Is it common in the US not to pay medical bills?
"Is it common in the US not to pay medical bills? Certainly not.  What some might do, however, is not pay them immediately, with the intent to negotiate them down or get them written off.  You can also see if there's a discount for paying immediately - I've had moderate success with this, but it was during a time where we couldn't pay them all immediately, so I was more trying to figure out which ones to pay first rather than just haggling.   The obvious risk is that they go to a collections agency and get reported as unpaid debt to your credit.  I'm with you, however - it's a service that you received and it should be paid. I must precise that they are wealthy upscale members, who can afford paying these bills. Are you certain that they have large medical bills?  I suppose it's possible that they have resources that  can negotiate these on their behalf, or they don't care about the impact to their credit score. But to say ""no one is doing it here"" seems ludicrous." "In addition to the good answers already provided, I want to point out that many (most?) providers will handle filing your health insurance claim for you even though it's really your responsibility. So here's how medical bills ""you don't have to pay"" might come about: * It's possible that your balance is $4, or $20, or $65, or even still $100 depending on your particular insurance plan. Whatever is left at this step is what you pay." There are some uniquely American issues in this question (and answer), but some general principles as well. Regarding the comment that you quoted, the context (some of which you excluded) needs some clarification. "Is it common in the US not to pay medical bills? Or do I misunderstood what had been said? I would feel comfortable saying that most people who face medical bills don't pay them.  They are unable.  If they were able, they would have gotten medical insurance.  In America, something like 55% of individuals do not have even $500 of savings, so when a big medical bill rolls in especially on top of lost work hours, they don't have a lot of options.  Hospitals charge reasonable prices to insurance companies and Medicare. These fees are negotiated in advance and reflect the hospital's actual costs.  This is called ""usual, reasonable and customary"".  Hospitals charge a wildly inflated, criminally outrageous ""cash price"" to the uninsured. For instance back when Medicare paid about $175 for an ambulance ride, a friend was billed $1100 for the exact same thing.   The hospital aims to scare the living daylights out of the patient (caring nothing about what that does to their health!) Perfect world, the patient pays them the $1100 instead of paying their rent.  If the patient puts up a fight, they hope to haggle them down to something like $400, remember it really costs $175. This tactic is a huge profit-center for hospitals, even the ""charity"" hospitals, and they feel justified because so many uninsured don't pay at all (the hospital considers them ""deadbeats"".) Well, patients don't pay because cash prices are unreachable, so they just give up. Anyway, your friends are correct, don't even think of paying those cash billing amounts. Research and find out what Medicare pays, offer 60% of that, and haggle it to 100%.  And sleep well knowing you paid what is fair. Not all services are as overpriced as my example, but most are at least 50% too high.  The hospital does send you all the bills as a formality, even while they submit them to your insurance company. And then the insurance company usually pays them, so it is correct to ""not pay that bill"". A lot of medical offices will check with your insurance company even before you leave the office, and ask you to immediately pay anything the insurance won't cover.  For instance they often have ""co-pays"" where you pay $20 and they pay the rest. To be clear: if your insurance company negotiates a rate with the hospital, say $185 for the ambulance ride, that is your price, which you are entitled to as a member of that insurance system. A lot of people get their livelihood from the inefficiency in medical insurance and billing.  Their political power is why it's so hard for America to install a simpler system (or even replace Obamacare in an ideal political environment).  It is also a big part of why America spends 18% of GDP on healthcare instead of 7-11% like our European peers who do not have to account for every gauze or rebill multiple insurers.  Sorting out ""who pays"" would be expensive even if everyone did pay." Is it common in the US not to pay medical bills? Or do I misunderstood what had been said? There has definitely been a misunderstanding as it is not that common for people to not pay medical bills. Yes, there are those that cannot afford to pay them, and that does contribute to increasing prices, but overall people do pay. I think there is an aspect to this that has not been covered by the other two answers. What is common, at least in my experience, is that medical providers (i.e. doctors, hospitals, radiology, etc) are much more likely to work with you on establishing a payment plan than utilities, credit card companies, banks, etc are. This is different than holding off payment in the hopes of negotiating a reduction in payment. I am speaking of paying the total amount, but over multiple payments, and without a penalty for paying over multiple payments. And usually they will ask you what you can afford. If you can pay $50 per month, likely that will work. And even what I do that and call to pay the monthly amount, they will ask if I will pay that or some other (including lesser) amount. Also, if I skip a month (usually from forgetting, not intentionally) there is again no additional fee. This doesn't cover ALL providers, but so far has been consistent across all of the ones I have used. I suspect this is what your colleagues were referring to. "What you have here is an interesting argument. Right now, this is totally complicated by the state of ""forced insurance"" that is currently in such hot debate right now.  