Your secrets hurt your mental health. What’s the alternative?

Your secrets hurt your mental health. What’s the alternative?

It was the beginning of the late 1980s. Don and Judy were finally ready to start a family. But, after a few attempts, they realised that they would have to adjust their plan. They would need a sperm donor. And, even before they found one, they had already decided. They were going to have two children, and they would never tell their children that their father was not biologically related to them. This was a secret they promised to each other that they would never tell.

For the past decade, I’ve studied the psychology of secrecy. I know the story of Don and Judy’s secret well because I’m their first child, and I learned about this secret the same day I gave an invited talk about my research on secrecy for a job interview. I was 26, and if you’re wondering what it’s like to learn such a major secret, I’ll tell you this: it was surprising. It was shocking to learn that I was not biologically related to my father nor his parents with whom I was very close. And it was even more shocking to learn that my brother was, in fact, my half-brother, conceived from a different donor. But I had not been the keeper of the secret for all those years. And, while the revelation for me was jolting, the greater impact and harm came to my parents themselves.

Secrets usually hurt their holders most. Keeping a secret is associated with lower life satisfaction, lower-quality relationships, and symptoms of poor psychological and physical health. Our secrets often hurt us, but not for the reasons you might think. While hiding a secret in conversation can feel uncomfortable, the hiding turns out to be the easy part. Simply thinking about a secret outside of a social interaction is associated with feelings of shame, isolation and inauthenticity. These experiences can leave us feeling helpless, at the mercy of our secrets, and unable to cope. And these harms can begin the very moment you decide to keep a secret.

My parents are a good example: the damage wrought by their secret started before my brother and I were born, a time when there wasn’t even anyone to conceal the secret from. The very existence of the secret caused them to worry: what if the children didn’t look like their father? What if they would need to know about their genetics one day? And, after we were born, the secret gnawed at them even more. It was extremely improbable that donor conception would ever come up in conversation when we were young, and so they never had to hide the secret in those early years. But still the secret could nag at them.

My parents told me that it wasn’t until I got older that they ever had to hold back the secret in conversation. In our teenage years, my brother and I would ponder which traits we had inherited from which parent, and we’d ask our parents to weigh in. They said that, even then, the secret was always easy to keep, but it did feel awkward to navigate around it, to hold back something so huge from us. It was after those conversations that my parents would sometimes wonder: should they reveal the secret? Were they making the right decision? The longer they carried the secret, the weightier it became in their minds.

Until recently, the story of secrecy was a short one: secrets hurt us because hiding is stressful.

When I asked participants to recall a secret that currently preoccupied them, they judged the hill to be steeper

A study conducted in the late 1990s asked women who had an eating disorder to conceal it from the interviewer. Without giving away the truth of their eating disorder, the women had to answer questions such as ‘Sometimes people have problems with self-control; is there any part of your life where you have self-control problems?’ and ‘Does anyone (eg, friends, roommates, family) ever tell you that you have unusual eating habits?’ The participants reported that they tried to push away thoughts of their eating disorder, but this was impossible to do while being asked questions like ‘Do you eat regular meals?’ The study purposefully made concealment difficult, and the researchers concluded that secrets hurt their keepers because concealment is difficult.

So, what about secrets that are easier to keep? Fifteen years later, another research team asked participants to answer questions about their ideal dating partner without revealing the gender of that person. This is technically easy to do, as all the participants had to do was say ‘my dating partner’ or ‘they’ instead of ‘he’ or ‘she’. Even so, participants found the experience somewhat burdensome.

Yet the idea that our secrets hurt us mostly because hiding them is difficult and stressful turns out to be wrong. Our secrets do hurt us, but often for other reasons. And holding back a secret in conversation is just a small slice of the pain and stress caused by secrets.

At the same time as those research participants were carefully stepping over the words ‘he’ and ‘she’ in the dating partner study, I was asking another group of participants to simply think about their secrets, and then to do something somewhat strange. I showed them an image of a hill and asked them to estimate how steep the hill was. This was in 2011, two years before I would learn about the major secret my parents had been keeping from me.

