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The Bills Pile Up

By Sandra G. Boodman
Kaiser Health News
Tuesday, January 13, 2009

Tyrone Clifford and his wife, Sheila Bell-Clifford, can't figure out how much they owe or to whom.

They have handed over their two-inch-high stack of statements, collection letters and past-due notices from doctors, labs and Inova Alexandria and Inova Mount Vernon hospitals to Silvia Portillo, the medical bill specialist at the Tenants and Workers Support Committee. Several years ago the Alexandria-based group, which annually helps about 100 low-income Northern Virginia residents deal with medical debt, successfully lobbied Inova, the largest hospital system in Northern Virginia, to adopt a 35 percent discount for uninsured patients.

While Portillo pores over their bills, the Cliffords, who are in their late 50s, are struggling to pay for treatment of their serious medical problems.

Last August, while undergoing chemotherapy for stage IV lymphoma, Clifford lost his $33,000-a-year maintenance job and with it the couple's health insurance. They said they could not afford the nearly $500 per month it would cost to continue coverage and are now uninsured. Clifford receives $1,100 per month in disability payments, which may end now that his cancer is in remission.

The couple, who live in an older mobile home community off Route 1 in Fairfax County, say they spend $555 per month on rent and at least $250 for utilities. Recently they liquidated Clifford's $6,000 401(k) account, their only savings, to pay bills. Clifford, who still has a port implanted in his chest to take blood and deliver chemotherapy, expects he will need to start looking for a job this month.

"I'm 59," he said. "Who's going to hire me?"

Mark Runyon, Inova's senior vice president of finance, said Clifford owes the hospital system $4,800, much of it in the form of co-pays and deductibles from the past year while he had insurance.

Several old unpaid accounts have been turned over to a collection agency because Clifford failed to make monthly payments as he had agreed, Runyon said.

"One thing this demonstrates to me is that we've never turned this patient away, whether he's paid his bills or not."

The couple say they receive frequent telephone calls from collection agencies about delinquent medical bills. When callers warn about the prospect of damage to their credit rating, Bell-Clifford, who says she earns less than $7,500 annually as an in-home day care provider, has a standard response: "I say, 'We're broke, and not because we want to be.' What are we supposed to give up? Eating? Heat?"

Although she suffers from severe type 2 diabetes, Bell-Clifford juggles taking her medications because she can't afford them. And she says she has put off seeing her doctor now that she is uninsured, because she would owe $90 for an office visit, rather than a $20 co-pay.

The one medical bill Clifford says he tries to pay every month is the $100 he owes his oncologist. The couple are grateful to Alexandria physician Ivan Aksentijevich, who has helped arrange free care, including two $6,000 PET scans to monitor the progress of Clifford's treatment.

Aksentijevich said he deliberately does not ask about any financial arrangements patients make with his staff.

"Ethically you cannot deny care," he said, adding that his practice writes off the debts of those who cannot afford to pay. Clifford, he said, "is doing the best he can, and that's the best I can ask."

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