I’m 70 years old and I live with a partial artificial heart and, thanks to New York State of Health and the Affordable Care Act, managed to avoid debt and retain a perfect credit score — but not without great difficulty. In fact, if it wasn’t for the fear of medical debt, I could have prevented the need to replace parts of my heart altogether.

It all started when I took a job with a major national company that promised good health insurance, and I needed that insurance to remove kidney stones — about $38,000 in all was paid by insurance, with me covering the remaining $8,000. I was happy. But then, the company that recruited me — with the promise of good health insurance — was sold to another company that canceled our insurance with no warning, forcing me to get a new, private policy that ridered out kidney stone coverage and cost $850 every two months.

Living and being physically active in the very dehydrating state of Florida, I was soon diagnosed with another kidney stone and staring down a $23,000 bill. I tried volunteering as a patient for medical students, which didn’t work, and then went as far as to look outside the U.S. for an affordable option. Eventually, my doctor told me about a program for uninsured patients — the upfront cost was $4,000 at a local clinic owned by doctors, the same that it would have been had I retained my old health insurance policy. After that procedure, I could no longer afford the $850 every two months, so I canceled that policy. This is when the actual debt — and the fear of more debt — started to impact my life and my health.

Just before canceling my health insurance, I went to a provider for lab work, with the hopes of learning about any potential health problems that might be on the horizon. Things went smoothly at first: I thought it was cool that my doctor, younger than me, was the son of one of my teachers in high school. He did a complete run of blood work and due to New York state law, I went in person to get the results from my doctor. He noticed immediately that he had forgotten to include a PSA test, which he then did and I returned the next week for the results.

This process of getting the test results was supposed to be free, a part of the office visit that I was supposed to pay for as I would normally do. But I asked the doctor a question while there and — heavens to Betsy! — I was charged for a whole new visit because of this one question that I asked but that nobody had warned me would happen if I opened my mouth. The doctor noticed I had high blood pressure and suggested I return weekly to get free checks to see if I needed further treatment.

Because of this surprise billing, to pay for asking a question, and which I couldn’t afford, I quickly decided not to risk another sudden bill, and never went for any blood pressure tests — and that decision almost killed me seven years later as I was climbing Scarface Mountain. But I felt good until then.

During the four months after the testing debacle, I received multiple bills, culminating in a threat that I would be turned over to a debt collector in Massena — I eventually used a credit card to pay the bill before it was due, but it ended up being sent to the debt collector anyway. It was after this process that I learned I had stubbornly high blood pressure, but due to the negative experience with my provider and the fear of accumulating more debt, I didn’t seek additional treatment out of fear that I would end up having to pay for the “free” weekly blood pressure tests offered to me by the provider, who charges you if you merely ask a simple question.

Seven years after all of this happened, I had a medical episode while hiking Scarface. After reaching the bottom of the mountain, my heart exploded due to high blood pressure. I suffered no pain and initially thought I was reacting to a bite by a deer tic, and was very weak and tired, but managed to stumble out of the woods and onto the property of a prison. This was the same day two inmates from Dannemora escaped and when I turned up at the gates of the Federal prison in Ray Brook, they were on edge about me suddenly showing up with a stuffed backpack. (This night was to be moonless and clear of clouds so I decided to climb up to a rock outcropping on the SW side and spend the night admiring the Milky Way, which would have been intense that night.)

I was flown from Saranac Lake to the University of Vermont Medical Center, where I learned that I’d suffered a heart dissection, which blew out a valve and created an aneurysm in the top two inches of my heart. It was repaired with synthetic material and a titanium heart valve was put in to replace the old one. They saved my life.

Fortunately, by this point, I was covered by Medicaid (because of my low income) and the new Affordable Care Act, avoiding a potentially catastrophic multi-million dollar medical bill. (Even if I had my old insurance, the six-hour operation, starting at 3 a.m., would have cost me at least $250,000, which I didn’t have.) But the heart failure itself could have been avoided altogether had the fear of debt not prevented me from seeking proactive treatment for high blood pressure. The reality is that medical debt doesn’t just affect people who get saddled with unpayable bills — the very threat of those bills is enough to dissuade people from getting the treatment they need in order to avoid potentially life-threatening problems down the road.

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Rick Gombas lives in Saranac Lake.