What happens if you don't pay medical bills?

The usual path of an unpaid medical bill

Most medical bills do not turn into a crisis overnight. The process is slow, and it often looks like this.

1. You get a bill, then one or more reminder letters or phone calls from the billing office.
2. The office may charge late fees or stop offering a discount, depending on its own rules.
3. After several months, the office may hand the bill to a collection agency, which is a company that is paid to collect old bills.
4. The collection agency calls and writes to you, and it may report the bill to the credit bureaus.
5. In some cases, the office or the agency files a lawsuit to collect.

Every office has its own timeline, so the dates differ. What matters most is that you have choices at every step, and the earlier you speak up, the more choices you have. A short phone call this week can help a lot, even if you have no plan yet.

How an unpaid bill can affect your credit

An unpaid bill can hurt your credit, but not right away. The big credit bureaus now wait a year before they list an unpaid medical collection. They also leave off medical collections under $500 and ones that are paid. These are company policies and not laws, so they could change. We explain more in our guide on whether medical bills affect your credit.

When an unpaid medical bill leads to a lawsuit

A lawsuit over an unpaid bill is possible, but it is rarely the first step. It is more likely when a bill is large and has been ignored for a long time. Each state also limits how long a lawsuit can wait, as our guide on the statute of limitations on medical bills explains.

The Consumer Financial Protection Bureau is a federal agency that protects people who use banks and lenders. It says to answer court papers by the deadline printed on them. A court can enter a default judgment against anyone who does not answer. That is a ruling for the other side because you did not show up, and it is very hard to change once it happens.

A judgment can give the collector more tools, depending on your state. These can include wage garnishment, which means part of your pay is sent to the collector, or a freeze on your bank account. A legal aid office can often help for free or at low cost if you get court papers.

Nonprofit hospitals must follow extra rules

The IRS requires nonprofit hospitals to have a written financial assistance policy. A nonprofit hospital must wait at least 120 days after the first bill before it takes big collection steps. It must also tell you about its help program first. Big steps include reporting you to the credit bureaus, suing you or garnishing your wages.

Once you send a complete application for help, the hospital must pause those steps until it decides. Our guide on hospital financial assistance explains how to apply. These IRS rules do not cover every doctor's office or clinic, so ask each office what it offers.

What to do now, step by step

1. Keep the bill and read all of it closely. Write down the due date, the amount owed and the phone number for the billing office.
2. Ask for an itemized bill, which lists every charge, and check it for mistakes such as a service you did not get.
3. Call the billing office and ask whether the account can be put on hold while you look at your options.
4. Start by asking about financial assistance. Then ask about a self-pay discount, and after that about a payment plan.
5. Write down the date and the name of each person you talk to, and ask for every agreement in writing.

Phone scripts you can read out loud are in our guide on how to negotiate a medical bill. If you cannot pay anything right now, say so honestly. Many offices would rather agree to a small plan than lose track of the account. A small payment each month is better for them than nothing.

Late fees and interest are another reason to act soon. Some offices add interest or fees to unpaid balances, so ask whether yours does and ask to have them removed. Some offices will agree when you set up a plan, and our guide on a medical bill payment plan shows how to ask.

Anyone with Medicare, Medicaid or other insurance should call the number on the bill before paying anything. Sometimes a bill was sent to you by mistake when it should have gone to your insurer.

A bill that is already with a collector

A federal law called the Fair Debt Collection Practices Act still gives you rights. A collector has to send a notice with the amount owed and the name of the original creditor. You can ask in writing for proof that the debt is yours, and the FTC says to do this within 30 days. Read more in our guide on medical bills in collections.

Ignoring a debt that you really owe usually does not make it go away. It also does not make the collector stop calling. Staying in touch in writing is a safer path.

Stay safe while you work on it

If you think you are having an emergency, call 911 or go to the nearest emergency room right away. Do not let a bill stop you from getting care. Hospitals must screen and stabilize you whether or not you can pay. For regular care you can afford, search our directory of cash-pay doctors. This page is general education and is not legal or medical advice.