In daily life, when people feel burdened, the surrounding world seems more challenging to interact with. It also turns out that when you show people a photograph of a grassy hill, face-on, so that the hill slopes upward and away from them, they aren’t very good at estimating that hill’s incline. And so, my image of the grassy hill was like a blank canvas on which my participants could paint their current experience. If they felt burdened for any reason, I predicted, this should make them perceive the hill as steeper. When I specifically asked participants to recall a secret that currently preoccupied them, they judged the hill to be steeper, compared with those who were asked to recall a secret that was not preoccupying.

My studies found that, when a secret preoccupied the mind, people felt a sense of burden. But my participants were not concealing the secret from an interaction partner. They were not even in a social interaction, and yet still their secrets burdened them. Why?

To find some answers, I developed a list of 38 common categories of secrets. This list came from asking 1,000 people to describe a secret they were currently keeping. With a team of research assistants (my research collaborators and generous friends), we projected as many of these secrets as we could possibly fit on a very large TV screen, and we arranged and rearranged the secrets until we arrived at a set of categories that we could all agree on. Then I asked another 1,000 participants about their secrets, and the 38 categories fit the new data. The list includes secrets about beliefs, family, finances, ambitions, habits, hobbies, discontents (romantic, social, professional, physical), drug use, mental health struggles, violations of trust, cheating, work, relationships, romance, sex, and more. When I show this list to people, they say, on average, that they have 13 secrets from the list.

The hard part of having a secret is that we have to live with it alone

List in hand, I conceived a series of studies. I asked participants to go through the list, and to indicate which secrets they were currently keeping. For each secret that participants had from the list, I asked how many times in the past month had they concealed the secret in conversation, and how many times had they spontaneously thought about the secret outside those conversations. On average, a secret was concealed from others two times in the preceding month, but was thought about outside those conversations four times, so twice as often.

I found that people visited secrets more often in their thoughts than they concealed them from others. This was the case for my parents, too. They told me that they rarely had to hide their secret, but that there were times when they thought about it often, and the secret would weigh on them.

In a follow-up study, I asked participants how much each of their secrets hurt their wellbeing. I found that the more that participants simply thought about their secrets, the more those secrets hurt their wellbeing. However, having to frequently hold back a secret in conversation was not harmful. I find that even secrets that participants never have to hide in conversation can make them unhappy and less satisfied with life.

Why is it that thinking about secrets hurts wellbeing, but not holding back in conversation? Perhaps you can recall an especially awkward moment when someone asked you a question related to your secret, and you had to dance around the truth in order not to reveal it. I’ve been there too but, when it comes to the universe of secrets, this turns out to be a relatively rare experience.

Thanks to the fast-moving nature of conversation, concealment moments are brief, few and far between. The average secret does not come up very often in conversation. And whenever a secret becomes relevant to a conversation, our secrecy intention prepares us for these moments. And so we are quite effective at keeping our secrets hidden. But our secrets exist before those conversations and afterwards too, and this is where the harms seep in.

Without something specific to attend to (a conversation, a work task, a movie) – and sometimes even while you are supposed to be paying attention to something else – your mind can roam away from the here and now. When left free to wander, your mind can cover expansive terrains, but it also tends to visit the same places again and again. When you have a problem not yet solved, you can be sure that your mind will check in on this problem from time to time. How else could you work on it?

If you keep a secret entirely to yourself, then you are leaving yourself only one avenue to work through the secret, and that is in your own thinking. And, unfortunately, a mind unchecked by others’ reactions is more likely to develop unhealthy ways of thinking. The hard part of having a secret is not that we have to hide it in conversation, but that we have to live with it alone.

One of the best ways to reduce the harm of a secret is to talk to someone about it. You don’t have to reveal the secret to the person you are keeping it from, but I find in my research that discussing a secret with a trusted other can make the world of difference. Someone who will be kind, empathic and nonjudgmental will serve you well here. But if you are not yet ready to talk to someone, there are other paths that you can take on your own.

