Don’t forget the possibility of refusing to identify yourself. Without an identity there is no way to bill you. So you just leave and the hospital has no way to contact you. This is the path taken by many, especially the poor.
You tell the hospital to pound sand when they send a five or six figure bill. Very few in the US have $20,000 or so just lying around. The hospital knows that, the court knows that, even the latest version of FICO knows that.
You can ask for an itemized bill, amd usually a bunch of stupid charges go away. You can try and arrange a payment plan.
But really, after a certain point, it doesn’t matter if the bill is $10,000 or $1,000,000, there’s just no money, and there will not ever be that money, and they can cry wage garnishment until their ears bleed but it almost never happens - because there’s no money.
But what happens if someone has a savings and happens to have say $50k in there and then they’re hit with a health issue that incurs a $25k hospital bill? Can they then come after you for payment if you have the money in savings?
When I was younger and made next to nothing, I ended up in the emergency room with a bill I couldn’t possibly afford to pay. I called up the billing dept and told them about my financial situation and they told me to contact Health Quest so I qualify for a discount. It was relatively easy and not only did it erase my previous debt but it gave me a 0% liability for any hospital fees for the next 6mos. The funny thing was that the hospital ended up selling my my debt to collections by that point so every time they called id fax them a copy of a letter and id never hear from them again and after a few times of them selling this debt to other collectors it just got dropped. This was in upstate NY in like 2010 so YMMV.
It can vary heavily like you’re saying. By law, all hospitals must treat all patients who arrive at the ER.
Most hospitals have programs so they can provide care for those who can’t afford it, though. Usually around 20-25% of their revenue is used to cover those patients.
If you qualify for Medicaid, they can backdate your enrollment so you’d be covered even before you arrived at the hospital. Coverage can vary, but this usually should cover all medical bills at no cost.
The big issue usually isn’t people who have no insurance or are too poor. It’s from hospitals treating you while your insurance refuses to pay. Normally this is because the bill was miscoded, but it can also be due to an uncovered treatment, high deductibles and OOP limits, or the insurance just being greedy.
Sometimes the hospital or doctors can work things out to minimize your bills, other times they can’t.
A lot of the protections above came about because of the Affordable Care Act (Obamacare). Before then, there were common horror stories of people who had hundreds of thousands in medical debt because they reached their lifetime maximum coverage - something that’s illegal now. Insurance could (and often would) just tell people they’re on their own from now on because it’s too expensive to keep them alive. Your coverage could be changed whenever the insurance company felt like it. And up until last year, they could make you pay for treatment if an out-of-network doctor decided to pop on by while you’re at an in-network facility.
And even if you do have insurance, the larger companies are being caught auto denying claims (supposed to be an instance company employed doctor reviewing your case and medical history to make determination on if treatment was medically necessary).
They deny first and automatically put patients at a disadvantage. If you do have the skill/time to fight, you’ll likely still only get to a point where you partially pay - and most are too polite/afraid to even appeal a denial in the first place (which is exactly what they are counting on).
The point of a bankruptcy is to move on. You start off at zero again, but you can start building up assets again.
As far as the health issues go, because of the bankruptcy and the ACA you probably qualify for medical care under one of the programs.
Yeah, you get fucked over pretty good. Life goes on because you’re not dead. But everything you had, everything you worked for, is gone. You are left literally with life, not with your life.
For all its faults the ability for an individual to declare bankruptcy sounds like a rather good thing in the US and something we don’t have in Finland. Granted we don’t have that level of healthcare bills either but if you somehow get youself millions into debt here it sticks with you your whole life.
There has to be some form of bankruptcy, isn’t there?
When you declare bankruptcy, you’re basically going to the courts and saying, “Look. I don’t have the money or the income to cover all my debts. I need help.” If the court agrees, they’ll force all your creditors to come to the table to negotiate.
The court determines what assets you can keep and determines the best way to divvy up what’s left. Usually you keep your house, car, and basic necessities but that can vary. Some states don’t protect the house or car but even then the court will consider if it’s cheaper or better for you to keep either of those than to go rent a new house and take alternate transportation.
Then they look at your income and decide what you can afford to pay over time. If your income is too low, they may consider all your debts settled at that point. Otherwise, they may set up a payment plan for so many years and consider you even after that.
Medical debt is the number one reason for bankruptcy. To twist the knife a bit, people who have large medical bills are often in a physical condition that makes it hard to work. About 2/3 of all bankruptcies, or 530,000 families annually, cite their medical bills when filing. After that is mortgage debt (45%), living beyond their means (44.5%), providing help to friends and family (28.5%), student loans (25.5%), and divorce (24.5%).
This seems odd to me because bankruptcy doesn’t currently get rid of student loans (which is completely wtf, but that’s another issue); maybe the student loan payments got so onerous that they got into other debt?
Federal student loans have exceptions to bankruptcy. Private student loans are subject to normal bankruptcy proceedings–much though they may imply they are not.
You still have to pay for the bankruptcy. I don’t know exactly how it works because I’ve never declared it, but it’s not free to go bankrupt either. In American Capitalism they will screw the poor people every way they can.
My parents went bankrupt like 4 times and it never seemed to make any difference to them. They’d just move on with life and have new credit debt racked up within a few months.
Something nobody else has mentioned her eis that even if a hostpital is required to provide care regardless of your insurance, in practice you’re not unlikely to get a lower standard of care if you have no insurance or even if you have insurance that’s seen as “inferior” like Medicaid.
