How banks and hospitals are cashing in when patients can't pay for health care

Many hospitals are now partnering with financing companies to offer payment plans when patients and their families can't afford their bills. The catch: the plans can come with interest that significantly increases a patient's debt.

Patients at North Carolina-based Atrium Health get what looks like an enticing pitch when they go to the nonprofit?hospital system's website : a payment plan from lender AccessOne. The plans offer "easy ways to make monthly payments" on medical bills, the website says. You don't need good credit to get a loan. Everyone is approved. Nothing is reported to credit agencies.

In Minnesota, Allina Health encourages its patients to sign up for an account with MedCredit Financial Services to "consolidate your health expenses ." In Southern California, Chino Valley Medical Center, part of the Prime Healthcare chain, touts "promotional financing options ?with the CareCredit credit card to help you get the care you need, when you need it."

As Americans are overwhelmed with medical bills, patient financing is now a multibillion-dollar business, with private equity and big banks lined up to cash in when patients and their families can't pay for care. By one estimate from research firm IBISWorld, profit margins top 29% in the patient financing industry, seven times what is considered a solid hospital margin.

Hospitals and other providers, which historically put their patients in interest-free payment plans, have welcomed the financing, signing contracts with lenders and enrolling patients in financing plans with rosy promises about convenient bills and easy payments.

For patients, the payment plans often mean something more ominous: yet more debt.

Millions of people are paying interest on these plans, on top of what they owe for medical or dental care, an investigation by KHN and NPR shows. Even with lower rates than a traditional credit card, the interest can add hundreds, even thousands of dollars to medical bills and ratchet up financial strains when patients are most vulnerable.

Robin Milcowitz, a Florida woman who found herself enrolled in an AccessOne loan at a Tampa hospital in 2018 after having a hysterectomy for ovarian cancer, said she was appalled by the financing arrangements.

"Hospitals have found yet another way to monetize our illnesses and our need for medical help," said Milcowitz, a graphic designer. She was charged 11.5% interest — almost three times what she paid for a separate bank loan. "It's immoral," she said.

MedCredit's loans to Allina patients come with 8% interest. Patients enrolled in a CareCredit card from Synchrony, the nation's leading medical lender, face a nearly 27% interest rate if they fail to pay off their loan during a zero-interest promotional period. The high rate hits about 1 in 5 borrowers, according to the company.

For many patients, financing arrangements can be confusing, resulting in missed payments or higher interest rates than they anticipated. The loans can also deepen inequalities. Lower-income patients without the means to make large monthly payments can face higher interest rates, while wealthier patients able to shoulder bigger monthly bills can secure lower rates.

More fundamentally, pushing people into loans that threaten their financial health runs against medical providers' first obligation to not harm their patients, said patient advocate Mark Rukavina, program director at the nonprofit Community Catalyst.

"We're dealing with sick people, scared people, vulnerable people," Rukavina said. "Dangling a financial services product in front of them when they're concerned about their care doesn't seem appropriate."

Debt upon debt for patients, as finance firms get a cut of payments

Nationwide, about 50 million people — or 1 in 5 adults — are on a financing plan to pay off a medical or dental bill, according to?a KFF poll ?conducted for this project. About a quarter of those borrowers are paying interest, the poll found.

Increasingly, those interest payments are going to financing companies that promise hospitals they will collect more of their medical bills in exchange for a cut.

Hospital officials defend these arrangements, citing the need to offset the cost of offering financing options to patients. Alan Wolf, a spokesperson for the University of North Carolina's hospital system, said that the system, which reported $5.8 billion in patient revenue last year, had a "responsibility to remain financially stable to assure we can provide care to all regardless of ability to pay." UNC Health, as it is known, has contracted since 2019 with AccessOne, a private equity-backed company that finances loans for scores of hospital systems across the country.

This partnership has had a substantial impact on patient debt, according to a KHN analysis of billing and contracting records obtained through public records requests.

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