Once you understand how your secrets make you feel, you can channel your emotions toward more helpful places.

In a recent study, my colleagues and I collected responses from 200 participants living throughout the United States. The participants were shown the list of 38 common categories of secrets, and they indicated which they were currently keeping. Some of the most common secrets participants kept involved sexual experiences, violations of trust, discontent (with one’s social life, romantic relationship, physical appearance, profession), and drug use.

We measured how each of their secrets made them feel. Experiences of shame and guilt were among the most common. And so, in a follow-up study, we asked how much the secret makes them feel worthless, small, helpless, and powerless: all experiences associated with shame. We also asked how much each of their secrets makes them feel remorse, regret, and tension over something they have done: all experiences associated with guilt. While both shame and guilt make us feel bad, shame arises when people think ‘I’m a bad person,’ whereas guilt arises when people think ‘I did a bad thing.’

Even though shame and guilt often arrive on the scene together, they don’t leave at the same time

Secrets that participants felt especially ashamed about included self-harm, trauma, and mental health struggles, whereas secrets that participants felt especially guilty about included telling a lie, theft (any kind of taking without asking), and cheating on their partner.

It didn’t matter what the secret was about, but rather how ashamed or guilty the participants felt. The secrets that participants felt most ashamed about were the ones their minds most returned to, and neither shame nor guilt was associated with how often participants had to hold back the secret in conversation.

You would be forgiven for using the words ‘shame’ and ‘guilt’ interchangeably because, quite often, when we feel one, we feel the other. When we judge ourselves to be in the wrong, we can feel deficient and small – shame – and we can feel regret and remorse – guilt. For example, the secrets that evoked the most shame also evoked the most guilt: hurting someone (emotionally or physically) and committing infidelity.

Even though shame and guilt often arrive on the scene together, they don’t leave at the same time. Shame can stick around for longer. The secrets that caused the most shame were the ones that most often lingered in participants’ minds.

But why? When we choose to keep a secret, we avoid whatever punishment would come from the information being known. Except, often, we don’t let ourselves off that easy. People, in general, tend to have a sharp sense of justice, and want to live in a world where those who do bad things get punished for it. And so, when we feel we have escaped punishment, we often feel that we still deserve punishment.

To study this phenomenon, I randomly assigned participants in committed relationships to think about a misdeed they were keeping secret from their partner or to think about a misdeed they had confessed to their partner. Thinking about the secret misdeed made people feel like they still deserved to be punished and this even made them more interested in receiving punishment. Compared with thinking about a confessed misdeed, thinking about a secret misdeed led my research participants to want to deny themselves pleasures. For example, thinking about a secret led participants to feel less comfortable in being the recipient of others’ kind gestures. And the participants who felt they still deserved to be punished were even interested in physical and emotional pain (in the forms of intense exercise, drowning oneself in one’s work, and even spending time isolated from others). In short, one reason to let thoughts of a shameful, upsetting secret take centre stage is because it hurts, and we feel we deserve it.

Based on these findings, my colleagues and I predicted that, relative to the shameful secret, a guilty secret would be easier to cope with. And that turned out to be right. The secrets people felt they could most capably cope with involved secret hobbies, preferences and romantic desire. The secrets people felt they could least capably cope with involved struggles with mental health and trauma.

When we feel ashamed of something, we often try to avoid the problem altogether, but when we feel guilty, we become motivated to do something about it. And so, when people feel guilty, they often want to make amends and learn lessons for the future. When we characterise our behaviour as wrong, we recognise that we can act differently next time, and so we feel capable of doing better.

So how can you move from shame to guilt? In a recent series of experiments, my colleagues and I tried to see if we could help people view their secrets in healthier, less shameful ways. Again, we asked people to examine the 38 categories of secrets, and to report which ones they were currently keeping. We then divided each participant’s set of secrets into two piles.

