AURORA — The ring sparkled: 18-karat white gold, double-banded, with a 1.5-carat diamond at its center. It was the ring that Cathy Woods-Sullivan’s late husband gave her on their wedding day, a family heirloom. Other than their two teenage daughters, it was the most precious thing she had left.

She handed it forward to the pawnbroker feeling sick to her stomach. He looked at her, then at the ring, then back up at her.

“I’m going to hold onto it for a little while,” he said.

But Woods-Sullivan knew she wouldn’t be back.

She needed the money to pay off a debt to UCHealth, Colorado’s largest hospital system and a system that a 9News/Colorado Sun investigation found sues thousands of patients like Woods-Sullivan, often hiding behind the names of the system’s collection agencies.

Taken together, UCHealth and these companies filed 15,710 lawsuits from 2019 through 2023, UCHealth revealed in response to questions from 9News and the Colorado Sun. That is an average of 3,142 lawsuits per year, or more than eight per day.

“They are essentially deliberately using those third-party collection agencies to obscure the fact that they are the ones suing the patients,” said Adam Fox, the deputy director of the Colorado Consumer Health Initiative, a consumer-advocacy group that helps patients in disputes over medical bills. “It makes it really hard for the patient to untangle.”

One of the debt collection companies working for UCHealth sued Woods-Sullivan over a bill from an emergency visit for chest pains. She tried at first to fight in court, then eventually entered into a payment plan to settle the case.

But when the stress of arguing with the debt collector over how much she still owed after every check was too much, she decided she wanted to be done. She looked through her house for something she could sell.

“It was beautiful, beautiful,” she said of her ring. “But I had to do what I had to do. I was tired of getting the runaround.

“It was all I had.”

Woods-Sullivan owed UCHealth $1,634.34.

The health system, which as a nonprofit community institution is exempt from paying taxes, recorded $839 million in total profit last year and collected more than $6 billion in revenue from patient care.

In a given year, UCHealth’s network of 14 hospitals and more than 200 clinics treats almost 3 million unique patients.

From those patients, UCHealth estimates that 99.93% of bills are resolved without involving the courts.

“Our job is to stay out of the courts,” UCHealth’s chief legal officer, Jacki Cooper Melmed said. “That is the very last resort.”

When bills aren’t resolved, the hospital system “assigns” the debt to a debt collector without relinquishing ownership of the debt. The debt collector — UCHealth currently uses two and has used a third in the past — then files the lawsuits against the patients in its own name, which is often nondescript. Credit Service Company. CollectionCenter, Inc.

The debt collector gets a cut of whatever money comes from the lawsuit — Cooper Melmed did not say how much — with the rest going back to UCHealth.

Most often, no publicly available court document contains UCHealth’s name. Woods-Sullivan said she initially had no idea who was suing her.

“It was so confusing to me,” said Woods-Sullivan, who is now a plaintiff in a lawsuit challenging the legality of UCHealth’s debt lawsuits. “I spent two days trying to reach out to people … just going through the process of trying to resolve the issue with the bill.”

The amount UCHealth collects from lawsuits is about $5 million per year, according to the health system. That represents 0.07% of the net patient revenue that UCHealth reported receiving last year.

UCHealth officials argue the lawsuits are an unfortunate necessity in the health care business, where sometimes bills go unpaid and hospitals need money to continue operating.

“I can tell you it is a common practice,” Cooper Melmed said. “I don’t think UCHealth is an outlier here.”

But not all large hospital systems in Colorado choose to pursue patients this way. The second-largest hospital system in the state, for-profit HealthONE, says it does not sue patients over debt. AdventHealth and Banner Health, two other large nonprofit hospital systems operating in Colorado, also said they do not sue patients.

SCL Health, which is a nonprofit like UCHealth, had sued hundreds of patients in Colorado per year under its own name, according to an analysis of court records. But when the system merged with Intermountain Health in 2022, it stopped.

“This was done to better align with our mission,” Intermountain spokeswoman Sara Quale wrote in an email.

An investigation by KFF Health News in 2022 found that about two-thirds of hospitals across the country have policies that allow them to sue or take other legal action against patients, including garnishing wages. But in recent years, major hospital systems in other states have chosen to stop suing patients over medical debt, often following negative publicity.

The Sun and 9News found at least two other hospital systems in Colorado — nonprofits CommonSpirit Health and Children’s Hospital Colorado — that use debt collectors to file lawsuits on their behalf but not under their name. Because of this, it is unclear how often they sue patients.

Some hospitals are more transparent in their litigation. A spokesman for National Jewish Health wrote in an email that, “If a lawsuit is deemed necessary, we use our own name in all matters.”

Cooper Melmed defended UCHealth’s use of collections vendors and the system of having them file lawsuits under their names. She said she believes there is “complete transparency” with patients about where the suits are coming from, and she said having the lawsuits in UCHealth’s name would confuse patients.

“It would make less sense, honestly, to do that because the debt at that point is assigned to the vendor,” she said. “So the real party who has control over the suit is the vendor.”

According to UCHealth, patients receive information about prices and available financial assistance even before their scheduled visit. They then receive as many as seven financial assistance letters, four billing statements and two phone calls before the bill is sent to collectors, who then conduct their own outreach efforts.

Of those who get sued, Cooper Melmed said: “We are talking about the tiniest fraction of patients that we simply cannot partner with earlier in the process.” At least, that’s how UCHealth says it’s supposed to work.

In 2021, Aurora resident Lorena Sanchez was involved in an accident on Interstate 25 just north of Colorado Springs as she, her husband and two other family members were on their way to visit relatives in Mexico.

Sanchez, who was uninsured, was taken to UCHealth Memorial Hospital North, where doctors performed an X-ray and a CT scan, according to medical paperwork she showed The Sun and 9News.

Later that spring, she said, she received a bill for more than $24,000.

She was shocked and began visiting and calling the hospital frequently to ask about financial assistance. Finally, in March 2022, more than a year after the accident, Sanchez received a letter from UCHealth.

“According to federal poverty guidelines and the documentation that we received, your application has been APPROVED for Charity assistance,” the letter stated.

It told Sanchez that she was entitled to a 73% discount on hospital charges. Her $24,000 bill had just become $6,000. It was still a lot of money, but it was massively less daunting.

Then, in July 2023, almost two-and-a-half years after the accident, there was a knock at her door. On the other side stood a man serving her with a lawsuit by Credit Service Company. The amount allegedly owed: $24,528.87.

“I said there’s a misunderstanding,” she said. “There’s something going on.”

UCHealth spokesman Dan Weaver said Sanchez’s experience was the result of billing errors that caused her financial assistance not to show up correctly in the hospital’s billing system. UCHealth has fixed the issue and CSC amended its lawsuit against Sanchez to reflect the lower amount, Weaver said.

Today, Sanchez is still making payments — $150 a month, a rate that will see her pay off the debt around the start 2027. She said she tells friends to avoid hospitals as much as possible, “unless you can’t breathe or you are bleeding.”

This story was done in partnership with the Colorado News Collaborative and KFF Health News. Noam N. Levey of KFF Health News and Anna Hewson of 9News contributed to this report.

The Denver Post is a partner in the Colorado News Collaborative, which is interested in hearing your stories about medical debt. If you are interested in sharing your story for publication, you can email us at newsroom@denverpost.com with “medical debt” in the subject line.