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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:
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/
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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.
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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."
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