As a general rule of thumb though, most Americans pay their medical bills in one way or another. Though It is also accurate to say that most Americans have avoided paying a medical bill at one point or another.  I will give an example that will help clarify. My wife gets a Iron infusion shot one every year or so. We choose not to have insurance. The cost to us is around $275. We know this upfront and have always paid it up front. Except for one year. One year we had insurance. The facility that does the infusions charged us $23,500 to do the infusion that year. The insurance paid $275 to them. We refused to pay the remaining  $23,225.  This is a real example using real numbers.  SO while we are more then able to pay the ""normal"" amount, and we could, in theory, pay the inflated amount, We out right refuse to.  The medical facility tried to negotiated the amount down to $11,000 but we refused. They then tried to talk us into a credit plan. We refused. Then they negotiated the entire thing down to $500. We refused. Finally, after 2 years of fighting they agreed that the service had been pair for by the insurance. And sent us a $0 bill.  The entire time, that facility was more then willing to keep doing this annual service for $275.At no time were we denied care. We did have a dent in our credit for a while, but honestly it didn't matter to us. Wrap Up It is fair to say that most Americans do pay their medical bills, but it is also fair to say that most Americans do not pay all their medical bills. The situation is complicated, and made more so by recent changes.  Heath insurance is the U.S. is nearly criminal and while some changes have been made in recent years the same overriding truth exists. Sometimes, a medical bill, when going through insurance, is just plain silly, and the only recourse you have as a customer is to not pay it, for a while, till you get it sorted out." Personal story here: I ended up at the Santa Monica hospital without insurance and left with a bill of $30k-$35k. They really helped me, so I felt like I had a duty to pay them. However, close inspection revealed ridiculous markups on some items which I would have disputed, but I noticed that I had been billed for a few thousands of services not rendered. I got very mad at them for this, they apologized, told me they'd fix it. I never heard back from them and they never put it in collection either. I'm assuming they (rightfully) got scared that I'd go to court and this would be bad publicity. Sometimes I feel guilty I didn't pay them anything, sometimes I feel like they tried to screw me. "My answer might be out of date due to the Affordable Health Care law.  I will answer for the way things were prior to that law taking effect. In my experience, hospitals have a financial assistance program you can apply for.  If you can show a financial need, the hospital will only charge you a certain percentage of your bill.  A person with a very low income will likely only be charged 5 or 10% of the theoretical balance.  That would be assuming the person is at or near the poverty level (which has an official definition -- but to give you an idea, your cashier at McDonald's is probably at or near the poverty level). Also note that sometimes it takes a while for hospital charges to be submitted to insurance, and to be approved and paid.  Thus, many people have learned through experience to ignore the first bill that comes in from a hospital, and wait a month before paying. There can be a dramatic drop in the ""What you owe"" line after the insurance company responds, and the billing office adjusts the bill to the negotiated amount and subtracts off what the insurance company covered." "While it is not common, it is also not ""uncommon.""  A subtle distinction. If you are poor, you almost certainly get some kind of government assistance (not even talking about Obamacare or Trumpcare, but just general assistance.) If you are middle class or rich, that is where you get hit the most.  They seem to realize you ""can't get blood from a stone"" and don't try to get payment out of poor people. But middle class and rich people, yes it just takes longer but they do hang in there with billing. My own experience is that years and years ago (way before Obamacare) I had a time in the hospital with a lot of tests, but I was poor and sleeping on a relatives floor at the time. I got all the tests I needed, and they took great care of me, and the hospital wrote it off as ""charity care."""
