The total cost of Cassandra’s mother’s heart bypass surgery after her second heart attack was $104,398.

In the United States, rising health care costs mean that Americans spend over $3.8 trillion per year on medical expenses, according to the Centers for Medicare and Medicaid Services. For many Americans, this can mean lifelong expenses that can burden generations of family members.

Her mother’s first surgery had already resulted in Cassandra* losing her job as a secretary for a real estate company. After the second operation, with no job, no insurance, no spouse, and nowhere to turn, Cassandra’s mother asked her daughter, a recent grad working as a marketing analyst, for help.

But Cassandra didn’t have that kind of money. She couldn’t even afford to pay her student loans or to live in her own apartment.

Still, Cassandra wanted to help. Her mom had raised her without any financial support and had struggled to ensure that she could pursue her dream of getting into one of the top universities in the country.

She couldn’t sit idly by while bill collectors hounded her mother during such a critical time.

“What kind of daughter would I be?” Cassandra says. “What kind of human would I be? I had to do something. If she knew what I had to do to pay off those bills, I think she would never forgive me.”

For Cassandra, paying down $104,000 meant restarting her life by beginning her own business as a prostitute — a job that could have landed her in prison — or gotten her killed.

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No Other Way to Pay the Bills

Cassandra shared her worries with a few friends. One mentioned knowing someone who worked as an escort in New York, who claimed that she made around $40,000 in three months. Cassandra reached out, and the escort explained how they ran their business, how to find clients, and how to handle security and health issues.

Cassandra tentatively began developing the business end. She bought a website domain and paid for web hosting. Then she uploaded tasteful pictures of herself, along with a bio describing how she enjoyed art museums, trips overseas, and shopping at Tiffany’s.

“It all felt normal,” she recalls. “It was like putting up an online dating profile.”

Two weeks later, her life as a prostitute had begun. She got her first call.

“It was a thrill,” she says. “I emailed him a copy of a contract I found online, and then I had him PayPal me a $1,000 deposit. He sent everything back within minutes, including an additional $500 for an extra hour.

“That night, we went to one of the top restaurants in NYC and saw a Broadway show. It was so exciting! I felt like a princess — until we got back to the hotel and the real ‘job’ began.”

When she went home to her mother’s place, she counted her money: a total of $6,500 for six hours. Cassandra called a collector and paid off the first chunk of what was owed to the hospital’s collection services, and then she went out and filled her mother’s pantry with healthy foods.

“Making that payment was the only thing I could do to keep myself from running out of my skin,” she explains.

“I didn’t sleep well for months after that. But I constantly reminded myself that it was temporary, a means to an end for both my mother and me.”

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Other Ways to Repay Medical Debt

Fortunately, turning to prostitution is not the only way to relieve your debt. There are many ways to satisfy collections agencies without having to use methods you may not want to pursue. Here are some tips from a bankruptcy and debt relief attorney at the Luftman, Heck, and Associates LLP, Matthew Alden.

  1. Pursue the Debt Settlement Option: By having a lawyer negotiate a lower balance with a medical provider, you can avoid having to pay the full balance, which can save you tens of thousands, if not more, in the long run.
  2. Hire a Debt Relief Lawyer: If you’re injured and unable to pay the medical debt, hire a debt relief lawyer to reach an agreement with the medical provider called contingency medical payments. As a result, they cannot bill you or send the bill to collections, until you have received your settlement.
  3. File for Chapter 13 Bankruptcy: This is not the most popular option, but it will help you eliminate extreme medical debt utilizing a three to five year repayment plan.

Paying off the Debt

In her first year in the life of a prostitute, Cassandra picked up six regular clients, which allowed her to pay off nearly $75,000 of her mom’s debt. Part of her income also went to keeping herself healthy and safe.

After a close call one night with a potentially dangerous new client, she began running comprehensive background checks and hired a security guard to join her at the start and end of each date.

She also paid for weekly visits to the doctor and an independent health insurance plan for herself and her mother. All of those business expenses accounted for nearly $25,000 annually.

“I really loved the idea that I was running my own business,” she says. “I started to learn things I never knew how to do in college, like accounting and payroll…But I still wanted nothing more than to close it down.”

Cassandra’s mom, who took about nine months to fully recover, never really questioned what was happening to the bills.

When the phone calls stopped coming, Cassandra told her mother that she had decided to go back to school and use the student loans to pay the monthly payments. She also disguised her life as a prostitute as part of a new job at a startup marketing company.

Meanwhile, Cassandra confided in her regular clients about the situation — and was surprised at their reaction.

“They stopped buying me designer clothes,” she recalls, “and instead gave me gift cards to grocery stores and gas stations, so I could get my mom to a doctor.”

One of her clients even offered to pay off all the debt in exchange for a weeklong overseas trip. She accepted, and after nearly 20 months, Cassandra’s call girl service ended with one trip to Japan.

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The Worth of Selling Yourself

The year after she stopped her business, Cassandra enrolled in an MBA program where she studied nonprofits and found a job as a marketing analyst for a major nonprofit. Her mother made a full recovery and now lives with Cassandra and her new husband.

Cassandra says she has many regrets. “Every day was a regret,” she says. “I don’t like what I did, even if it was for the right reasons.

“Now, I wish I had taken over the debt sooner, gotten a payment plan set up, or maybe even worked with a financial advisor on how I could have solved this without becoming a call girl. I was young and stupid. But it worked out in the end, and I can’t pretend like my life wouldn’t be this great or debt-free if I hadn’t done what I did.”

*Name has been changed to protect privacy.