The Medical Debt Journey: How a Health Condition Can Drain Your Bank Account

Healthcare expenses can pile up quickly, turning a simple medical visit into a financial burden that many struggle to escape. Let’s be honest—the reality is that a single health condition can trigger a chain reaction of costly medical bills—starting from primary care and leading to expensive specialist visits, lab work, and prescription costs.

In this blog, I will break down each step of the medical debt journey, helping you understand how and why medical costs escalate and what you can do to manage expenses before they spiral out of control.

1. The First Stop: Primary Care Visit

Your journey often begins with a primary care visit—the first point of contact for most medical concerns. Whether it’s a routine annual exam, sickness or sudden health issue you went to ER for that now requires a follow up. Seeing your doctor can come with potential extra expenses you may not expect.

Cost Scenarios as follows:

• Co-pays plus balance until plans deductible is met per visit

• No co-pays but have a balance to pay after plan processing per visit

• Co-pay no further charge, plan pays 100% rest of the balance per visit

• If you have no insurance it's pay right there on the spot full balance per visit

The tricky part is, trying to understand the costs that your doctor will charge your health plan or you on the spot until you walk in for the appointment and your exam completed. Follow visits to meet with your doctor are easier to get quotes for most times. When we try to plan for potential out of pocket due to the run around we get from the doctors offices. Why is this? Fun fact—customer pay prices are not the same pricing that will be billed to your insurance plan. This how doctors offices make more money.

If your doctor finds a potential concern, your next stop with costs is with the pharmacy, maybe lab work or potentially seeing a specialist.

2. Medical Diagnosis Testing Expenses

Medical tests such as bloodwork, stool samples, and urinalysis are crucial tests for diagnosing health concerns. However, they add up quickly.

For every test that is needed your health plan will get billed no matter if it's covered or not. Did you know that testing performed at a lab in the hospital is far more money than performed at a lab clinic? Hospitals contracted %'s with all insurance companies are less than lab clinics. Not to mention on most plans that have co-pays for care, they are less $ amount done at a clinic than at a hospital. A plan that has no copays does save you money on the upfront, however the balance still remains per test.

Example (on guesstimates):

• Hospital charges $1450 to insurance, your co-pay is $60 and balance is $600

• Lab clinic charges $1450 in insurance, your co-pay is $25 and balance is $250

For those without proper coverage, diagnosis testing can be a major unexpected financial strain. It forces many to delay or skip necessary tests due to cost concerns.

3. The Specialist Referral with Higher Costs Ahead

If your primary care doctor refers you to a specialist, the cost can skyrocket. Specialists often charge significantly higher rates per visit. What we have to discover is whether or not the health plan we have based on our plan’s network and design has a referral needing to be obtained before we are seen. This information is key to understanding how the visit will be covered by the plan. Another situation is the new doctor that you want to see recommended by your existing provider is not in your health plan's network—you have two choices: pay full price for the visit or choose another provider in your plan's network.

We often at times can seem “pushed” into taking our provider’s recommendation versus who we want to select for care. If we have no insurance, shopping around for a new doctor on who has the best price per session can seem overwhelming on many levels.

Cost Breakdown:

• Insurance copay for a specialist: $30–$200 per office visit plus possible balances towards deductible or no copay’s only just a balance per office visit (balances are depending on plan’s co-insurance and in-network pricing structure)

• Without insurance: $250–$500+ per office visit

• Additional procedures/tests can add hundreds or even thousands to the bill

Many specialists require follow-ups, additional tests, or even procedures that increase the costs. Most people managing on-going health condition such as abnormal thyroid as example or chronic condition such as Type II diabetes as example, this step in the journey often becomes a repeating cycle of visits and bills.

4. Radiology & Imaging Expenses

If your potential health condition requires advanced imaging like an MRI, CT scan, X-ray, Ultrasound, HSG or Sonogram for diagnosis or for managing the condition be prepared for another potential big expense in your medical journey.

Potential Cost Breakdown:

• Ultrasound & Sonograms: $250–$1,500

• X-ray: $350–$1,000 (depending on location and body part)

• MRI scan: $1,000–$5,000 (prices depending on area of the body and if contrast is needed for the scan)

• CT scan: $450–$4,000 (prices depend on area of the body and if contrast is needed for the scan)

A few situations that does not get talked about is the fact that many insurance plans only cover a portion of these costs and Providers’ hidden radiology department referral agendas that keep money in their pockets. What do I mean by this? At times, your provider will write a radiology referral for a hospital or bigger medical group to perform and not a smaller Radiology clinic. If the provider that you are working with is partnered with a hospital or bigger medical group they are required to recommend that you go there.

The way providers recommend these places is with pushy verbiage: “this place has best new innovative machines and most places are behind on having their machines updated.” It leaves many of us with huge out-of-pocket expenses. Without proper coverage and timely research on affordable places to go, most people opt to skip these critical tests, risking misdiagnosis or delayed treatment.

