A student sought counseling help after panicking over a tuition bill. A weeklong stay in a psychiatric hospital followed — along with a $3,413 bill. The hospital soft-pedaled its charity care policy.



It's time for our medical Bill of the Month, and this time, it also involves college tuition, another dreaded expense. Dr. Elisabeth Rosenthal, editor-in-chief of Kaiser Health News, is here to tell us about it. Hi, Elisabeth. Welcome back.

ELISABETH ROSENTHAL: Thanks for having me.

MARTIN: Who are we hearing from today?

ROSENTHAL: Today, we're hearing from Divya Singh. She's a first-year college student. And like a lot of college students in the pandemic, she's had to deal with a lot of mental health issues in the middle of her academic semester.

MARTIN: Which has been so difficult for so many people, right? Dan Weissmann hosts the podcast "An Arm And A Leg," and he talked to Divya. Let's listen to their conversation.


DAN WEISSMANN: Comedy drew Divya Singh to the U.S. from India last year. She loves Amy Schumer, Sarah Silverman.

DIVYA SINGH: Everybody who has a Netflix special, basically.

WEISSMANN: For college, she wanted to be near New York City's comedy scene, and she got into Hofstra University on Long Island. But starting school in a pandemic - not much to laugh about.

SINGH: You're not allowed to go to anybody else's room. It's hard. It's really hard.

WEISSMANN: And Divya's had other worries. The day before Halloween, she called the school's mental health line because she was overwhelmed about money. Her family back in Mumbai had been having trouble getting her tuition together. A few weeks before, they'd had to pay a penalty because the first installment was late. Another time, she had skipped dinner because the money to refill her meal card hadn't arrived on time. Now she had a new email from the university.

SINGH: OK, you're officially late on your last installment of tuition. And this time, it also came with a warning that if you don't pay it soon, you will be kicked out.

WEISSMANN: She ended up at the counseling center. After an hour of venting to a psychologist, she says she just wanted to go to her room and rest, but the counselor wasn't letting her go.

SINGH: He said, like, because of what you've told me, you can just leave at the moment.

WEISSMANN: He said, you mentioned suicide occurred to you. I've got to send you to a hospital. They kept her for a week. She did not find it therapeutic. She got out, finished the semester, her tuition money came through just in time. The first thing she saw on January 4 was an email with great news. She had all but aced her last exams.

SINGH: I'm like, oh, my God, this is such a great day.

WEISSMANN: And then she walked by her physical mailbox and saw an envelope from the hospital.

SINGH: I opened it up, and I see it's a bill for $3,500. The letter fell from my hand. It took me a couple of seconds. I picked it up, took the bill with me inside and just cried.

WEISSMANN: And then she got mad. Getting hospitalized had not been her idea, and it hadn't been a good idea as far as she was concerned. Even if her family could find another $3,500, she wanted to put up a fight.

SINGH: You got to because I don't think you get anything unless you, like, yell for it in this country. Like, I've been here for five months, and I've realized that already.

WEISSMANN: Coming to the U.S. had been a gutsy move for Divya. She had a history of panic attacks. Moving halfway around the world to start college in a pandemic - not for the faint of heart. And then there's the money.

SINGH: I still remember the immigration officer when I landed in Newark Airport actually said, like, $70,000 a year for Hofstra. Do you think it's worth it? I was like, let's see. Like, that moment still sticks in my head, especially after everything that's happened. I'm like, no, no, it is not. I am - but I don't know what to do.

WEISSMANN: For now, she's making her way through her second semester of college. For NPR News, I'm Dan Weissmann.

MARTIN: So, Elisabeth Rosenthal, I mean, that sounds like a total ordeal for someone who did something very brave - right? - just coming to this country, going to college here. What did Divya end up doing about the bill?

ROSENTHAL: She didn't know what to do. She's thousands of miles from home, unfamiliar with U.S. medicine, trying to just make it through a pandemic. And a lot of college students are dealing with a ton at the moment. They're very vulnerable, but they may not know it. Like, she didn't know that there are things you can do when faced with a medical bill you can't pay.

MARTIN: OK, so like what?

ROSENTHAL: Well, first of all, there's charity care. Every nonprofit hospital has to offer it by law. And about two-thirds of hospitals are not-for-profits. But it's often in the fine print and buried on a website. And, you know, by the way, I hate to call this charity care when it involves, as it so often does, an outrageous bill for a treatment that the patient never consented to.

MARTIN: Right, right. So who is eligible for getting help, getting a bill reduced?

ROSENTHAL: More people than you think since U.S. health care is so damn expensive. Middle-class families can qualify at the hospital where Divya went for reduced fees. It's the law that hospitals have to offer these kind of discounts or free care in exchange for their not-for-profit status. That's part of the deal. The problem is hospitals don't want you to know that. They want you to pay so they don't advertise that option.

MARTIN: Do we know what happened with Divya, with that huge bill?

ROSENTHAL: Well, after our reporters called, the hospital looked into it and said, oh, a student without income - as if they hadn't known that before - she's eligible for Medicaid in New York. So no more bill. Medicaid is picking up the balance.

MARTIN: Dr. Elisabeth Rosenthal, thank you so much for bringing us the story. We appreciate it.

ROSENTHAL: Thanks for having me.

MARTIN: If you have got a bill making you yell, please go to NPR's Shots blog and write to us. Transcript provided by NPR, Copyright NPR.