The form letter was succinct. The March 2007 appointment Ron Eaker had made to see a doctor at the Carle Clinic in Champaign, Ill., had been canceled by the clinic.
The reason: Eaker had filed for bankruptcy three years earlier and was, in the parlance of the huge multi-specialty medical practice, "no more serviced."
"I was upset," said Eaker, a longtime patient of the practice who had been treated by its doctors for three heart attacks and wanted to continue receiving care there.
Although the letter doesn't offer details, Eaker's history with Carle is marked by large, unpaid bills. Bankruptcy wiped out his debt to the clinic, whose doctors include about 60 percent of those practicing in the central Illinois city. But after the bankruptcy Eaker ran up another $30,000 tab when he suffered his third heart attack and doctors at Carle implanted a defibrillator.
The clinic will still see Eaker to check on the defibrillator, he said, but he remains angry, calling Carle "money-hungry" for refusing to see him for other problems.
Struggling With Medical Debt
Eaker's experience illustrates how medical debt can impede care. Unlike hospital emergency rooms, which are required by law to treat patients, doctors in private practice are not obligated to do so.
Although Eaker signed a release permitting Carle Clinic to discuss his case with a reporter, officials declined, saying that it was against their policy because it might upset other patients.
"We don't rush to 'no more service' patients," said Carol Koenecke-Grant, Carle Clinic's vice president of marketing. "Individuals who choose not to work with us" may face that status.
Those who are barred from the clinic can seek care in the emergency room of the nonprofit Carle Foundation Hospital, to which the clinic's 330 doctors admit patients. Such bans do not cover ongoing treatment such as chemotherapy, Koenecke-Grant said, and can be lifted, although Eaker said he has been told his is permanent.
Eaker, a former Methodist minister, and his wife, Mary Ann, who is also barred from the clinic, have a long history there.
In November 2004, nearly $109,000 in debt, most of it to the hospital and clinic for treatment of his heart attacks and her nearly fatal brain aneurysm, they decided bankruptcy was their only option. Although both were working, they were uninsured and figured that short of winning the lottery, they would never be able to pay off their debt. Bill collectors were hounding them, Eaker recalled.
"I didn't want to declare bankruptcy, but I swallowed my pride and took it," said Eaker, who left the ministry after 20 years to become a nursing home administrator, then suffered his first heart attack at 52 and lost his job.
After his third heart attack, Eaker said, the hospital wrote off his debt. He proposed to pay off his $30,000 clinic tab in $50 monthly installments. A clinic employee rejected that, saying, "You won't live long enough to pay it off," Eaker said. He said he is making regular payments, including $100 last month, to a collection agency.
Eaker, who works as a desk clerk at a storage facility and as a handyman, said $50 was all he could afford on the couple's annual take-home income of $36,000. He said his wife earns $8 an hour as a housekeeper at an assisted living facility. She took the job in 2007 because it provides them with insurance, which he said consumes more than 50 percent of her check.
"The irony is that we have good health insurance now," said Eaker, who now receives care at a clinic where the choice of doctors is "very limited."