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Tamesha Auxier holds her newborn son, Jackson, at her grandparents’ home where she now lives. Ms. Auxier is one of many area residents being taken to court by Heartland Health over a failure to pay bills.

When lack of insurance or low income prevents payment of medical bills, patients can find themselves tied up in a lawsuit.

In St. Joseph, those on the receiving end of that litigation complain of the treatment they’ve received from a collection agency for Heartland Health. The issue has led to a federal lawsuit claiming that Heartland is in violation of Fair Debt Collections Act.

Three former patients, though not involved in the pending federal lawsuit, know what it’s like to fight illness one day and fight a collection agency the next. They described the experience as stressful and frustrating.

“They’d call you at least 14 times a day, all the way up to 10 at night,” Tammy Wells said of Heartland’s collection agency.

Ms. Wells said she and her husband, Kevin, have accrued about $3,000 in medical expenses from when she gave birth to her daughter and from repeat visits when her child was sick. Before her court date, Ms. Wells said she got a bill for those expenses in the mail at least every three weeks and received phone calls more frequently than that.

Ms. Wells, who said personal bankruptcy is a possibility, said the family often feels harassed by the debt collectors, especially because additional bills sometimes come for amounts that have already been paid.

“They want their money before we put food on the table,” Mr. Wells said.

A top official with Heartland Health said turning a patient over to the collection agency, known as Northwest Financial Services, is a last resort that comes after several unsuccessful attempts at contacting the patient to work out a payment solution. If the hospital didn’t collect some of its unpaid bills, more of the cost would be shifted to patients who do pay, said John Wilson, chief financial officer for Heartland.

“We also have this obligation to those that have the ability and do pay their bills to try to collect from those that have the ability and don’t pay their bills,” Mr. Wilson said.

Those who say they can’t afford to pay their bills report having to cut back on food and other necessities as medical bills mount and the collection agency gets more persistent.

Carol Seever said she owes $30,000 for a heart attack that resulted in a weeklong hospital stay a few years ago. She said a lawyer representing Northwest Financial Services offered her a $300-a-month payment plan, which the judge approved even though she had never agreed to it.

“It was just harassing,” Ms. Seever said of the experience.

In order to make those $300 payments, Ms. Seever said she would have to set aside money she normally uses for food before even earning it. She said she was not offered any alternative to that payment plan.

Without insurance, Ms. Seever has not been able to meet the payments. Since the original lawsuit was filed, she has made return visits to Heartland and acquired more medical bills but has not heard anything about those expenses.

Tamesha Auxier also has past medical bills at Heartland from a miscarriage she suffered in October 2007. Ms. Auxier said she owes less than $3,000 but could not pay it off immediately because she was on bed rest.

In January, Ms. Auxier filled out paperwork to get help with the bill, according to what her Missouri Medicaid caseworker told her, but said she still would receive as many as 50 calls about the bill in one day.

“Once they started calling it was like they just kept hitting the re-dial button every day and they wouldn’t stop,” she said.

After mailing paperwork back and forth with the collection agency, Ms. Auxier said she finally just kept it and has only heard from the hospital a few times since.

Once she is released by her doctor, Ms. Auxier said she plans to get a job and start making payments on her bill.

“I don’t have a car, I don’t have a house, I don’t have anything,” she said of her current situation. “I’m only 19, I have nothing.”

Suzanne Shepherd, leader of patient financial services at Heartland, said the hospital goes to great lengths to find a payment program or financial aid to help patients with their bills, though patients need to initiate that process so that the hospital knows they need assistance. Ms. Shepherd said that depending on the circumstance, a patient’s balance might be reduced or even taken care of completely.

Charlie Shields, chief marketing and communications officer at Heartland and a state senator, said Heartland officials could not discuss Northwest Financial Services, partly because of the agency’s involvement in the debt-collection lawsuit.

In its legal response to the federal lawsuit, Heartland denied that it violated debt collection guidelines and argues that the lawsuit does not merit class-action status. Heartland, in its court filing, admitted that it owns a corporation called Midwestern Health Management and shares offices with it.

Heartland admitted that Midwestern Health is registered as owning Northwest Financial Services but denied allegations that Northwest is closely affiliated with the hospital. Heartland denied “controlling” Midwestern Health.