Bridget Narsh resides in Chapel Hill, North Carolina and is the mother of a son who suffers from autism, post-traumatic stress disorder (PTSD), and attention-deficit/hyperactivity disorder (ADHD). In 2020, her son spent over 100 days at Central Regional Hospital, which is a mental health facility run by the state. The state charged the family nearly $102,000 for the hospitalizations. This situation arose when Narsh’s son, Mason, required urgent assistance in January 2020 due to his destructive behavior and tendency to run away from home. Fearing for the safety of her family, Narsh was offered the option to send Mason to Central Regional Hospital. However, North Carolina lacks the necessary services to promptly accommodate children in crisis, resulting in prolonged waiting periods for psychiatric beds. When beds do become available, they come at a high cost. Central Regional’s standard rate was $1,338 per day, which Narsh couldn’t afford. Luckily, they were offered a discounted rate of less than $60 per day, leading them to sign an agreement. Mason, who is now 17, spent over 100 days in Central Regional across two separate stays that year. However, when the bill arrived the following year, Narsh was stunned as it exceeded the expected amount by a significant margin. The paralegal in North Carolina’s attorney general’s office had signed letters marked as “final notice” requesting immediate payment. The total bill amounted to $101,546.49, significantly more than the approximately $6,700 the Narshes had anticipated paying based on their agreement with the hospital. Distressed by the situation, Bridget Narsh, 44, expressed her inability to afford such an amount. This case highlights the issue of medical bills causing disruption and financial struggles for millions of Americans. Hospitals resort to extreme measures like placing liens on homes, which often leads individuals to file for bankruptcy. Over the years, lawmakers have criticized privately operated hospitals, prompting states to enact laws that promote transparent medical billing and limit aggressive debt collection strategies. However, state attorneys general, responsible for protecting residents from harmful billing and debt collection practices, find themselves in contradiction as their offices are also responsible for collecting unpaid debts owed to state-run facilities. Josh Stein, a Democratic gubernatorial candidate in 2024 and the attorney general of North Carolina, has prioritized hospital consolidation and healthcare price transparency during his time in office. Stein has expressed concerns regarding the rising trend of hospital consolidations and its correlation with increased healthcare costs. Unfortunately, Stein declined an interview request regarding Mason’s bills. Debt collection efforts by states, including seizing money, assets, and filing lawsuits, tend to disproportionately impact racial and ethnic minorities, as well as individuals with lower incomes. In North Carolina, officials are allowed to garnish residents’ income tax refunds to collect unpaid debts. Balancing their obligations to protect consumers from harmful collection practices with the state’s responsibility to serve taxpayers and fund services is a challenge faced by attorneys general. Vikas Saini, the president of the Lown Institute, emphasizes that the Narsh case exemplifies everything wrong with the healthcare system, including unaffordable healthcare, lack of billing transparency, and the resulting financial burden faced by patients and their families. Although the Narsh family had Blue Cross and Blue Shield health insurance at the time of Mason’s hospitalizations, Bridget Narsh states that she received bills totaling approximately $7,200. Medicaid now covers Mason’s healthcare expenses since he is eligible as an individual with disabilities and comes from a low-income family. According to Nazneen Ahmed, a representative from Stein’s office, state law mandates that most agencies send their unpaid debts to the Department of Justice for collection. The North Carolina Department of Health and Human Services, which oversees Central Regional Hospital, asserts that they followed proper procedures in billing the Narsh family and determines rates based on treatment costs and other factors. The spokesperson did not address the discrepancy in the discounted rate offered to Mason’s parents but not applied to his hospital stays. Narsh sought legal assistance to negotiate the bill with the state. In April, the family reached an agreement with North Carolina officials to pay $100 per month in exchange for a reduced charge of approximately 96% to about $4,300. However, if Narsh fails to meet these payments, she will be responsible for the original total. Different states adopt various approaches to debt collection, and North Carolina is one of approximately a dozen that can garnish residents’ income tax refunds. Richard Gundling of the Healthcare Financial Management Association acknowledges the responsibility of state officials to protect taxpayer funds and collect owed debts but highlights that seizing income tax refunds can disproportionately affect individuals with lower incomes. In North Carolina, unpaid medical bills have become a major political concern due to their contribution to personal debt. Lawmakers are currently considering the Medical Debt De-Weaponization Act, designed to restrict extraordinary collection practices employed by debt collectors, such as foreclosing on homes or garnishing wages. However, this legislation does not apply to state-operated healthcare facilities like the one Mason was admitted to. Stein supports measures to enhance consumer protections and ensure access to affordable healthcare for all North Carolinians. Narsh finds the unexpectedly large bill frustrating, particularly because she struggled to find affordable preventive care for Mason in North Carolina. She notes a shortage of services for individuals with behavioral issues, an issue acknowledged in a state report from last year.
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Rohit Malhotra is a medical expert and health journalist who offers evidence-based advice on fitness, nutrition, and mental well-being. His articles aim to help readers lead healthier lives.
