In 2013, while working as a housekeeper, Miriam knew she needed to see a doctor for the debilitating pain radiating from her breast to her back. Like many of Florida’s low income workers, she was uninsured, and so months went by when she did not seek care.

Finally, desperately needing relief from the pain, she went to her local publicly funded hospital which has a financial assistance program for low-income, uninsured county residents. Based on her income, she received a “J03” classification, entitling her to the second lowest copayment charges. She also received a somber diagnosis – breast cancer.

After being diagnosed with breast cancer, Miriam underwent chemotherapy and radiation in addition to surgery.

Even though she had enrolled in the hospital’s charity care program, she was still required to pay $25 for each radiation session. For other treatments, including chemo, she was charged copays ranging from $70 to $95.

Also, although her doctor recommended that she receive her chemotherapy through a port, rather than intravenous, she could not afford the $200 copayment required for putting in the port (an outpatient procedure). Instead she received the chemotherapy through her veins, a much more difficult and debilitating method of treatment.

Miriam was no longer able to work while she was undergoing treatment. After paying for rent, phone, gas, food, there was no money left over. With her rent over $1000 and as the sole provider for her family, every copayment was literally “beyond her means.” Looking back, she remembers paying many of the copayments before she checked in for her treatment, but due to the overwhelming number of treatments and visits she had to pay during her bout with cancer, it was difficult for her to keep up with the many copayments while extremely sick.

Desperate to obtain the healthcare she needed for her cancer treatment, she scraped together whatever money she could to meet her copayments.

“I needed to live to be there for my children,” she says.

Ultimately, treating her cancer also took a financial toll: she got into credit card debt for which she is being sued.

When Miriam thought the cancer battle was behind her, a new disaster struck. At the end of 2020, in the midst of the Covid-19 pandemic, after losing her job and barely making her rent payments, she received a shocking letter. It was a notice from the County‘s Credit & Collections Department for old bills from the hospital for $2183.

Other than a list of account numbers, the collection notice provided no clue regarding what the charge was for or the dates of treatment. When Miriam called the number on the notice, she was told the matter would either go to court (where she’d be forced to pay the whole amount) or the county would “cut her a deal” where she could pay $200 a month until the bill was resolved.

“I had to decide whether to put a roof over my children’s heads or to pay for my medical bills from seven years ago.”

She could not afford $200 per month with her $1000/month salary. She explained to the collection official the burden that paying $200 a month would place on her family. The official told her she only had two options: to pay the bill or be taken to court. She managed to pay twice, $400, which she really couldn’t afford. The thought of being taken to court where she’d be made to pay the full amount caused extreme anguish for this single mom who is trying to settle into a new job and support her children. In June, she got a second notice from the Credit and Collections office – this one for $1783.

She called the number again, trying to find out exactly what the bill was for. On that call, she was told that it was for some unpaid copayments from 2013-2014. It was her old cancer treatment copayments, coming back to haunt her. And, she was told she needed to pay her debt or be taken to court.