stay off his ankle.
Six days into recovery, he felt a sharp pain in his side that with every breath felt like “an icepick in his organs.” Fearing more debt, he endured clamminess, frozen feet and sweats for about 13 hours.
He only agreed to go to a hospital when he started to feel like he might die. Even then, he decided an ambulance would be too expensive.
His ankle still in a protective boot, he crawled down the 16 stairs from their second-floor apartment to his truck.
Emergency room doctors said he had suffered a saddle pulmonary embolism, a potentially fatal blockage of the main artery between the heart and lungs. He was given blood thinners and the next morning undergoing emergency surgery. Doctors removed 27 blood clots, some several inches long. He spent almost four days in intensive care.
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The embolism was almost certainly a result of his ankle surgery, a cardiologist told Naylor. Inactivity after surgery causes blood flow to slow, increasing the likelihood of clots.
The bills started to arrive two weeks later: $652 for a chest X-ray; $2,161 for an electrocardiogram, $1,121 for two doctors who each provided an hour of critical care. Naylor hasn’t received his final hospital bill yet but a 12-page itemized hospital statement also came in the mail; it totaled $155,000.
Deb Gordon, a contributor at MoneyGeek, a personal finance website, and co-director of the Alliance of Professional Health Advocates, said she’s not surprised so many Americans are on the hook to health care providers.
Her group represents professional health advocates who help consumers find and pay for health care. She said most households lack enough savings to deal with an unexpected medical bill, and many in debt feel they’ll never recover.
And health care costs and premiums have risen so sharply over the past three decades that many fear seeking medical attention, putting it off until it’s too late, she said.
“We have a system that leaves virtually half the population unable to pay for their care,” she said. “It’s crazy how this wealthy industrialized nation with the ‘best medical care in the world’ cannot provide basic services.”
Care for the uninsured
In the United States, some safety nets exist for the uninsured.
Those just below the federal poverty level qualify for Medicaid in most states. Administrators at HCA Trinity screened Naylor on his first visit but determined he earned too much to be eligible for the program.
Hillsborough, Pinellas and Polk counties provide basic safety-net programs known as indigent care, but Pasco County, where Naylor lives, has no such option.
Naylor may have qualified for insurance through the Affordable Care Act, but he said he didn’t know about it. A record 14.5 million Americans obtained insurance through the federal program this year.
Hospitals typically treat anyone who arrives in the emergency room.
Some, like Bayfront Health St. Petersburg, offer free care to uninsured patients who earn less than 225% of the federal poverty level. That’s about $30,000 for a single individual or $62,400 for a family of four. The hospital also provides help in cases where a medical bill is more than a quarter of a patient’s gross income.
The Trinity hospital where Naylor was treated operates charity programs for patients who cannot afford treatment. In 2021, its charity and uncompensated care totaled $21.5 million.
Naylor has applied for assistance but has yet to hear if he will qualify.
Patients have some options to try and get out of medical debt.
A recent study by Forbes found that 10% of medical bills are wrong and can be challenged. Gordon said people should scrutinize bills to ensure itemized treatments and medicines match what was given.
Medical charges, especially unexpected ones, can also be challenged. Those in debt should also reach out to the medical provider and try to negotiate a smaller debt or a manageable repayment plan.
A medical credit card can be a good option but only if it can be paid off quickly, she said.
“Otherwise, you will find yourself in a situation with a crushing medical bill bearing high interest rates,” she said.
Bankruptcy should only be used as a last resort, she said. Once on someone’s record, it can affect their ability to rent or buy a home or borrow money as well as negatively impact their credit score.
“It can have a lot of implications for your financial life and take a lifetime to recover from,” she said.
Three weeks after the surgery that likely saved his life, Naylor still feels pain in his lungs and sometimes coughs up blood.
His ankle may take up to a year to heal. Naylor should be in physical therapy but can’t afford it. Instead, he uses resistance bands for exercises and stretches at home.
Concerned about the risk of further blood clots, his cardiologist also advised exercise. At least once an hour, he stands up and circles his small apartment with a walker.
His cardiologist prescribed blood thinners for at least six months but, depending on test results, he may need to take the medication permanently.
He knows he could have died but the weight of medical debt has made it hard to feel like he got a second chance.
With so many different bills to pay, it feels impossible to know where to start. He’s already started getting second bills that warn his balance may be passed to debt collectors.
The $9,000 he put on a medical credit card must be paid off in six months or the interest rate will rise to about 22%.
Adding to his stress is that he’s not recovered enough to work at his job in the lumber section of Home Depot in New Port Richey. He is getting about 60% of his regular pay through short-term disability.
Like many in medical debt, the couple started a GoFundme campaign to try and raise money. It has been brought in $6,300, but donations have slowed.
They had planned a wedding this fall with upward of 50 guests in Daytona Beach where many of Nolan’s family lives.
Instead, they married June 26 so Naylor can be added to the medical insurance his wife gets through HCA where she works as a patient care tech. They hope that will cover the cost of physical therapy and blood-thinning medication. Even with a prescription drug card, it costs about $600 a month.
The couple said their vows in front of about 15 close friends and family at AL Anderson Park then celebrated with a meal at Tarpon Turtles restaurant.
Instead of a wedding gown, Nolan wore a $21 white floral maxi dress she ordered online. The ring she placed on Naylor’s finger was silicone not gold.
After living for six years in their 750-square foot, one-bedroom apartment, they are desperate to move somewhere bigger, ideally their own home where they could start a family.
That modest dream now feels beyond their reach.
Editor’s note: After the Tampa Bay Times contacted HCA West Florida Division, hospital officials told Naylor his application for assistance for the $4,000 hospital bill for his Achilles tendon treatment will be significantly reduced. When asked how much the aid would reduce his bill, officials didn’t elaborate.