In some states, hospitals are required to provide charity care to certain low-income and uninsured patients, but several advocacy groups told me that these patients sometimes get regular bills instead. “We were seeing hospitals sending debtors to debt collections without saying anything to the debt collectors” about charity care, says Emilia Morris, the legal director of Central California Legal Services. “The debt collectors are trying to collect these debts without making charity care available. The patient sometimes gets sued, gets a judgment entered against them, without ever having heard of charity care.”

In a statement, an American Hospital Association spokesperson told me that in 2017, hospitals provided more than $38 billion worth of care to patients who could not afford it otherwise. “Hospitals across the country strive to find ways to help under- and uninsured patients navigate the health system,” the spokesperson said. “Hospitals offer charity care programs, check public assistance to see if the patient qualifies and provide discounts to these patients when possible. Every day, America’s hospitals treat patients who can make only minimal payment, or no payment at all.”

Still, some patients do wind up with medical debt, which discourages them from seeking medical care, because they fear they will incur even more debt if they go to the doctor again. The debt can also worsen people’s credit, which can make it hard for them to live healthier lives by, say, moving to better neighborhoods. In the end, they get sicker, and risk plunging even further into debt.

The $26,203 bill wasn’t the last one Lockett would receive from the incident that April. A separate bill, for two doctors’ consultations during Lockett’s hospital stay, came on April 28, for $1,301. (She provided these bills to The Atlantic for verification.) That amount was added to several more charges, for various X-rays and other diagnostic tests, for a new bill totaling $2,617, which arrived a month later.

Another bill, in May, came from Grady EMS, an ambulance service, for $1,807, for picking her up “from the scene,” as well as “mileage.” This bill encouraged her to leave her feedback in an online survey for the chance to win a $50 Kroger card. Lockett says she called the company to try to work out a deal, and a month later, Grady EMS sent her a new, reduced bill for $1,084. (Grady EMS did not respond to multiple requests for comment.)

Lockett’s attempts to negotiate with the hospital were less successful. On April 26, Lockett received a letter from Chamberlin Edmonds, a service that said it works with Emory Healthcare and claimed it could help her “find government benefits,” such as Medicaid or Medicare, to help pay her bill. This might have led to some confusion. Lockett says she didn’t have or qualify for either Medicare or Medicaid. (Georgia did not expand Medicaid under the Affordable Care Act, leaving about a quarter million low-income adults in a so-called Medicaid gap.) But she thinks her first call upon receiving the bills was not to the hospital, but to Chamberlin Edmonds, which she incorrectly assumed could help bring down the overall hospital bill. (Chamberlin Edmonds’s website no longer exists, and the company that acquired it did not respond to requests for comment.)