Folks without insurance or with “lesser” insurance tende to be poorer. More likely to be seeking pain meds to use recreationally. More likely to be disabled, overweight, etc. More likely to be racially discriminated against or, if white, seen as “white trash”. So, having no insurance or inferior insurance itself may get you written off as “probably lying” or otherwise somehow undeserving of the same level of care.
And if that’s an issue for life-threatening injuries, it’s… probably much more so an issue for more routine kinds of medical care. It’s literally not even an option to self pay in some cases. And I don’t just mean because it’s so expensive. Even if you did say “I don’t have insurance, but my bank account has $100 million in it and I can use my debit card,” you may be told you’re not allowed to self pay.
Poor people without insurance are often sent to alternative care facilities specifically for poor people without insurance. And as you might expect, those places are often very understaffed. So you can expect longer wait times and more rushed care.
Poor people without insurance also often don’t get treated early when a problem isn’t a huge deal for fear of accruing medical debt. So they’re also more likely to end up unexpectedly needing a trip to the ER because that minor infection that, had they gotten it treated a week ago, would have been taken care of with a round of antibiotics has now spread to some much more vital organ.
Adding to this, there is no requirement that hospitals ensure that you are safe when they release you from their care so sometimes people who can't pay for care and have dementia, uncontrolled or poorly controlled mental health issues, or are otherwise vulnerable get left at the nearest bus stop. It even makes the news sometimes because someone got dropped off only wearing a hospital gown at night in winter.
I can’t speak for every hospital since I’ve only worked at a few but this is rare. Some places might still be doing it, dumping people who can’t be placed or don’t have insurance, but EMTLA was put in place to combat that stuff and the lawsuit and probably fines would make this a bad move. We’ve kept people where I work for months because we can’t place them or psych won’t take them. At minimum they’re going to a nursing home.
The having money to pay for something and being turned down is such nonsense. I’ve run into something similar with some procedures I need done. Place would let people without insurance self pay, I have insurance but the wrong kind, they were apparently legally required to bill my insurance but they couldn’t. So I was denied service entirely even though I could have paid in full out of pocket. I spent two months getting my insurance to negotiate a contract with them but by then I was/am running into a time constraint and had to switch where I’m going to be an out of state place that can do the same thing but faster. Things are so broken over here.
Folks without insurance or with “lesser” insurance tende to be poorer. More likely to be seeking pain meds to use recreationally.
Do you have a source for this? This sounds wrong, pain pills are rich/middle income people drug as I perceive it. You can’t really get hooked up on pills if you never got them by a doctor first.
There are definitely pill mills in the poorer parts of town. And usually poor populations receive Medicaid, which will typically pay for the stuff. Just anecdotal evidence as a pharm tech in a rough part of town during college, but after a while we had to actually stop taking scripts for most pain meds (still got a ton of people using trazadone and stuff, though) because the pharmacist just didn’t think it was worth his license if the scripts were tied back to a pill mill.
What happens if I’m a foreigner? Let’s say I travel there as a tourist, break an arm hiking, they put me in plaster. Let’s assume I’m careless and made no travel insurance. Are they going to stop me on the border?
Someone else will need to answer on the border bit (though I doubt it), but I know from a friend who visited without travel insurance that he did have a bill for something like 30 thousand USD for a broken leg and rib. I think he just never paid it. He’s back in the UK now, and says he’ll never visit here again because of the experience with our hospitals
You get billed, but you can just go home and not pay it. That doesn’t necessarily mean that the issue won’t still be waiting for you if you come back, though. I can imagine a situation where a foreigner left behind substantial medical debt and the State Department refuses to allow them back in. So if you’re a frequent visitor, or need to visit here again in the future, it would be a problem.
A one-time visit? Fuck it. Go home, back to your more civilized country, and leave it behind.
The hospital will keep sending you bills. Every month, and if you don’t pay that or set up a payment plan with them… they absolutely send it to a collection agency. That law agency will hound you all day every day, phone calls… text messages… Mailing threats and lawyer fees on top of the OG bill.
Eventually, I know from personal experience… they will take you to debtor’s court. Where you sit in a room full of strangers till your name is called. Then you have to prove how poor you are and they can pause the collection efforts for a period of time… or if the judge believes you can afford something… then your court ordered to pay… or else.
Most hospitals are setup as non-profit entities and use medical debt write-offs to exhibit their charity. In all truth, they intentionally drive their own expenses sky high to increase revenue to astronomical levels so to give executives running these organizations excessively high compensation. These write-offs are just part of the gig.
Hospitals haven’t been non profit since they were delayed in the early 1980s, and are absolutely structured for profit, with shareholders and conglomerate ownership and everything.
The medical write offs are exactly that. Tax avoidance.
In short? Medical debt. Emergency rooms will treat you, and in some cases might offer discounted rates for patients without insurance, but at the end of the day you are still responsible for the bill, however large it may be.
Worth noting that those discounted rates are still significantly higher than what insured patients pay, and astronomically higher than what people in actually sane countries pay.
If someone calls an ambulance and you’re unconscious they will take you the hospital for treatment. You will be responsible for the bill. Including the thousands of dollars for the ambulance ride.
And no, even though you were unconscious and not able to consent to treatment willingly you will still be responsible for the bill. There are ways of dealing with it, but one accident is all it takes for a ruined credit score for some people. It is as fucked up as it sounds.
There are ways of waiving bills, getting financial assistance etc but it’s a total nightmare dealing with hospital billing departments
Unless you are out for a very brief period of time, being unconscious is a seriously bad sign. Like brain hemorrhaging which left untreated will kill you.
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