When Katy Cady opened the medical bill in her mailbox, the number didn’t look right.
The total — $2,454.78 — came from her labor and delivery at Bon Secours Mary Immaculate Hospital in 2023. The bill listed only a single charge and a payment deadline, without a breakdown of services.
She asked for an itemized bill. When she got it a few weeks later and reviewed the breakdown, she noticed charges that didn’t add up — including two epidurals, even though she had received only one.
She called the hospital’s billing department, which sent the account for review. Weeks later, Bon Secours issued a revised bill for $1,739.43, more than $700 less than the original charge. Cady set up a payment plan and began paying down the adjusted balance, eventually paying $1,100 toward it.
Then, in March 2025, she received an email notifying her that her payment plan had been canceled.
“I knew something was wrong immediately,” Cady said. “Either I didn’t owe anything anymore, or they had sent it to collections.”
Within hours of making a scheduled payment, she learned her account had been sent to a debt collector. After multiple calls, a billing representative with Bon Secours pulled it back from collections, but the increased balance stuck.
Instead of reflecting the adjusted bill she'd already paid on, the balance jumped from roughly $800 owed to more than $1,200. Cady said she was told the system no longer recognized the lower, reviewed amount.
She disputed the charge and involved her insurance company, submitting explanations of benefits and records of the earlier adjustment. She said she never received a clear explanation, and the account was later sent back to collections, where it remains.
More than two years after she gave birth, Cady is still trying to resolve the bill from her delivery.
“As a mother I felt back into an impossible position where I would be robbed of either outcome: be robbed financially, or be robbed of precious moments with my baby because I was physically distracted on the phone — being juggled around the billing department— or mentally disengaged from the mental exhaustion and stress,” Cady said.
Patients across Hampton Roads are facing similar issues — non-itemized bills, incorrect services listed on their statements and billing systems that leave patients struggling to resolve disputes before accounts are sent to collections.
A national study found that only 4% of patients who identified a billing error were able to get it corrected, and about one in five households received a medical bill that they disputed or could not afford.
Hospital bills are often not itemized by default, leaving patients without the information they need to verify charges or catch errors.
Disputes can stretch on for months across hospital and insurance systems that do not always communicate clearly, while patients are still expected to make payments.
Christopher Whaley, associate professor at Brown University's School of Public Health, said cases like Cady’s reflect broader problems in the way medical billing works in the United States.
“I think this issue is systematic within the US healthcare system,” Whaley said. “The opaqueness and huge variation in healthcare prices that we see, it's hard to think of anywhere else in the economy where we have the same situation.”
Hospitals and insurers typically have access to detailed, itemized versions of medical bills as part of claims processing, Whaley said. Patients, however, often see only summary balances unless they know to ask for more information.
“There's a concern of many policymakers that many providers and health systems charge as much as they can, and then when they maybe get called out on it, magically lower the price to not face further scrutiny,” Whaley said.
Whaley said patients need timely access to itemized bills so they can review charges and flag errors. Medical bills under dispute, he said, should not be sent to collections while patients are still trying to resolve them.
Jenna Green, public relations and external communications manager at Bon Secours, said in a statement that they take patient billing questions seriously and work with patients to provide clarity on charges, including sharing itemized bills upon request.
She said financial counselors and patient advocates are available to help patients understand bills and insurance coordination, and that accounts under dispute are managed according to established policies.
But Bon Secours said it cannot comment on individual accounts.
Kelly Parsons, manager of media relations at Blue Cross Blue Shield, said in a statement that it provides members with explanations of benefits outlining provider charges, negotiated rates and what patients may owe.
She said they aim to make cost information easier to understand through digital tools and customer support.
For people without the time, knowledge or resources to navigate the process, billing errors can be difficult, and sometimes impossible, to resolve before accounts are sent to collections.
Julie Garrant, a Yorktown resident who works in medical insurance, said she struggled for months to access billing information from Riverside Health System and did not receive paper bills for her services.
She later learned that charges tied to care dating back to 2022 had been sent to collections, despite her attempts to get itemized bills and clarification about her financial assistance eligibility, which she said was not an issue before in other healthcare systems.
“There’s a clear disconnect, and a lot of information is missing,” Garrant said. “It doesn’t seem right to put all the responsibility on patients when they’re trying to get answers and either aren’t getting accurate information — or aren’t getting any information at all.”
Stacy Goodwine, a certified medical biller and coder now living in Richmond, said her training is often the only reason she can challenge charges.
Her insurance denied the out-of-state care she received at Massachusetts General Hospital, leaving her with an $8,000 bill — far more than what insurers typically allow for the same procedure — before it was sent to collections.
“If I didn’t know billing and coding,” Goodwine said, “I would have overpaid on my healthcare a million times in my life.”
Whaley, the Brown University professor, pointed to recent legislation in Colorado as an example of how some states are trying to shift the burden away from patients. Under the law, hospitals cannot pursue unpaid medical bills if they fail to publicly post their prices.
In Virginia, a new Medical Debt Protection Act taking effect July 1, 2026, will cap interest and late fees on unpaid medical bills, curb aggressive collection tactics like wage garnishment and liens, and require advance notice to patients of financial support options before taking action.
