At a Glance

In the article, Dr. Virgie Bright Ellington, founder of Crush Medical Debt, and Karen Selby, a Registered Nurse and patient advocate, shed light on the critical issue of medical debt. They discuss the profound impact it has on individuals and families, emphasizing the importance of understanding and addressing this growing problem in the healthcare system. Their insights provide valuable perspectives on the urgency of tackling medical debt to ensure equitable access to quality healthcare for all.

In an interview with Credello, Dr. Virgie Bright Ellington gives an inside look at the realities of medical debt in America and shares what she wants patients to know about the process. “Because 80-90% of medical bills in the U.S. have mistakes in favor of the provider or the insurer, most Americans — even those of us with ‘great’ insurance — are just one accident or serious illness away from a lifetime of debt.” This stark revelation is not merely a statistic; it’s a testament to the fragility of financial stability in the face of health crises.


Despite recent reports from the White House that the overall medical debt burden of Americans is declining, stories from families in the midst of financial hardships brought on by crushing medical debt paint a different picture. Yes, it’s true that the total number of Americans with medical debt on their credit reports decreased by 8.2 million from 2020 to 2022, per the Consumer Financial Protection Bureau, and 5.5 million fewer Americans reported trouble paying their medical bills between 2020 and 2022, per the Centers for Disease Control and Prevention. However, healthcare providers are still quick to express concern over the average American’s ability to pay off medical debt and the medical billing process that so often leads to confusion and, eventually, collections.

One doctor shares her experience with medical debt from a patient perspective

Dr. Virgie — as she is best known to patients, readers, and podcast listeners — is the author of What Your Doctor Wants You to Know to Crush Medical Debt and the host of the weekly “Crush Medical Debt – Medical Bills Uncovered” podcast and radio show. She has more than 20 years of experience in primary care and psychiatric settings and as a health insurance executive.

“I’m a board-certified internal medicine physician and a former health insurance executive, which gave me a complete, 360-degree of the U.S. medical system and how it works. Or so I thought,” Dr. Virgie shares.

At one point, she became a patient herself, and that’s when Dr. Virgie met Mia, her hospital roommate. A mom to two young children, Mia did not work outside the home and relied on her husband’s insurance through his employer, a 24-hour diner where he made a modest income for their family. Dr. Virgie says she discovered that Mia had been “tricked by a hospital representative into signing an agreement to pay a bill” that she was “pretty sure she didn’t owe.” Dr. Virgie recalls that she was “definitely sure [the bill would] instantly put her and her family into debt for the rest of their lives.”

According to Dr. Virgie, “There are 100 million Mias in the United States.” This harsh reality is backed by findings from a 2022 KFF report that revealed that approximately 100 million Americans report having some amount of medical debt.

“Knowing Mia and millions of others have deliberately been taken advantage of because of lack of basic medical financial literacy made me incredibly angry,” she explains. This experience led Dr. Virgie to found Crush Medical Debt, her medical financial literacy content production company.

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The crushing impact of medical debt

As Dr. Virgie emphasizes, the cascading consequences of facing medical debt can extend far beyond financial strain. “There’s a great deal of data demonstrating those with medical debt often significantly delay or skip needed and recommended care in fear of adding to their already unaffordable debt, resulting in increased morbidity and mortality.” In Mia’s case, she contemplated leaving the hospital against medical advice due to the fear of accruing more debt, highlighting the life-altering decisions individuals are forced to make.

Dr. Virgie’s experience with Mia isn’t unique. The perspective of registered nurse and patient advocate Karen Selby echoes the haunting realities faced by those navigating the labyrinth of healthcare costs. With more than two decades of experience, Selby provides a unique glimpse into patients’ challenges and the profound impact medical debt has on their choices and outcomes.

“I spoke to the daughter of an end-stage cancer patient just yesterday,” Selby shares. “She was upset because her mother had to make the choice of not filling a prescription for her husband due to the astronomical out-of-pocket cost. Patients are often put in this position of choosing what they can afford and what they feel they must do without.”

A patient who was recently diagnosed with advanced cancer faced a similar dilemma. “When asked when he started feeling symptoms, he shared that he knew something was wrong for about a year. He was worried that he couldn’t afford the medical bills so kept delaying seeing a doctor until advanced symptoms started. Delays in diagnosis can often make treatment more costly when determining effective options,” Selby says.

How healthcare professionals are seeking change

Now, let’s talk solutions. From a healthcare industry perspective, Shelby explains that considering policy changes involves a lot of liability but does share her ideas for preventing what she calls “unnecessary redundancy in specific labs and testing.”

“For example, the U.S. could establish a centralized database where all of a patient’s medical history could be accessed wherever they go,” Shelby says. “There would be less chance of redundant testing and prescribing of overlapping medications.”

Systemic changes regarding a complete overhaul of how hospitals operate could also shift the high costs away from patients. However, as Shelby explains, there are a number of hurdles to address that make this unlikely to happen anytime soon.

“Frankly, the standard of care hospitals provide is too high considering the costs involved,” Shelby says. “The system is set up with hospitals competing with other hospitals with higher and higher levels of care. They are experts in maximizing what can be billed to insurance and if there is an insurance coverage gap, it can result in an enormous bill. Life is precious, but we pour significant resources into marginal patient gains. Hard decisions are not being made. Nobody has the will or political capital to consider how to reduce costs and change the overall system. The healthcare industry has its own momentum, which will be difficult to change.”

But, until the system changes, the onus is on the patient to learn how to protect themselves from falling into medical debt. Talking to your healthcare provider is a significant first step, but both Selby and Dr. Virgie say patients are typically hesitant to speak up.

“Patients frequently don’t bring up the conversation about financial difficulties they’re facing due to their healthcare needs,” Dr. Virgie says. “As a physician, I might get a hint – and have to bring up the topic – after there’s some discussion about a prescription not getting filled or an outpatient specialist appointment that was missed.”

In her quest to empower consumers, Dr. Virgie offers a three-step strategy to become financially literate about medical bills:

  1. Get an itemized bill with CPT codes: This is the universal language of the U.S. medical care system, akin to bar codes in retail.
  2. Do an online search of Medicare prices: With this information, patients can negotiate with providers to secure fair payment.
  3. Negotiate an interest-free payment plan: Work with providers to establish a payment plan that aligns with your financial capabilities.

When facing potential medical costs, Selby has this advice for patients and their families: “Find a patient advocate who can help navigate through troubling healthcare concerns. Most medical facilities offer assistance through patient navigators who may be able to offer guidance. Shop for more reasonable coverage. There are not-for-profit organizations such as that can assist in making the best choices.”

Bottom line

When confronting the devastating toll of medical debt on Americans, the collective voices of healthcare professionals like Dr. Virgie and Selby call for both systemic change and individual empowerment. The battle against medical debt is not merely financial; it is a call to arms for a healthcare system prioritizing every American’s health and overall financial well-being.