For half of their secrets, we asked participants which of these three options fit their secret best: 1) I feel ashamed; 2) I feel like a bad person; or 3) I feel helpless. You’ll likely recognise this language because it is all shame-oriented. And the problem with this buffet of bad feelings is that they are all especially unhelpful when it comes to coping. Feeling ashamed might make you want to crawl into a hole and to give up entirely. But such responses don’t address the problems or work toward solving them. When we led our participants to think about their secret through these three shades of shame, it didn’t matter which option participants chose. Simply thinking about their secrets in this manner led them to feel less capable of coping with the secret.

You might wish that the thing you feel bad about never happened, but that wish will get you nowhere

For the other half of their secrets, we showed participants three different options, asking which fit their secret best: 1) I feel bad about something I’ve done; 2) I feel sorry about something I’ve done; or 3) I feel tension about something I’ve done. In this condition, we were hitting participants with a psychological sledgehammer, asking them to read ‘something I’ve done’ three times. Now the feelings on offer, while all negative, related to a previous action. When we led our participants to focus on their prior actions, we pushed them toward guilt. Again, it didn’t matter which option participants chose. Simply thinking about a secret in this healthier manner led them to feel more capable of coping with the secret.

This effect is simple but powerful.

Rather than focus on how bad a secret makes you feel about yourself, think more specifically about the behaviour in question (this is the simple part). You might wish that the thing you feel bad about never happened, but that wish will get you nowhere. Instead, focus on what you can do differently next time, and what you can do moving forward into the future.

And then, like magic, feeling that you are capable of coping well translates to… (drum roll) coping well. When we believe that we can control our emotions, we become more assertive in our efforts to do so – and more effective at staying calm and in control.

Changing how you think about a secret (or any other stressor) for the better will lead you to more actively problem-solve, and this may even include reaching out to others for help. When people feel more in control of their emotions, they report higher wellbeing.

Likewise, my studies find that when you feel capable of coping with your secret, the secret hurts you less, day to day. Often, when we rehash the details of the secret, we are focusing on the past. And I find that when we fixate on the past, thinking about secrets tends to be harmful. In contrast, present- or future-focused thinking about secrets can actually help you chart a better life course. If a secret of yours comes to mind, think about what the secret means for your present, and trace out the different paths you can take into the future.

And that’s where shifting from shame to guilt comes in. My studies show that when people feel guilty rather than ashamed, they become more interested in learning from the past and moving forward from it.

Feeling guilty is a good thing. When people feel guilty, they become motivated to do something about it. You can’t change the past, no matter how much you wish it were so. But you can move in the right direction today, and continue to do so tomorrow.

My parents still regret that they didn’t tell me and my brother sooner about the secret of our donor conceptions. Even though the secret is now out, my parents can still feel bad about it. Fortunately, they don’t. I’ve long assured them that I don’t hold the secrecy against them, and that learning that I’m not biologically related to my dad and his family actually made my relationships with them feel more meaningful, not less; our relationships are not based on a sense of genetic obligation, but rather a deeper sense of family, closeness and love.

While you can’t change the content of your secret, you can change how you feel about it, and that’s the goal.

Is There an Alternative to the High-Deductible Health Plan? Glad You Asked.

Is There an Alternative to the High-Deductible Health Plan? Glad You Asked.

By cutting charges for employers and decreasing or getting rid of
out-of-pocket expenses for staff members, option overall health designs are having market place share from regular coverage. The ideas say they can cut expenditures by steering associates to significant-worth companies.

For more than two decades, businesses and overall health insurers have promoted the idea that health care shoppers should have “skin in the game” by significant-deductible well being options (HDHPs).

HDHPs caught on immediately. But all that skin in the match has intended out-of-pocket costs that are so significant that several individuals skip care, suggests Brooks Deibele, business product sales chief for employee positive aspects at Holmes Murphy & Associates, an insurance policy broker in Minneapolis. In 2023, for example, anyone getting a high-deductible program on the federal marketplace that complies with Very affordable Care Act regulations could have an yearly deductible of up to $9,100. For a spouse and children, the deductible may possibly be as large as $18,200, in accordance to Health care.gov.

