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PaperclipPerfector  4d ago (text post)   13593 thread views

Culture War Roundup for the week of November 17, 2025

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Thankfully, it's not a huge dollar figure, but it's the sheer stupidity of clinging to price opacity, which inevitably finds some way to reach into my pocket and pull out more money, that annoys me.

Suggestion: consider not paying. My conversations with a few in the know and my personal experience has led me to the understanding that in the US, in many cases, paying hospital bills is essentially optional. Like many modern systems, it's one that relies on the charity of good faith actors to subsidize deadbeats.

A while ago I went to the hospital to get a scan done. After taking an obscene amount of money from my insurance, I got no less than three invoices in the mail: one from the hospital, one from the hospital's network, and one from a radiologist society or something, all claiming that I owed them money. I never paid out a cent, and nothing ever happened.

I am not a lawyer and I don't know your specific situation, but consider the virtues of simply refusing to pay.

I work in medical administration and billing, and have for many years. This is good advice!

If you have a bill you don't think is fair, or simply can't pay, call up their billing department and tell them that. Say you can't pay this, and ask them what they can do. 9 times out of 10 they will negotiate the bill down (often by more than 50% if you keep poking), or if they're a larger hospital they might direct you to their financial relief program. For a lot of the larger hospitals applying for financial assistance can be well worth it: I make well over the median wage, yet in two different situations I applied and they wrote off my bill, accepting what insurance paid as the full amount.

The secret of medical billing is that there is very little we can do to someone who calls us up and says "I'm not going to pay", so it's worth it to negotiate you down to an amount you are willing to pay. Because otherwise we get nothing. Are there things we can do? Technically yes: we could sue you and try to get a court order to repo your stuff or garnish your wages. But that's complicated, and takes a long time, and isn't guaranteed to work: and more importantly, we get over 80% of our revenues from insurance companies anyway. Any bill a patient is getting is a small piece of the pie, and most medical billing man hours are better spent getting insurance companies to pay up. For one thing, the insurance companies actually have the money!

I'd suggest caution with this, the rules vary state by state and hospital by hospital. Some almost always go "eh" when people don't pay. Some will fuck you.

I know multiple people who got hospital bills sent to collections. Always the same story: they never got the bill and were certain they paid all they owed and got a nasty surprise of collections coming after them for more. I don't suppose that's good for your credit score, if that eventually happens to you.

Happened to me a couple of times. If your portion of the bill is under 500$, they legally can't report it to credit rating companies.

I move locations frequently, so bills got lost in the move. Collections called me twice. But, because they didn't know where I lived, they gave up.

They were small (100-200$) bills, but still. Odd feeling.

I have one of these from an unnecessary test a pediatrician ordered during a visit in which they did not bother to tell me they stopped accepting my insurance. It was a situation where I'm not unable to pay, or necessarily unwilling, but whenever I saw mail or something about it, I said to myself "I should call some offices and demand an accounting about this bullshit before I pay anything", and then it just sort of slipped through the cracks for six months. Now I get periodic emails from a "collections" agency. There has been no impact on my credit score. According to my nurse mother, they are legally not allowed to follow up on it like a regular debt or missed payment.

From what I've heard, they can certainly "send it to collections", in the sense that they can give it to an internal department to harass you about it. But they can't actually sell it to real collectors who ostensibly have a legally enforceable debt that they can collect from you, and who ostensibly have a legal justification to put marks on your credit score. I'd be curious to know if these individuals you know actually got marks from this specifically.

An even if they do, there's an entire playbook for effectively telling these people to fuck off. I've never had to use it, because in my experience, it never even got to the harassment part. Once again I will say that your experience may vary depending on many, many factors, but I would just urge anyone reading to appreciate that fact that just because someone shoves an invoice at you doesn't mean you have to pay it.

From what I've heard, they can certainly "send it to collections", in the sense that they can give it to an internal department to harass you about it. But they can't actually sell it to real collectors who ostensibly have a legally enforceable debt that they can collect from you, and who ostensibly have a legal justification to put marks on your credit score. I'd be curious to know if these individuals you know actually got marks from this specifically.

Not only can they do so, there are debt collectors who specialize in medical debt.

Well, all I can say for sure is that I've never met one asking about the hospital bills I never paid, and that debt collectors are notorious for collecting on things they have no business doing so. Consult your local and state laws.

Like many modern systems, it's one that relies on the charity of good faith actors to subsidize deadbeats.

Not charity. The good faith actors have something to lose -- credit rating, property, time in court if they're sued by the collections agency. The deadbeats don't. So it's anarcho-tyranny. YOU, respectable working-to-upper-middle-class person, must pay those hospital bills. You might be able to knock them down some but you will pay or you will go to the poorhouse. YOU, Mr. Frequent Flyer drug-seeking deadbeat, you're fine, carry on.

They can't sell it to the real debt collectors. They can sell it to medical debt collectors who can't take your property or hit your credit.

My understanding is that there are many cases in which there is essentially nothing substantive that they can do, not even touching your credit score. I don't know if this changes if you, for example, sign something ahead of time that explicitly says you agree to pay with specified remediation if you don't, etc. This is why I urge the poster to evaluate their position for the freedom to decline paying, and consider taking that option if it exists.

My understanding from a lot of searching old reddit threads on the topic a few years ago is that it varies greatly. Sometimes they send it to collections and you can negotiate paying pennies on the dollar. Sometimes the hospital plays hardball and will get a order order to garnish your wages or bank account.

