Kelly Gunn: Fighting Cancer and a Broken Billing System

Kelly Gunn, a 46-year-old Virginia resident with employer-sponsored insurance, thought having health coverage would protect her from the financial devastation that goes along with cancer. Instead, after being diagnosed with stage 1 breast cancer in July 2024, she found herself facing unexpected bills, upfront charges before surgery, and medical debt that followed her through recovery.

After moving back to Virginia from Hawaii, Kelly sought care from a medical team she trusted. Like many cancer patients, her first instinct was to focus on treatment, not cost — and the financial reality didn’t hit her until later. “When they tell you that you have cancer, nobody is talking about costs because the first thing you’re thinking is, ‘Get it out of me,'” Kelly said.

Kelly had a high-deductible health plan and contributed to a health savings account. But even with coverage, she quickly learned that cancer care could come with significant out-of-pocket costs.

Within a month of her diagnosis, Kelly underwent a double mastectomy. She later had reconstructive surgery, a partial hysterectomy, and numerous biopsies, mammograms, and follow-up appointments.

Even before she entered the operating room, Kelly encountered the financial side of her diagnosis. On the morning of her mastectomy, as she prepared for an emotional, life-changing surgery, the hospital asked her to make an upfront payment toward her care. “It was around $800,” she said. “Why are you asking me to pay right now, because I’m about to go get amputated?”

As Kelly’s bills continued to arrive, she was stunned to learn the totals. “My jaw dropped to see how expensive that was,” she said about her mastectomy. “It was like a quarter of a million dollars or something like that.” Although insurance covered much of her care, Kelly still faced thousands of dollars in out-of-pocket costs. She paid approximately $2,000 by putting the balance on a credit card, sharing, “I wasn’t done because now I have to pay interest on it.”

For six months after surgery, Kelly focused on recovering. She ignored the mounting stack of medical bills and phone calls waiting for her response. “I just wanted to get better,” she said. “I didn’t look at my bills. I didn’t look at my chart. I didn’t answer the calls when the health care system was calling to say, ‘Hey, you owe money.'”

When Kelly finally answered one of those calls, she was told that if she paid her balance in full that day, the hospital would cut the bill in half. “I was like, well, that’s messed up,” she said. “Why did you just charge me double?” The conversation left her questioning why patients are charged one price upfront, only to be offered a dramatically lower one once their bills reach collections — a pattern she’s seen repeat since. “The second time they gave me 35% off,” she said. “And then the third time they gave me 25% off.”

Although Kelly was ultimately able to pay her bills, the experience made her think about the many patients who face impossible choices when medical debt accumulates. “You feel this guilt because you’re like, I’m very fortunate because I can pay, but there are so many women out there, especially in the breast cancer community, who are homeless or who don’t have access and can’t,” she said.

Her experience motivated her to speak openly about the financial challenges patients face alongside a cancer diagnosis. “I realized this is a system issue, and that’s when I started talking about it because this is so messed up.”

After experiencing how medical bills changed throughout the collections process, Kelly believes patients deserve transparent pricing from the very beginning of their care, not only after they are struggling to pay.

As she reflects on her cancer journey, she shared this message for policymakers: “If a medical bill can be negotiated to 50% after it reaches collections, then 100% was never the real price. Cancer patients shouldn’t have to navigate hidden pricing while trying to rebuild their lives. Fair, transparent health care pricing should begin on the very first bill, not after financial hardship.”