Well, if someone who owes me money defaults, I lose the money he promised to pay me.    To me that would be a huge moral obstacle for declaring myself bankrupt.  I was raised in believing that you keep your promises. So how does that work when you're past retirement age? Do you just keep paying huger and huger sums for insurance, or are you covered by your pension plan (if you have one)?  Or do Medicare and Medicaid cover everything (i.e. you don't have to pay)? In which case if you move to Latin America, you could get stuck with a big medical bill, but not if you stay in the States? The chronically ill should be seeking out charities not insurance companes. Since companies are into making profit and paying thier employees. While someone who is already fucked is a hugely bad bet for a new client. I'ts nothing personal just the way things are. Your rights end where someone else's rights begin. Meaning you can't force other people to pay your way through life. As much as being able to breath is an achievement for some it does't entitle people to a free ride at someone else's expense. I would say generally, the answer is No.   There might be some short term relief to people in certain situations, but generally speaking you sign a contract to borrow money and you are responsible to pay.  This is why home loans offer better terms then auto loans, and auto loans better than credit cards or things like furniture.  The better terms offer less risk to the lender because there are assets that can be repossessed.  Homes retain values better than autos, autos better than furniture, and credit cards are not secured at all. People are not as helpless as your question suggests.  Sure a person might lose their high paying job, but could they still make a mortgage payment if they worked really hard at it?  This might mean taking several part time jobs.  Now if a person buys a home that has a very large mortgage payment this might not be possible.  However, wise people don't buy every bit of house they can afford.   People should also be wise about the kinds of mortgages they use to buy a home.  Many people lost their homes due to missing a payment on their interest only loan.  Penalty rates and fees jacked up their payment, that was way beyond their means.  If they had a fixed rate loan the chance to catch up would have not been impossible. Perhaps an injury might prevent a person from working.  This is why long term disability insurance is a must for most people.  You can buy quite a bit of coverage for not very much money. Typical US households have quite a bit of debt.  Car payments, phone payments, and either a mortgage or rent, and of course credit cards.  If income is drastically reduced making all of those payments becomes next to impossible.  Which one gets paid first.  Just this last week, I attempted to help a client in just this situation.  They foolishly chose to pay the credit card first, and were going to pay the house payment last (if there was anything left over).  There wasn't, and they are risking eviction (renters).     People finding themselves in crisis, generally do a poor job of paying the most important things first.  Basic food first, housing and utilities second, etc...  Let the credit card slip if need be no matter how often one is threatened by creditors.  They do this to maintain their credit score, how foolish. I feel like you have a sense of bondage associated with debt.  It is there and real despite many people noticing it.  There is also the fact that compounding interest is working against you and with your labor you are enriching the bank.  This is a great reason to have the goal of living a debt free life.  I can tell you it is quite liberating. From accounting perspective, an unpaid bill for internet services, according to the Accruals Concept, is recorded as a liability under 'Current Liabilities' section of the Balance Sheet. Also as an expense on the Income Statement.  So to answer your question it is both: a debt and an expense, however this is only the case at the end of the period. If you manage to pay it before the financial period ends this is simply an expense that is financed by cash or other liquid Asset on the Balance Sheet such as prepayment for example. For private persons you are generally given some time to pay the bill so it is technically a debt (Internet Provider would list you as a debtor on their accounts), but this is not something to worry about unless you are not considering to pay this bill. In which case your account may be sold as part of a factoring and you will then have a debt affecting your credit rating. "This is the best tl;dr I could make, [original](http://www.marketwatch.com/story/one-third-of-american-households-cant-afford-food-shelter-or-medical-care-2017-09-27) reduced by 63%. (I'm a bot) ***** &gt; Nearly half of Americans have a tough time paying their bills, and over one-third have faced hardships such as running out of food, not being able to afford a place to live, or not having enough money to pay for medical treatment.  &gt; The State of the American Wallet shows how Americans are saddled with mounting car loan and credit card debt and not saving enough money - even enough to cover emergency expenses.  &gt; The survey included questions on whether respondents could &amp;quot;Enjoy life&amp;quot; because of the way they managed their money, and how often respondents had money left over at the end of the month.   ***** [**Extended Summary**](http://np.reddit.com/r/autotldr/comments/75tq9p/onethird_of_american_households_cant_afford_food/) | [FAQ](http://np.reddit.com/r/autotldr/comments/31b9fm/faq_autotldr_bot/ ""Version 1.65, ~226611 tl;drs so far."") | [Feedback](http://np.reddit.com/message/compose?to=%23autotldr ""PM's and comments are monitored, constructive feedback is welcome."") | *Top* *keywords*: **survey**^#1 **American**^#2 **respondent**^#3 **money**^#4 **how**^#5" It's not that they don't want to pay it, it is that there is now an economic incentive to do it. People can no longer be turned down because of a preexisting condition.   That means that I should wait until I break my arm to sign up for insurance. Then once it's better I should cancel it again. That is simply what makes sense economically. Only people who are sick need insurance if sick people cannot be turned down Sorta. Though it's not every American - just the ones needing healthcare (don't know what percentage that is, but I have not seen a doctor in ten years). It IS enough to bribe the hell out of congress, though, and maintain the current system of keeping insurers between doctors and patients as parasitic gatekeepers. Hey, I was thinking back to that X-Ray you got done at the hospital, that you said was cheaper than 90% of the population. I am wondering if maybe that hospital wasn't one of the many that qualify for DSH reimbursement payments. What could have happened is that they saw that you are uninsured, and made a decision that they would only charge you for the portion that they didn't think Medicare / Medicaid would reimburse. If that happened, it wouldn't even show up on your credit report, as the hospital is the one that would file a credit claim. Likely, if they have to go through this a lot, they wouldn't even waste time filing a credit claim, they would just go after a reimbursement through Medicare / Medicaid. And thus, to you, it would just look like a very small bill, but in reality it would only represent a smaller portion of the true bill.   I would also wonder, if they do a lot of these, if they aren't also one of the hospitals that article I linked to showed was super-inflating the prices of uninsured in the hopes of getting a larger portion reimbursed. If you read all that paperwork they made you fill out at the emergency room, there is probably something in there explicitly stating that you owe any bills you rack up regardless of what happens with the insurance company. They generally have a disclaimer that filing for you with your insurance company is a courtesy service they offer, but they are not obliged to do it.  Ultimately, you are responsible for your bills even if the provider slow-billed you.  Sorry. The main points shine a very bright light on the need for healthcare policy reform, FIR EVERYONE, not just the poor.   - Using a conservative deﬁnition, 62.1% of all US bankruptcies in 2007 were medical.  - Most medical debtors were well educated, owned homes, and had middle-class occupations.  - Three-quarters **had health insurance**.  - Illness and medical bills contribute to a large and increasing share of US bankruptcies. There no legal framework that allows states like the US or countries in Europe to default on their debt.  Should congress pass a law to default the US supreme court is likely to nullify the law. "This is only partly true.  The main problem is that the average person is not a fully informed healthcare consumer.   For example if you go to your local doctor with lower back pain: One doctor might prescribe a whole bunch of expensive diagnostics tests; another might tell you to go to a physiotherapist; and yet another might tell you to take some cheap pain killers and come back in six weeks time if nothing has changed. Most people will have no way of knowing which is the best course of action. Then, in a country like the US which is very litigiousness, all the doctors will recommend the most comprehensive and expensive care-package so that they don't get sued.   Ultimately economists do not work in healthcare and are not qualified to recommend the best financial model for healthcare delivery.  To quote Donney ""Who knew that healthcare was so complicated?"" certainly not the economists." You're not missing anything. Consumer protection in the US is very basic and limited, if at all. So if someone claims you owe them something, it would be really hard for you to prove otherwise unless you actually drag them to court. Especially if there actually was a relationship, and there probably is some paperwork to substantiate the claim. I suggest talking to a consumer issues attorney. In short, no, or not retroactively. There really are multiple companies involved, each of which bills you separately for the services they provided. This can be partly avoided by selecting either a high-end health plan with lower out-of-pocket maximum, (costs more up front, of course) or by selecting a genuine Health Management Organization (not a PPO) which gathers more of the services into a single business. Either of these would result in fewer cash payments needing to be sent.  But I don't know of any way to simplify things after the fact. Even if there was a consolidation service, you would have to forward the bills to them, which really wouldn't be any easier than just paying the bills. (I'm assuming you are in the US, where we have a health insurance system rather than a health system. Other countries may handle this differently.)