Eighty percent of health care debt collection cases in Connecticut are brought by physicians, dentists and other non-hospital entities.
WSHU’s Ebong Udoma spoke with KFF Health News’ Noeam N. Levey to discuss his article, “In CT, doctors now sue patients most over medical bills, surpassing hospitals,” written with CT Mirror’s Katy Golvala and Jenna Carlesso as part of the collaborative podcast Long Story Short. Read their story here.
WSHU: Hi, Noeam, quite a bit of analysis went into this story. So, how did you go about doing the story?
NL: Sure. Well, you know, we've been covering the issue of medical debt and its associated problems for several years here at KFF Health News. And so, you know, one of the things which we've been trying to understand is just how frequently patients are sued by their medical provider, and in a lot of states, that's very difficult to figure out, because you can go to a court record, and if you know that, you know Hartford General Hospital is suing people, you can look up the name of the hospital, but you're not going to capture every single medical provider unless you know all their names. And so that's one of the reasons this remains kind of a murky part of the medical debt landscape in America: hospitals have gotten the most attention because everybody can identify a hospital; there are not that many, but there are thousands and thousands of other medical providers.
WSHU: How easy was it to do in Connecticut? Is Connecticut a bit different from other states?
NL: So, Connecticut is different because Connecticut requires that medical debt collection cases be tagged in the state court system, and so you can isolate medical and dental debt collection cases in the small claims in Connecticut. You can't do that elsewhere. So it's easier to get a full picture of all of these health care cases in the courts. We did some additional analysis to enhance that, which I'm happy to tell you about. But that's why we went to Connecticut and we worked with the Connecticut Mirror, because Connecticut provides this sort of unique opportunity to do this kind of research.
WSHU: Now in Connecticut, we've had for quite a few years now an emphasis on trying to deal with hospital debt. What did you find, as far as hospital debt is concerned, and why are they no longer the highest number of lawsuits?
NL: So we looked at six years of data, and at the beginning of that period, 2019, hospital systems constituted the overwhelming majority of healthcare collection cases in the state's court, like three-quarters. But since then, in 2024, they had fallen to about 20%, and so that means 80% of the collection cases being filed in Connecticut are now from non-hospital providers. So we're talking about physician groups. We're talking about dentists, ambulances, behavioral health, medical supplies, you name it.
WSHU: Why did it change?
NL: Well, so I think there are a few things going on. One is that there's been a lot of scrutiny over the last few years of hospitals and what they're doing to their patients. There have been news reports in Connecticut and elsewhere over the years that have focused on hospitals, and so there's a little bit of naming and shaming. I think that's gone on, frankly, where hospitals are scared of the bad publicity. They don't, they don't like it. Many of the hospitals in Connecticut and elsewhere are nonprofit institutions, and as a sort of condition of their tax-exempt status, they're supposed to provide a community service, and there's a debate about whether or not suing patients over bills that they can't pay is consistent with hospitals being community institutions. And so you're seeing in Connecticut, and this is true nationally as well, that hospitals that have come under scrutiny have dialed back their use of the courts, and I think that kind of explains what's been going on.
WSHU: But isn't it alarming that 80% of the lawsuits are now coming from doctors' offices and other medical providers? And what type of lawsuits are we talking about? How much money are we talking about here?
NL: So to answer your second question first, I mean, many of the bills for physician offices and other non-hospital providers are for a few $1,000 at most. So these are not your $50,000- $100,000 bills that you sometimes see from hospital systems. Nevertheless, in a lot of cases, certainly in the cases of many of the people that we interviewed who'd been sued, several thousand dollars can be a lot if you're kind of living paycheck to paycheck, if you're living in a financially precarious position.