But now the pendulum is swinging in the other way, in accordance to Deibele. A developing quantity of employers are obtaining so-known as alternative health and fitness options, several of which do not have large deductibles and lessen or reduce copayments altogether.

“The human being generating an typical wage and facing a deductible of $5,000 or $6,000 each individual yr doesn’t use the health care procedure correctly,” claims Deibele. “Designing a strategy that gets rid of some of individuals obstacles forces people to become correct healthcare individuals.”

Also, these different health and fitness plans expense businesses 10{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} to 15{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} fewer in rates than standard protection, in accordance to Deibele. Any kind of health strategy that gives coverage for fewer than what traditional wellbeing insurers charge will be appealing to businesses wanting to reduced health care prices, notes Suzanne Delbanco, Ph.D., M.P.H., executive director of Catalyst for Payment Reform, a nonprofit firm in Berkeley, California, that encourages value-based mostly treatment.

One way that different well being plans preserve charges down is by working with information on the high-quality and price of healthcare that doctors and hospitals present and then introducing money incentives to steer associates to the best and most charge-efficient doctors and hospitals. Some consultants, having said that, issue regardless of whether the strategies can generate cost savings over the lengthy time period.

However in August 2022, UnitedHealthcare announced that Surest, its substitute wellness strategy featuring, was the speediest-developing plan between its self-insured businesses. Extra than 150 companies in 16 states had been enrolled in Surest strategies, in accordance to UnitedHealthcare. Surest was previously regarded as Bind. Stacy Hintermeister, MBA, senior vice president of promoting for Surest, claims the program has no deductibles or coinsurance and that out-of-pocket expenditures for personnel fall by as significantly as 44{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}. In addition, businesses help you save 15{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} on rates when compared with common health strategies, according to Hintermeister.

Other alternative options contain Coupe Well being LLC, which is remaining presented by Blue Cross and Blue Shield of Minnesota. Five years right after Coupe was founded in 2016, it obtained SimplePay Well being, a different alternate program, from Holmes Murphy & Associates. Gravie, a health added benefits organization in Minneapolis, has an choice program identified as Ease and comfort. And Centivo, an alternative health and fitness system administrator in Buffalo, New York, suggests it will save its employer consumers 15{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} to 30{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} as opposed with common wellbeing coverage. Workforce get totally free major treatment, predictable copayments and coverage without the need of a deductible, in accordance to an announcement from Morgan Overall health, a division of JPMorgan Chase & Co. Bloomberg Information noted that Morgan Overall health has invested $30 million in Centivo. JPMorgan begun Morgan Overall health in 2021 to swap Haven, the joint healthcare enterprise that JPMorgan shaped with Amazon.com Inc. and Berkshire Hathaway Inc. that shut early in 2021.

Pursuing decreased charges

It’s striking that two regular well being insurers — UnitedHealthcare and Blue Cross and Blue Shield of Minnesota — have ownership stakes in alternate health options, states Delbanco. “To me, that just displays that they are receiving fearful about the competitiveness,” she adds.

A growing proportion of insured Individuals are unable to pay for their deductibles, leaving several men and women burdened with healthcare debt, Delbanco notes. “Health insurers have been not able to maintain rates down, and there’s no correlation amongst the price ranges we pay and the top quality of care that folks get,” she suggests. “For all these motives, the common wellbeing insurance coverage product isn’t performing for a lot of people today.”

Deibele agrees, noting that common insurers are viewing the development of option overall health strategies carefully.

Distinguishing attributes

Choice well being strategies are making use of information to determine effective vendors that produce higher-quality treatment (see sidebar, “How two alternate well being options evaluate provider top quality and cost”). By linking this kind of data to monetary incentives, the ideas can steer members to far better and much more successful medical professionals and hospitals, Delbanco says.

