At this point, I’m more afraid of collections than cancer.
The worst has already happened to me (perhaps). I live with cancer. Yet it’s usually collections that wakes me up at night in a brutal hot flash/cold sweat panic.
The c-word, cancer, is a scary and all too common concept for young women. But since my breast cancer diagnosis in 2013, so many hands have been forced: want those breasts removed or not? You didn’t really need those eyelashes and brows, did you? Can you choke on your sorrow when clumps of wavy hair fall out onto the bed sheets, shower drain and shirt collar? And mean little girls who later ask you to remove your hat and wig, to show them your bald head? (NO, I am not up for showing you my bald goods, kids! Eventually, after much wearing down, I will tell them that it’s not nice to make that request.)
I’ve got a medical condition, but it also gifted me a ton of trauma (emotional and physical), loss, and uncertainty that was definitely not present in my pre-cancerous years.
I’ve said goodbye to surgically removed body parts and sat through brutal chemo sessions. There, and while I sit at home “recovering” (really, wondering how I’m supposed to rest and finally giving in to Netflix dozing), I’ve forced myself to figure out if I can accept the way disease and dying happens. There are many surprises in life as a medical patient, but seeing my fellow sickies struggle and die (sometimes in great pain) at least puts me in contact with them. I offer a sympathetic ear when I can (along with jokes when I can, because silence is just so awkward and uncomfortable), but I also take their ideas, histories, jokes, stories and medical knowledge and try to plan for the known (my death) and unknown (when?!), if you will.
Being sick is exhausting. But getting sent to collections is stressful. The tricky part about having a serious illness? I’m supposed to avoid stress or at least “manage” my stress, to use common parlance. I’ve taken up meditation and ditched some workaholism and people pleasing ways in a huge effort to be well(ish) — but life, bills and work still dish up some doozies.
I am lucky that I have health insurance from my husband’s work. Still, things are not always workable financially. I’ve been seriously schooled on what co-pays and deductibles are (or really, what they cost!), as well as medical phrases like “mets” (slang for metastatic cancer, when new tumors made from cancer cells show up in other parts of the body) and “BRCA1” (my genetic mutation that made it more likely that I would get breast cancer).
I get ongoing bills for blood draws, last minute ER visits for horrific pain in my lady parts and left side, eye appointments, steroid creams and medicine. They are all nestled together, in the top tray of a yellow metal standing rack. The rack is a sunnier-looking garage sale version of the black plastic (or metal) ones often seen atop office desks. Papers that need to be dealt with typically go on the top “in” tray and the bottom tray is usually the “out” box. This rack is where I store papers, so many papers: insurance premium explanations, info about cost shares, receipts from out of pocket expenses. In the middle of the night, when I do my best worrying, I cost out other family needs: food, school supplies and basics for my young son. Knowing that the moon is beaming outside as it has for billions of years is little comfort in those moments.
When my husband asks, “How could you get sent to collections?”
What he really means is: “How could you get sent to collections over $9.34?”
How could we get caught up by such a small bill?
While I can blame my ongoing messy “open-and-ignore” system, I know that collections often lead to a lower credit score, and possibly bankruptcy. It’s not that I shrug these things off when I at first do not pay the $9.34. I use a messy system: pay what I can when a bill first arrives. Or I wait to see if the deductible that has been paid somehow over time makes part of my bill lower. The longer I am sick, the tougher it is to pay a bill when I open it, because the number of bills and medical appointments continue. One of the trickiest things about having a serious illness is that for many patients (like me), there may not be an end to treatment (ever).
I want to be better, but is that more of a wish than reality?
Millions of American patients struggle with medical bills. Things may get worse for each of us financially, emotionally and in turn physically. High stress is to be avoided when you have a serious disease. But the bills keep coming. Last year a notable survey from The Kaiser Family Foundation and New York Times showed that 1 in 5 of working-age insured Americans faced “serious financial challenges and changes in employment and lifestyle” due to medical bills. Those without insurance have it worse, with 53% of them saying they took a steep financial hit.
When I open (in the nick of time) that collection notice for a $9.34 blood draw, I realize how quickly folks can struggle financially when undergoing medical treatment. Consumer-patients rarely can anticipate and plan how exactly to stay afloat while getting treatment — often, a surgery means bills from up to six providers.
Collections affects my credit score and ability to potentially do other “adult-ing” slash American dream things like buy a car and home. Collections and the process of owing money on a bill helps me understand what other uncomfortable personal finance experiences like foreclosure and bankruptcy may feel like — it brings up fear, anger (at myself) and a double dose of shame and feeling incompetent.
I didn’t think I would have these big medical bills in the middle of my life. When I’m a bona fide senior citizen, let’s maybe talk. However, I’ve learned that serious illness effects my ability to work, save and pay bills. I’d love to pay these bills since it’s responsible adulting. Sometimes, I am just not sure how exactly to do just that.
Sometimes, it’s easier to put unwieldy medical bills totaling over $10,000 in the same chaotic pile as a $9.34 bill for a blood draw. Those bigger bills mean I set up and juggle payment plans. My paper trail and phone pleas for bill reductions often lead to slightly lower bills or payment plans. An over $3,000 surgery bill goes into the same pile because when I am sick, the ability to spend money to pay anything is dramatically altered for the worse.
I continue to need healthcare. I fear that my $9.34 collection notice shows me how many of us can be just one bill away from collections, credit card debt and other bleak realities.
Mary Ladd’s writing has appeared in Healthline, Playboy, Time Magazine/Extra Crispy, San Francisco Weekly, Oakland Magazine, the Contra Costa Times, & KQED. She is co-author of The Wig Report, a graphic novel on catastrophic illness and first place winner of the 2017 Litquake essay contest.