After an emergency gall bladder surgery back in 2016- when Bethany Birch was 23 at the time- she lost her housing in Kingsport, TN and crashed with family for a few months. Without insurance, Birch spent years avoiding any medical care for fear of bills that she couldn’t afford. Two years later, she was served a lawsuit and owed over $11,000.

I photographed Bethany for Bill of the Month, a monthly series investigated by KFF Health News and NPR.