Experience with access, hospital billing, debt and payment

One in every four Americans struggles to pay medical bills. Please take a moment to share your experience with medical bills and debt from hospitals in northern Vermont and the North Country. All answers will remain strictly confidential, will not be shared with third parties, and will be securely stored and destroyed when applicable.

Have you or has anyone in your household had trouble paying medical bills in the past two years?

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* 1. Have you or has anyone in your household had trouble paying medical bills in the past two years?

Have you experienced any of the following access challenges when you've tried to get care ?

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* 2. Have you experienced any of the following access challenges when you've tried to get care ?

Where did you receive the treatment that resulted in medical bills you had trouble paying? Check all that apply.

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* 3. Where did you receive the treatment that resulted in medical bills you had trouble paying? Check all that apply.

When you had trouble paying medical bills, did the hospital inform you of any financial assistance policies? Check all that apply.

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* 4. When you had trouble paying medical bills, did the hospital inform you of any financial assistance policies? Check all that apply.

What actions did the hospital or provider take to receive payment? Check all that apply.

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* 5. What actions did the hospital or provider take to receive payment? Check all that apply.

If medical billing issues have affected you, a member of your household or a loved one, or you/they were uncomfortable about how the hospital pursued payment, please take a moment and share your experience.

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* 6. If medical billing issues have affected you, a member of your household or a loved one, or you/they were uncomfortable about how the hospital pursued payment, please take a moment and share your experience.

If timely access to needed care in your community has been a problem for you, a member of your household or a loved one, please take a moment and share your experience.

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* 7. If timely access to needed care in your community has been a problem for you, a member of your household or a loved one, please take a moment and share your experience.

What is your age?

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* 8. What is your age?

Which race/ethnicity best describes you?

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* 9. Which race/ethnicity best describes you?

Please mark the category that best describes your household’s total income over the last year, before taxes.

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* 10. Please mark the category that best describes your household’s total income over the last year, before taxes.

Where do you work?

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* 11. Where do you work?

Where do you live?

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* 12. Where do you live?

OPTIONAL: If you would like to be sent the results of this survey or would like more information about efforts to improve staffing and protect access to affordable care, please provide the following:

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* 13. OPTIONAL: If you would like to be sent the results of this survey or would like more information about efforts to improve staffing and protect access to affordable care, please provide the following:

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