“Twenty many years ago, I couldn’t notify you if a service provider was very low high quality, higher expense or higher excellent, lower price tag,” Delbanco notes. “But now, even if the data aren’t ideal, there are info these companies can mine to continue to keep expenses down. Then employees can choose companies that have a observe file for remaining economical and subsequent guidelines, all of which can help save a great deal of money.”

Traditional wellbeing strategies have extended made available numerous healthcare navigation and procuring capabilities to users and extended economic inducements to staff members to go to small-expense, substantial-quality medical professionals and hospitals. But these option wellbeing programs go a stage more by lowering employees’ out-of-pocket expenditures when they pick out the very best suppliers, with “best” outlined as some mix of value and quality metrics.

For illustration, prior to associates select a supplier, Surest presents the true prices members would pay out for additional than 490 health care companies. When those people members opt for large-excellent companies, additional than half get the least expensive selling price for hip substitute, reflux surgical treatment or other procedures, according to Surest. “It could experience like it is an option, but Surest is just like we shop for
all the things else,” Hintermeister notes. “Ultimately, what individuals want is a greater health and fitness strategy, better advantages, and they want to save money.”

Some alternative plans spend suppliers right, shifting that duty from personnel and conserving medical professionals and hospitals from acquiring to chase shoppers for payments. At least two option ideas present lower-charge or no-interest financial loans so that employees can make payments more than time for any costs the designs don’t address.

Expenditures disclosed upfront

By getting rid of deductibles, Coupe Wellness can inform users when they pick out vendors how substantially the plan will shell out and how considerably is their responsibility in conditions of copayments, claims Wally Gomaa, M.H.A., MBA, who co-started SimplePay Well being. For case in point, if a member needs healthcare facility treatment with a higher copayment, the member might will need to shell out a number of hundred bucks relying on the company needed, he points out. “For numerous family members, an out-of-pocket value of $400 or far more is unaffordable,” he says, adding that a no-fascination line of credit rating from Coupe Overall health enables those associates to prevent utilizing a credit card with a superior fascination fee for the copayment. For every single protected treatment, Coupe Overall health utilizes doctor and medical center general performance facts to rank companies on a few concentrations: The crimson amount is Okay yellow, improved and eco-friendly, the best.

Christopher Fanning, president of professional marketplaces for Blue Cross and Blue Protect of Minnesota, describes how these tiers have an impact on payment. “A primary care pay a visit to could price a member $10 to go to a green medical doctor, $30 for yellow, and $50 for pink,” he claims. “Once you make a selection, there is price certainty and an incentive to pick out a greater-top quality company for the reason that you will pay considerably less out of pocket.”

Employers’ general prices for Coupe Wellness are about 14{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} lessen than what they would shell out for a conventional program, Gomaa states, and discounts for workers come out to about the exact percentage. Coupe Well being contracts with administrative company companies to shell out providers specifically for the charge of care and workers fork out their employers for their remaining share of the cost.

In addition, Coupe Wellness contracts with a financial institution to offer funding so that staff and dependents with high health care charges can distribute out payments in excess of months employing no-interest traces of credit rating, states Gomaa.

“In this model, personnel get a month to month statement of what they owe,” he explains. “They can pay the stability in full or pay it in excess of time.”

Ease and comfort, the alternate overall health system sold by Gravie, has a identical attribute. Comfort doesn’t need users to pay back for care. As an alternative, employers pay out a month to month payment for each and every employee enrolled just as employers shell out to classic health and fitness insurers. For that rate, Comfort covers, in total, all the health care companies that the ordinary human being would use every yr, says Marek Ciolko, Gravie’s co-founder and co-CEO. Gravie’s Comfort program is the first zero-deductible, zero-copay well being system, he provides.

“That usually means visits to main care or specialists, lab checks, imaging, urgent treatment and other expert services are all delivered with no out-of-pocket cost at the time of services,” he states. “Our approach design effectively insulates associates from the expense of solutions mainly because that member would access care with no copay or deductible.”

