44+ million uninsured people in America...

April 8, 2007 8:44 AM

Will a $6,000 bill from the ER completely cripple my credit score for the next ten (plus?) years if I don't pay it?

I am getting ready to leave a dead-end job to start work as an EMT. The dead-end job, like most dead-end jobs, offered quite bad insurance coverage under an awful HMO, the payments were outrageous, the coverage was minimal, etc. Rather than continue paying for such a terrible plan and expecting to start my new job much sooner than has worked out, I canceled the coverage. Shortly thereafter I developed the meanest staph infection known to man on my calf. I treated it with OTC antibiotics and did a good job soaking and cleaning the infection but ultimately woke up one morning a few weeks ago and found my leg turning slightly gangrenous and was completely unable to walk without crying in pain and then falling. So...I clearly had an emergency. I took a cab to the ER and the doctors appeared aghast at the progression of the infection, told me I'd be admitted for a couple of days, etc. Long story short, after being released, coming back to the ER several more times for follow up in the ensuing two weeks, and paying $400 in prescriptions for everything from anti-nausea medication, top opiate painkillers and several anti-biotics, I had drained my (meager) savings and had no income from being out of work so long. The bills have arrived and total about $6,000, which is about 1/4 of my entire income last year -- and, worse, I live in a very expensive city. Obviously, I'll be making a bit more than that when I start my new job but not that much more. In my past experience, with a few short ER visits totaling about $230 each, I never paid and it never appeared on my credit report. But I've heard mixed things recently: new legislation has been passed that requires hospitals to report to the credit agencies, only debts in excess of $1,000 are reported, nothing gets reported, etc.

Apart from my rage at not starting my job and getting coverage again, at the whole misfortune and irony of the situation, I'm worried that if I don't pay it or pay it within a certain period of time, my credit will be crippled by this debt. In my EMT program we were repeatedly told that the reason most private EMS companies offer such (comparatively) low wages is because people, by law, do not have to pay their ambulance bills and -- as everyone knows -- for the tens of millions of uninsured people in this country, the emergency medics, nurses and physicians are their only choice for treatment. It all seems more than a little criminal. (What else does the government exist for than the protection of its citizens? I know, a naive question...) Any insight into the law and potential consequences of not paying would be appreciated. I have an odd feeling that Michael Moore's new film about the health care industry is going to find a huge audience.

posted by inoculatedcities to work & money (30 comments total)

My fiance has been hospitalized several times with poor insurance coverage so I can tell you what I know. In our case we received bills not just from the hospital, but also from the radiologist, and any specialists that were consulted (cardiologist). Those offices will send your bills to collection agents if you don't pay them, and that does end up on your credit report.

On the other hand, if you set up payment plans, and carefully pay every month, they won't bother you. If you can only afford $50 a month, then send that. Yes, it will take a long time to pay off.
posted by cabingirl at 8:57 AM on April 8, 2007

It appears that you live in Massachusetts. Have you checked with the hospital to see if you're eligible for Free Care or another state program?

Second cabingirl that you should be able to set up a payment plan.
posted by backupjesus at 8:59 AM on April 8, 2007

You cannot not pay the bill. It will eff your credit. Get on a payment plan. The hospital will accept whatever you can pay per month. Alternatively, look into some other options in your state for getting assistance with such costs. You can get facts from the Department of Public Health or whatever the body is that regulates such things where you are. Also, there are probably a few non-profits who disseminate this info and offer advocacy services for people in your situation. I would start with a state office-- they can usually direct you someplace helpful. Good luck.
posted by sneakin at 8:59 AM on April 8, 2007 [1 favorite]

If it's under a thousand dollars it's not generally worth their while to pursue it. In your case, it might eventually result in garnished wages, but more than likely they'll just charge it off. They have insurance for that.

I work for a company who routinely looks @ credit scores. We care a LOT less about medical bills on a credit report than we care about maxed out credit cards, repo'd cars, etc.

It'll hurt your score, but..eh. Like sneakin said, look to your local department of human health and resources, or whatever it's called, generally they're able to help out depending on your particular circumstance.
posted by TomMelee at 9:22 AM on April 8, 2007

I have so far only received bills for the physicians' time and for the ER services (pharmacy, observation, etc.). I did have one CT scan but apart from that, no special services. Just lots of drugs, and minor invasive procedures performed by the ER doctors. The only assistance program in Massachusetts for the uninsured is called MassHealth and the only way I would be eligible would be if I had three kids, no income, etc. I've looked at the requirements and I (incredibly) make too much money to qualify. So I guess it's going to be the payment-plan route as I expected, I just feel like I keep getting mixed messages about what gets reported and what doesn't.
posted by inoculatedcities at 9:23 AM on April 8, 2007

First thing to do is call the hospital (and anyone else who is billing you), explain the situation, and ask for a discount. Like, say, half off. Or more. The hospital has dealt with uninsured poor people before, and they will understand. It's very likely that, for the asking, they'll cut lots off the amount owed and be willing to set up a long-term payment plan. They would rather get half the face amount of their bill without a hassle than sell the debt to a debt collector for 15 cents on the dollar, which is what will happen if you don't pay at all.

