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I was in total shock, strapped to a gurney in the back of an ambulance.

I had been repeatedly abducted, beaten, and sexually assaulted by a transient man over a period of a year. Completely defenseless and traumatized, I was later groped by a series of predatory homeless men. Defeated, my extreme circumstances elicited an extreme response: I began lying naked on a patch of grass near a busy street in Salt Lake City.

Bystanders called 911. Police and ambulances arrived, and before they touched me the paramedics politely asked me if they could take my vital signs. However, no one ever warned me about the financial duress that I would face when I emerged from my nervous breakdown on the streets.

That burden translated into nearly $4,000 for three ambulance rides between April 2016 and March 2017. These debts wrought havoc on my credit and hampered my recovery from homelessness.

The interest on my uncollected debts damaged my credit score. As a result, stores like Best Buy rejected my attempts to buy a laptop on credit, which would have let me pursue my vocation as a journalist once again. This pulled me further into the catch-22 of credit in America: How can you improve it without already having good credit?

After all, credit is used to gauge everything from job eligibility to rental applications. An estimated 43 million people have unpaid medical debt on their credit reports, and 52 percent of all debt on credit reports relates to medical expenses, according to a 2014 study by the Consumer Financial Protection Bureau.

My story is unusual only because I managed to extricate myself from homelessness, as well as the financial shackles that constrained me during those two long years.

MEDICAL DEBT IS A leading cause of bankruptcy and an increasingly common cause of homelessness. A 2017 survey by Addictions.com found that the top reason for homelessness in South Florida was medical debt.

Once a person becomes homeless, for whatever reason, that lack of housing drastically increases the need for emergency medical care. According to the National Health Care for the Homeless Council in Nashville, Tennessee, homelessness dramatically elevates the risk of illness, injury, and death, which is why people without homes die 12 years sooner on average than the general U.S. population.

Homeless people are also often unable to store medicine, seek out regular medical treatment, or avoid contagion from others staying in shelters. They also find it hard to protect themselves from physical harm, and I endured these risks—psychological as well as physical.

Between November 2014 and May 2016, I spent 442 days at the The Road Home, a homeless shelter in Salt Lake City. Most nights at the shelter, I saw someone being carted off in an ambulance. I will never forget one woman lying down and curling up in a ball inside the shelter's front entrance. I sat down and held her until the paramedics arrived. Most mornings when I stepped out of the shelter, another ambulance was parked at the curb, waiting for the next emergency.

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My ambulance bills ranged from $937 to $1,105 per ride. When asked why the price was so high, Gold Cross Ambulance, the private company that transported me during my homelessness, did not respond to requests for comment. Similarly, The Road Home would not speak to me on the record, with its marketing director supplying a written response that they have “many community partners that play important roles in providing support for people who come through our doors, including emergency medical services.”

While there's no detailed ambulance cost data in Utah, anecdotal evidence shows that I am not alone.

Kenyon House, a soft-spoken 31-year-old who is spending his nights at The Road Home, had much the same experience.

When I took him to lunch on his day off from working as an attendant at a gas station convenience store, he told me how he had accumulated four ambulance bills during his homelessness. He said he had no idea how much he owed and that he was saving money for a place to live. But even if he wasn't paying attention, the debt remained, ready to frustrate his attempts at financial and mental recovery.

Each of the ambulance rides was the result of House's extreme pain and anxiety, which he said he experiences when he tries to stop drinking and his body goes into withdrawal. House recalled that his trauma started when as a child he was beaten and ostracized by his family for being gay.

Now, when House drinks, he knows he is still trying to deaden that pain, which is compounded by the anxiety of living in the chaos of a homeless shelter where he is rarely able to sleep. At the time of our interview, he told me he had been sober for three weeks, but he was unsure whether he could maintain his sobriety.

“I'm trying to stay clean,” he said. “I need a place to live before I can deal with anything else.”

Bad credit has since put up roadblocks to this important step. House has recently been denied acceptance into two different apartment complexes, due to his 560 credit score. He told me he sometimes thinks about giving up, but is doing his best to “stay strong.”