5. Prescription Costs: A Never-Ending Expense

Once you have a diagnosis, you may need prescription medication—another ongoing expense we not think about. Why do we not think about it? Most of the time the costs for them are small and some medications are only needed for a week or two. It's when we need to manage a particular condition or conditions the costs add up. Once on them, most providers do not seem to want to take you off of them either. At times they may switch them out or add more into the mix of already listed.

Potential Cost Breakdown:

• Generic drugs: $10–$100 per month

• Brand-name drugs: $100–$1,000+ per month

• Specialty drugs (e.g., for cancer, autoimmune disorders): $2,000–$10,000+ per month

Many insurance companies are pushing back and not covering most of the expensive medications currently. Also, pushing back on covering the type of medication being prescribed such as opiates/opioids, various other pain medications and weight loss drugs. The side effects patients face create more health conditions rather than helping them get better.

Example: In 2018 Cigna Health began rolling out an overdose reduction pilot program that implemented strategies to address the opioid crisis.

On the patient side the pushback from insurance companies causes patients financial strain due to costs, and on the insurance company side it's holding doctors accountable to rethink what they are prescribing to patients. Any medications recommended should be researched by the patient before accepting it as part of the treatment plan. The costs, side effects, details for potential coverage by the insurance company and what cost-saving opportunities for the medication should be reviewed.

6. Ongoing Follow Up Visits: The Cycle Repeats

Even after all these steps, you often have to return to your Primary Care or Specialist doctor for follow-ups, prescription adjustments, or to discuss new concerns.

• More health conditions potentially pop up

• More time off work or leaving work early = less money in the paycheck

• More medical bills

This cycle can feel endless for us as patients under a traditional medical treatment plan. In the system who wins? The Patient or the Healthcare System.

7. The Final Destination: Low Bank Funds & Medical Debt

With each visit, test, and prescription, your medical expenses keep accumulating. For many, this journey ends with:

❌ Maxed-out credit cards

❌ Overdue medical bills

❌ Debt collection threats

❌ Financial stress impacting mental health

❌ Lost wages from work

Just to show you how insane this has gotten—studies show that medical debt is a leading cause of bankruptcy in the U.S. Many patients are forced to choose between paying for medical care and covering basic living expenses while still in poor health.

How to Protect Yourself from Medical Debt

Let’s face it! Medical expenses can be so overwhelming, there are ways to manage costs and reduce the financial burden with Kat the Health Wizard to the rescue.

1. Review Existing Health Coverage or Obtain a Health Plan

• Know what your plan’s network, deductibles, copays, and out-of-pocket maximums are

• Check if you need prior authorization before seeing specialists and having tests completed

• Use in-network providers to avoid unexpected bills

• Know when to switch health plans based on your health and lifestyle needs

• Do not fall for Cost-Sharing/Health Share or Discount Medical plans

2. Compare Costs & Negotiate Bills

• DON’T LET THE SYSTEM PLAY YOU! Request itemized bills to check for overcharges, hidden medical fees, and billing errors

• Compare prices at different lab testing and imaging centers—costs vary widely

• Ask for cash discounts if paying out of pocket

• See about Patient Assistance programs based on your income for hospital bills

• Never believe that a claim with your insurance company has been denied from your doctor’s office unless your insurance company confirms it

• Question all high-price lines on the bill. If it seems high to you, then the charge for that service is high—negotiate or have the charges removed

3. Prescription Savings Ideas

• Look for generic drug options instead of brand-name medications

• Use programs like GoodRx, SingleCare, Prescription Hope or manufacturer coupons

• Check if you qualify for prescription assistance programs

• Research the medication thoroughly before saying YES!

4. Explore The Functional/Homeopathic Medicine Route

• Look for new doctors in this niche local to you

• Have a copy of your medical file to bring them for your appointment

• Have an open mind approach to care—these doctors are about healing and detoxing the body, not treating the symptom cycle

• Have a support circle—either a family member, friend, or partner—part of your journey. Change is HARD!

5. Consider a Meeting with Your Local Banker

• Advice given on your current banking accounts

• Strategies on ways to handle your debt if you have any

• Insight on FSA and HSA accounts for medical costs

• Compound interest and money market accounts explored

• If you need a loan, options are explored

Final Thoughts: Avoiding the Medical Debt Trap

The healthcare system is a trillion-dollar industry; having all of us at times feeling exhausted, overwhelmed, and trapped. It feels like a never-ending cycle with little to no education on how to get out of it. When we think of the trap itself, its design is to keep us stuck in a "treat the symptom" agenda.

So we get educated about our health, search for next-level medical care, discover new ways to keep money in the bank, research what’s in the foods and water, understand that insurance plans are a financial tool, and take mental health days for our well-being.

When reviewing steps above; to note—I too have been a victim of this very healthcare system and have had medical debt. The information I provided here is educational insight, advice that has worked for myself and clients alike.