Personally, I'm speaking from two different articles of personal experience:

  1. Knowing both a nurse and an EMT, who have seen the internals of hospital billing and know how the sausage is made, both of whom have advised me to not pay hospital bills if I do not feel like it;
  2. My doing exactly this multiple times, and suffering no negative consequences whatsoever.

I don't know the parameters of how these reddit people were sought after. Perhaps I've seen so much success because I establish myself as a nonpayer immediately. I've heard from sources on the internet sounding credible that there's some arcane legal black magicks wherein one can be bound to a largely fictitious debt by sending its conjurer so much as a single dollar. Some sign on penalty of perjury that they are owed an imaginary debt on the hopes the legal ritual will coerce payment from targets. I'm sure there's a lot of Weird Tricks that people can use to extract money from hapless victims.

However, my personal experience with medical bills has been as follows: I go to the hospital to get something done, I get something in the mail that says something to the effect of "after your insurance paid 100 gorillion dollars, your remaining balance is 10 gorillion dollars, please send check or money order", I throw this demand directly into the trash, and I never hear about it ever again. It goes to the same black void as the jury summons. One time I got three invoices, from three different organizations, demanding three separate pounds of flesh for one thing I got done at a hospital. I ignored them all, and never heard from any of them ever again.

I'm not saying that this is applicable to all bills one can receive from a hospital, or that this maneuver could be pulled in any American jurisdiction, etc. I'm just saying that people getting demands from hospitals should consider their nonpayment options, if available.

It's been said that you can't con an honest man, but this may be another wisdom that modernity has turned on its head.

Looks like it might vary a lot by state: https://old.reddit.com/r/personalfinance/comments/14towop/what_happens_if_you_can_never_pay_back_your/jr5zc7b/

Also "It's relatively uncommon to sue over medical debt for a lot of reasons - including that the patient often doesn't have the money, also because it's easy to make a bogus counterclaim for medical malpractice , and nobody wants to deal with that over an unpaid $1300 invoice."

Example of someone getting wages garnished: https://old.reddit.com/r/personalfinance/comments/ue3xgd/getting_wage_garnishment_for_medical_bills_was/

Do you sign the documents at the hospital they give you where you agree to be responsible for any bills you accrue? If not, how do you talk them out of making you sign?

As someone who works in medical admin: you definitely have to sign documents like that, but we probably won't enforce them. Like, we could take you to court and say "here's the contract, he signed it, he's responsible" and get a court judgement against you, but nobody has time for that, and I don't know of any medical provider who does it. Besides, the court isn't guaranteed to agree with us: they might reasonably rule that because the client was not informed of the exact prices, he can't be responsible for paying them even if he signed a doc agreeing to be responsible. Since most medical companies get the vast majority of their revenue from insurance company payouts, it's just not worth the manhours to go to court against one guy and get a judgment against him that might not even be practicably enforceable.

The best advice is to call their billing department up, say you can't pay, and negotiate a lower price with them. There is a high probability that they will write most of the bill off if you agree to pay pennies on the dollar while you're on the phone with them, because otherwise they know they'll probably get nothing.

Just like ignoring a jury summons, this works until it doesn't. Yes, you can get away with it often. You can also get fucked when someone actually bothers to take the next step instead of saying "Eh, fuck it."

My conversations with a few in the know and my personal experience has led me to the understanding that in the US, in many cases, paying hospital bills is essentially optional. Like many modern systems, it's one that relies on the charity of good faith actors to subsidize deadbeats.

It’s optional if you’re poor or a criminal. If you have fixed, easily confiscated assets like property, a brokerage account etc then I think they can and will just go through the courts and get a lien.

The weirdest I had is when some medical equipment company sent me to collections for an $80 brace. They never billed me the regular way for it in the first place, mind you, they billed the insurance company and when the insurance company wouldn't pay, they just sent me straight to collections. Not even the insurance company's fault in this case; when I called them they said it was covered but I hadn't met my deductible, which I'm sure they told the equipment company too.

They cannot repo your property or hit your credit score. Medical debt is worth even less than regular debt and normal collections agencies won't touch it. Hospitals will happily negotiate your bill down to pennies on the dollar because the chances are, they just won't get anything if you say 'fuck you'.

Acting like an Indian small business owner dealing with contractors will get the debt cleared easily.

So if I’m a respectable middle class person and I don’t want to pay my deductible or whatever, I just email the hospital and say “I don’t want to pay $10,000, how about $500?” and then…they just say “yeah sure, you got us, here’s the link”?

just email the hospital and say “I don’t want to pay $10,000, how about $500?” and then…they just say “yeah sure, you got us,

YesChad.jpg

You call the billing department(call don't email, you need to speak to a person) and say you're not paying the bill they sent you. They will almost immediately begin negotiating the price, because the alternative to half a loaf is literally nothing.

As someone who works in medical admin and billing: this is 100% correct. Anybody who calls me and says they can't pay, I start talking to them about how much they can pay. Because if they decide to just not pay anything there is pretty much nothing practical I can do about that, and we make most of our money from insurance companies anyway so it's not worth the trouble.

I'm honestly not sure about the laws around medical debt; I am reasonably sure that they do not do this, but consult a lawyer first. I am not a lawyer.

I would like to stress that I don't know the exact conditions under which this works—so please take this strategy at your own advisement and peril—but I have had multiple hospital visits in my life so far and have gotten away with paying exactly $0 by simply ignoring demands for money. These were organizations that had all of my info, my insurance, knew where I worked and lived, etc—and so far I've experienced no durable negative repercussions.

Your mileage may vary.

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