And I think that sort of gets to your first question, which is, should we be disturbed by this? You know, if you interview medical providers about why they go to such extreme measures to try to collect, they'll give you a number of different arguments. They'll say, " We're a business. We have to keep the lights on. We have to pay the nurses, the receptionists, and everybody else who works here. And if people can just come here and then duck out on their bills, we're not going to be able to continue serving our patients. Or they'll say, Look, we try to work with people, but people won't respond to us, or we can't, we can't work with them if they just don't send the bill back. And I think, you know, there's, there's certainly, that's an argument that makes a certain amount of sense. But the thing, I think that really jumped out at me, sort of interviewing people who had been sued, and we knocked on a lot of doors around Connecticut to talk to people who'd been sued, was that many cases, you know, I wasn't knocking on a lot of doors of houses with, you know, four-car garages. I mean, the people that we were interviewing were in pretty dire financial straits, you know, living in small apartments, maybe not having jobs. I talked to somebody who'd lost his job because he'd had a stroke. Another woman we interviewed, you know, lived off an expressway on a ramp. The reason people are not paying these $1,000 bills is that they don't have $1,000 lying around.
The other thing that has come up is that people are oftentimes very confused by their medical bills. I think all of us probably have had the experience of getting a bill from, you know, a hospital or doctor's office and not understanding, “wait, I thought my insurance was supposed to pay for that or wait a minute. That doesn't seem right. I don't remember getting that service.” And it can be very frustrating and time-consuming to kind of go through the process of trying to understand that people sort of throw up their hands. They stop opening their mail. I think the thing that comes out is that the patients are suffering, and in many cases, the people, the medical providers, who are trying to collect, I don't think they're necessarily bad people. They're trying to exist in this crazy system that we have here, where, if you go to the radiologist or the orthopedic surgeon and you need service and you get a bill because your health plan doesn't cover what you think it will, people just can't afford these bills. And I guess the question sort of comes down to, if people are not paying, is this the way that those bills should be handled?
WSHU: Is that where the state would like to come in? Is there any movement to try? Because they did that with the hospitals, the state actually stepped in. Is there any hope of that happening with the doctor's offices?
NL: So some of my colleagues who worked on this story at the CT Mirror talked to some folks in state government, like the governor and state legislators. I think, you know, as we talked about earlier, most of the focus has been on hospitals. And I think this probably will come as a surprise to some people that there are so many non-hospital providers that are using the courts. The sense I get from my conversations with my colleagues who talk to state officials is that nobody likes a situation where patients are getting dragged into court. It's not the best place to adjudicate these billing disputes. A lot of times, the people who are getting dragged into court can't pay anyway. So if I don't have $5,000 in my bank account, you can sue me. But what am I going to do? Right? I'm not going to be able to pay you, so I think there is some interest in looking at this. The one thing that's important to keep in mind is that not-for-profit hospitals are a different breed of animal than a private physician group, a private radiology group, big radiology group in Connecticut may have offices all over the place, may take care of thousands of people in Connecticut, but they're a business, just like a landscaping company.
WSHU: And some of them are run by private equity companies.
NL: You've got private equity certainly stepping into some of these places as well. They're not, they're not bound by the same community obligations as hospitals are. And so if the state was going to step in and start thinking about, how do we regulate this space? What do we think about restricting bill collection? It's probably a different kind of debate, and not a lot of states have gone there. To be honest with you, when you look around the country, more states are like Connecticut, where they've really looked at hospitals rather than the whole gamut, but I will say that Connecticut is among them. Lots of states have put some restrictions on how medical debt can be treated by everybody. So, for example, medical debt can't be put on people's credit scores in Connecticut anymore. It doesn't matter if it's from a hospital, an ambulance, or wherever it can't go there. And so could one conceive of legislation that would restrict the use of the courts until people's incomes are checked, or could deal with the worst excesses of sorts of legal collections like liens on people's homes or garnishing wages. That may be where the debate goes if people are thinking about how patients can be better protected.
WSHU: Okay, well, thank you so much, Noeam, I really appreciate you doing this, and it's really an eye opener to see how people are dealing with medical debt.
NL: Thanks for having me on, good to talk to you.