Delbanco claims she’s not absolutely sure if choice plans will have a transformative result on U.S. health care. “But,” she states, “there are quite a few, numerous companies who could be attracted to these designs due to the fact they don’t always want to go back to the times when they made use of to handle a lot of different vendors.”

Option programs may not sign the conclude of HDHPs so significantly as provide as but a different way of shelling out for and masking healthcare costs — an choice, as their name denotes, not a substitute. But they are on the primary edge of the motion towards well being prepare price transparency. For policies that get started Jan. 1 or later on, most group well being ideas have to have to disclose individualized price data to all customers for all protected treatment and providers, according to a new value-transparency rule from CMS.

A health insurance alternative left a pastor with a big hospital bill : Shots

A health insurance alternative left a pastor with a big hospital bill : Shots

Jeff and Kareen King received a hospital bill for $160,000 a few weeks after Jeff had a procedure to restore his heart rhythm.

Bram Sable-Smith/KHN


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Bram Sable-Smith/KHN


Jeff and Kareen King received a hospital bill for $160,000 a few weeks after Jeff had a procedure to restore his heart rhythm.

Bram Sable-Smith/KHN

Kareen King calls it “the ultimate paradox”: The hospital that saved her husband Jeff’s heart also broke it.

What Happened Jeff King, of Lawrence, Kan., needed his heart rhythm restored to normal with a procedure called an ablation — sooner rather than later, his doctor said. Jeff asked the hospital for a cost estimate, but said he didn’t hear back before his scheduled surgery in January 2021 at Stormont Vail Health in Topeka, Kan.

The real pain came when the bill arrived in the mail a few weeks later. The Kings, who were uninsured at the time, were on the hook for nearly all of the cost.

Jeff King, 63, Lawrence, Kan.

Approximate Medical Debt: $160,000

Medical Issue: Heart ablation

Jeff and Kareen King received the bill for $160,000 a few weeks after Jeff had the procedure to restore his heart rhythm.

Instead of signing up for traditional health insurance, the Kings had joined what’s called a “medical cost-sharing plan” with a company called Sedera, which describes its service as a “refreshing non-insurance approach to managing large and unexpected health care costs.” With this alternative to health insurance, members agree to share one another’s expenses. The plans are often faith-based and have surged in popularity in recent years because they can be cheaper than traditional insurance — the Kings said their plan cost $534 a month, plus an additional $118 a month to join a direct primary care medical practice.

But the sharing plans offer fewer protections than insurance and come with provisos. The Kings said their plan did not fully cover preexisting conditions like Jeff’s heart condition for the first two years of coverage — and he needed the surgery after 16 months.

In a statement a Sedera spokesperson said it’s important that members understand the cost-sharing model and membership guidelines. “Sedera members read and agree to these prior to joining,” the statement read.

The Kings have dabbled in all sorts of health coverage in their 42 years of marriage. Jeff’s work as an evangelical pastor in his hometown of Osage City, Kan., almost never provided insurance for the couple or their five children, all of whom are now grown. The exception came during Jeff’s most recent stint leading a congregation, starting in 2015. Kareen remembered feeling “unworthy” of the $1,800 a month the congregation paid for their insurance.

“We certainly had never come up with those kinds of premiums ourselves,” she recalled.

But Jeff decided he had to leave that job in 2018. He said he felt forced out over differences with some of his congregants on eternal damnation (“As a loving parent, I could never punish my child forever”) and gay marriage (“Maybe God is a whole lot more inclusive than we are”).

After Jeff resigned, the Kings briefly bought insurance through the Affordable Care Act marketplace, but later dropped it because they weren’t eligible for subsidies and felt they couldn’t afford it.

That’s when they joined the Sedera plan. They knew the preexisting condition clause was a gamble, but medication had managed Jeff’s heart condition for years, and they didn’t expect he’d need medical procedures to address it.

What’s Broken: Without employer-sponsored insurance or federal subsidies to help fund their coverage, the Kings felt priced out of traditional insurance. But being uninsured left them exposed to hospital charges that ordinary patients typically never see.

