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?
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.
But you get a ridiculous bill, then likely “settle” for a much lower amount of if you’re truly pennyless, you just never pay it and eventually the hospital gives up and uses it as a tax write off.
It’ll also wreck your credit, and if you’re unlucky they’ll sell your debt off to debt collectors to harass you and your family. Even if they’ve died. And then the truly desperate will sometimes commit heath insurance fraud making the system even more immensely fucked for everyone except for the hospitals and insurance companies
Not exactly. Medical debt is different compared to retail debt like credit cards. It still sucks but the rules are different to protect people at least a little bit.
It’s somewhat in the credit agencies best interests to ignore or heavily discount medical debt. Because so many people have it, and not by choice, to destroy everybody’s credit rating because of medical debt would decimate a significant portion of the country’s ability to get credit. That would have a domino effect on a great many things, and cause enough of an issue that it’s likely there would be further regulations on the credit agencies.
Yep. Medical debt is often not calculated into your credit score by the credit agencies, either, though not in all cases. Or if it is calculated in, it is heavily weighted against so it doesn’t cause much damage.
And it makes sense. Credit score is supposed to be a judge of your credit worthniess based on your history seeking credit and repaying debts. While medical debt is legitimate debt, it isn’t credit seeking behavior in the way an auto loan is. You didn’t choose to take it on, it would be inaccurate to take a trip to the ER into account when determining your credit seeking habits.
I sustained a workplace injury (working on a movie set) and the production company never filed the paperwork, so their insurance would not cover me. I refused to pay the bill and it showed up on my credit report and caused issues for three years. Eventually i found my wrap gift from movie and inside the set medic had put a copy of the paperwork. I scanned it and emailed it to the hospital and within 72 hours it was taken care of and like a month later it was off my credit report. (Time frames may be off as this transpired in 2015)
About five or six years ago, most creditors started using a different FICO model which doesn’t include medical debt. Basically, the idea is that being unable to pay medical debt says very little about how well you can handle debt.
There are also models that don’t consider student loans, but those aren’t used as often.
The big story in my city a while back was a shitty debt collector that stole money from a guy’s bank account.
‘It is like robbery’: A debt collector wrongly wiped out an Oregon man’s entire bank account
According to court records, the debt collector said Salazar owed money for treatment at Providence Portland Medical Center in late 2007 and 2008. Providence claimed it sent 26 billing statements and six financial assistance applications to the home address provided by the patient. The unpaid bills for six emergency room visits originally totaled $4,750 but have since ballooned to more than $14,000 after costs, fees and interests associated with the debt collection.
Salazar tried explaining to Professional Credit Service that he didn’t have the money to pay, but a customer service representative seemed unsympathetic.
“They did not care if my brother is sick and this is going to put us on the street,” explained Salazar. “They did not care.”
In April, Salazar filled out court papers challenging the garnishment. It temporarily froze his bank account, preventing the debt collector from taking any more money. At the same time, it kept Salazar from accessing much needed funds, including his paycheck, which is electronically deposited into the account.
I feel like a lot of people ignore collection agencies when they advise others to “just not pay.” Yeah you could probably get away without paying, but you and your entire family will be harassed nonstop. There’s been few things more chilling to me than a stranger calling me out of the blue with my sister’s name and info telling me to get her to settle up (thankfully just a small amount).
Part of the reason it’s like this is because insurance companies try their very hardest to avoid paying, but that means you have to do the same if paying yourself.
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).
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.
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.
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.
Emergenty rooms in hospitals are legaly required to help all patieints, so you would recieve care. Usually until you are able to leave the hospital. You would not receive followup care without going to the emergecy room, or paying cash. You would be billed for all services, usually at a higher rate than insured patients
My wife worked in the ER for a few months and had to change departments because of a mental breakdown.
Understaffed, abused, and a huge chunk of people who are in the ER are desperate and came there as a last resort because of our fucked up healthcare system.
Not to mention the unstable. Say what you want, but I can count a dozen times where patients threatened to harm my wife for providing care.
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.
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.
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