EVERY HOMELESS PERSON is homeless in a different way. For example, I was never an addict. Yet, like House, I was focused while homeless on the bottom tier of psychologist Abraham Maslow’s theoretical hierarchy of needs: food, water, warmth, rest.

As important as they would turn out to be, credit scores were my last concern.

The explanation is simple, according to G. Robert Watts, chief executive of the National Health Care for the Homeless Council: “Most homeless people have to ignore medical bills because they have no way to deal with them.”

Some homeless receive insurance through Medicaid or access debt relief through indigent care and hospital forgiveness programs. Others, however, have no insurance and no one to advocate for their future financial health, Watts said.

I didn't.

The moment I had my own roof over my head, I began working on improving my credit, which had dipped into the low 600s, a score considered by the three official U.S. credit bureaus—TransUnion, Experian, and Equifax—as “fair.” First, I paid off a $159 cellphone debt. I was earning $11 an hour as a part-time grocery store clerk at the time, so the step was significant.I did not try to pay off the ambulance bills, as I was barely able to pay for my necessities: rent, food, a car note, car insurance, and the trauma therapy that was helping me walk out of my collapse.

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Unable to qualify for any other kind of credit card, I paid $100 for one that was secured. Six months later, I applied for and received an unsecured credit card with a $500 limit from my credit union. Slowly, my credit scores rose into the high 600s and I began earning a little more money in better-paying jobs. Then, an old line of credit dropped off my reports due to nonuse, and my score plummeted by 82 points.

The only way I knew to raise my score was to increase the limits on my credit cards. But the company that owned my secured card said that wasn't possible, and my credit union wouldn't approve an increase until I decreased my debt. Meanwhile, when I filled out a rental application for my first apartment after I'd been homeless, I was asked to pay an extra $676 security deposit because of my credit history involving collections by the ambulance company.

I was doing everything right, but I was still cash and credit poor.

In December 2018, I decided to try to take action. I booked an appointment at AAA Fair Credit Foundation in Salt Lake City, a nonprofit organization that predominantly serves low-income people. After going over my credit reports, two financial advisers noticed that two of the ambulance rides were placed for collection on the same day, for almost the exact same amount. Perhaps that was a mistake?

I had to do a lot of research to find the specific dates and times of each ride, which my financial counselor at AAA, McKenzie Walsh, said was common.

“Some homeless people who have been taken in ambulances are unconscious,” she said. “They can't even remember having taken the ride, as they were either assaulted, raped, or so drugged out they can't remember anything.”

Because of this, Walsh was familiar with what I needed—so-called debt validation letters. She helped me write them to the collection agency that had bought my debt from the ambulance company. I sent the letters by certified mail. Within weeks, two of the three ambulance bills had been dropped from my record and my score rose into the low 700s. The average credit score in America is 687, according to the credit bureau Experian.

Finally, my credit union approved a $1,500 increase on my credit card, which raised my score even more, to the mid-700s.

Walsh said her clients rarely enjoyed such quick success. She remembered one in particular, a homeless woman who was living on the streets, who could not escape her credit history. She had multiple collection debts, some of them medical, including ambulance debts. “We took a look at her credit, and she was just being rejected by everyone for everything,” Walsh said.

Walsh helped the woman investigate which of her debts could be disputed. Then the woman ran straight into the kind of walls that prove insurmountable for so many of the homeless: her lack of a physical address to which the debt collectors and credit agencies could send letters, her inability to regularly access an email account, and her lack of funds to cover the cost of sending the certified letters.

I was in better shape, so much so that Experian dropped my remaining $1,039 ambulance bill from my credit report, because the collection agency had not responded to my debt verification request within the 30 days required by law, something I also learned from the counseling service. In my second appointment at the fair credit foundation, Walsh helped me write a deletion request letter to each of the credit bureaus to ensure the expungement of those outstanding debts.

Suddenly, I had gone from being a woman struggling to emerge from homelessness to one who might qualify for a low-interest home mortgage loan.

Still, as happy as I am about my success, I always wonder: What about the other homeless people who also took ambulance rides to hell?

This article was supported by the Economic Hardship Reporting Project.

Click here to read some Facts and Fallacies about credit scores