Hospital charges are generally understood by health economists to bear little resemblance to the actual prices that are typically paid. Instead, they are more of an opening salvo in the high-stakes negotiations between hospitals trying to get as much money as they can for providing care and insurance companies trying to pay as little as possible.

But patients lack the bargaining power of large insurers, which may cover hundreds of thousands of patients in any given hospital’s catchment area. For patients like Jeff, the main recourse is to go through a hospital’s financial assistance program, although even with that help many patients can’t afford the bills hospitals send them.

Stormont Vail’s assistance program eventually knocked about $107,000 off Jeff’s original bill. Sedera provided a negotiator to help him haggle over costs.

Stormont Vail provided $19.5 million in financial assistance in tax year 2020 and wrote off about $13 million in bad debt, according to tax filings. Its net revenue from patient services was $838.7 million.

Bill Lane, a Stormont Vail administrator, said that in addition to providing financial assistance, the hospital works with patients facing high bills and offers payment plans with zero interest. Payments are often in the range of 10{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of a person’s monthly income,” Lane said. For some patients the hospital has a “catastrophic discount” program that caps their balance at 30{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of their gross household income. The hospital also works with a local bank to provide loans to patients to pay their bills. And the hospital sometimes sends patient balances to debt collection agencies.

Lane said he generally recommends that patients carry traditional insurance. He also said the hospital offers a “patient estimates module” and suggests patients wait to schedule surgery, if possible, if they want an estimate “to make an informed decision.”

What’s Left: Despite Sedera’s two-year waiting period to cover preexisting conditions, the plan did give Jeff $15,000 to help with his bills. After Jeff paid that to the hospital and then negotiated for several months, his final balance was reduced to $37,859.34 in November 2021.

For his payment plan, Jeff said he was told the hospital would accept no less than $500 per month — the equivalent of an additional mortgage payment for the Kings. Jeff estimates it will take the family more than six years to pay it off.

“I never expected this to not cost me anything,” Jeff said, “but I wasn’t expecting what it turned out to be either.”

The Kings are piecing together the funds to pay what they owe the hospital. A few months after Jeff’s ablation, they sold their home in Osage City — where they raised five children and where Jeff grew up — and bought a smaller house in Lawrence. They had hoped to use that money to build their retirement account, since Jeff’s decades of pastoral work didn’t include a pension or 401(k).

Instead, the home sale is helping pay Jeff’s medical debt. Kareen has part-time jobs, and the couple leveraged their life insurance policy, as well.

Jeff began work as a hospice chaplain — for the extra income, but especially to qualify the couple for health insurance. That meant less time for his passion project, running a nonprofit called Transmuto through which he provides spiritual guidance.

In February, Kareen checked again on whether the couple could afford Affordable Care Act insurance so Jeff could get back to Transmuto full time. Her Google searches for the federal government’s health insurance marketplace (HealthCare.gov) instead unwittingly landed her on websites that sell consumer information to insurance brokers. Speaking to one of those brokers on the phone, she bought what she said she was told was an Aetna plan. But it turned out to be a membership in a cost-sharing plan with a company called Jericho Share, which has received over 160 complaints on the Better Business Bureau website in the past year.

Jericho Share spokesperson Mark Hubbard said in a statement that the organization is “issuing full refunds when there is consumer confusion” and is continuing to “evaluate and update our marketing efforts to increase transparency and awareness.”

Hubbard also said Jericho Share is cooperating with regulators in California and New Hampshire that have questioned whether the organization meets state requirements of a health care sharing ministry. California is also questioning whether Jericho Share has indeed received 501(c)(3) nonprofit status from the IRS.

After canceling that plan and getting their money back, the Kings eventually did sign up for an ACA marketplace plan. Jeff has reduced his hours as a chaplain, freeing up more time for Transmuto. All in all, the couple feels pretty fortunate.

“It’s just so tragic the way our system is,” Jeff said. “It puts so many people into impossible financial straits.

KHN (Kaiser Health News) is a national, editorially independent program of KFF (Kaiser Family Foundation).