The reason most private EMS companies pay such low wages is that EMT is a job that can be done without a ton of specialized training. Sounds like your EMT instructor was trying to excuse his company's stinginess with a bogus excuse. In countries with nationalized healthcare - where the ambulance service gets paid for every single call - EMTs still get crappy wages. Sorry.
posted by jellicle at 9:41 AM on April 8, 2007

Oh, and in case it isn't obvious - once you've negotiated the debt down as low as the hospital et. al. will go, THEN you can decide whether to pay it or not. It may be that you're willing and able to pay $2,000 to avoid the hassles that go with bad debt, where you were not willing or able to pay $6,000.
posted by jellicle at 9:44 AM on April 8, 2007

By all means, first negotiate the bill down. Even if you had excellent insurance, it's quite likely that they would have paid the full bill-rate.
posted by Good Brain at 9:46 AM on April 8, 2007

If you call and talk to patient financial services, in addition to setting up a payment plan, they may write off part of your debt. (google "hospital bills write-off" to see some discussions of the details).
posted by katemonster at 9:49 AM on April 8, 2007

Ultimately it's preferable to file bankruptcy than to NOT pay a big bill, as 10 years later your credit scores can be good again after the fallout of a bankruptcy, but a debt can keep dogging you for 10 or 15 years with creditors hassling you the entire time. But $6K is not worth doing bankruptcy over -- pay the darn thing.

Many doctors/hospitals are among the most lenient creditors, so it's better to try to work with them and get on some sort of payment plan. I've dealt with hospitals twice and both times they offered discounts; one was 20% off and the other was 40% off. They may also have special terms for hardship cases.
posted by rolypolyman at 9:49 AM on April 8, 2007

My mom is a loan officer at a credit union. She says that when they're evaluating people for loans and such, that as a general rule they completely disregard medical debt as a factor because it's so common. So it may not screw you the way other problems will.

But yeah, pay it if you can.
posted by hermitosis at 9:50 AM on April 8, 2007

they saved your leg - and possibly your life, too. Do the right thing, pay them back however you can. If they will take $50 a month, then do that - however long it takes.

Where would be now, if you had not had the services of that ER?
posted by seawallrunner at 10:00 AM on April 8, 2007 [6 favorites]

jellicle: I take your point, and that is certainly true of some EMT-B's and EMT-I's, but I refer also to paramedics who are far more educated than EMTs and (in my city at least) are routinely put in dangerous situations and who still make very little working for a private service. They're not just ambulance drivers and to reduce the job to that is insulting and ignorant. EMS has only been around since the 60's (the Vietnam War, really) -- that's a big reason why it's not quite the institution, with all its requisite benefits, that nursing is. Municipal services, such as BostonEMS, pay extremely well (starting at $21/hr for a brand-new EMT, I believe) compared to the private companies and you get a pension, are in the police union, etc. They also carry handcuffs and mace, work hostage situations, work with SWAT, etc. Every place is different and some EMT's who work for services with no 911 contracts do only transports for old ladies going to dialysis, but I take real offense to the whole "EMT's have no skills" line of bullshit. Have you ever worked as one? In a major city? In the past twenty years?

Thank you for the replies so far.
posted by inoculatedcities at 10:01 AM on April 8, 2007 [1 favorite]

I, for one, am both an EMT and a glorified cab driver. Hooray for private transport companies!
posted by The White Hat at 10:13 AM on April 8, 2007

Friend of mine is a doctor. She said she is personally responsible for collecting medical debts owed by her patients under her practice. She said if her patients pay as little as $5.00 a month, she will not report them, but the important thing is that they contact her, tell her they are making an honest effort at paying, and then follow through.

Good luck with this. It is hard to have crippling debt on top of such a serious illness.
posted by clarkstonian at 10:17 AM on April 8, 2007

Since when has NOT PAYING for something you've received even been an OPTION?
Many have given you excellent advice about re-negogiating the price; My heart goes out to your being underpaid but no matter how tight your budget is---even $5.00 a month is the right and responsible thing to do.
Otherwise you're transferring that burden onto the rest of us.
posted by Dizzy at 10:46 AM on April 8, 2007 [2 favorites]

Dizzy: My question had more to do with which was the better option for my future credit: not paying (hospitals do write off a large amount of their debt), sending small payments for the the next x number of years, paying with a credit card, etc. There actually seems to be some controversy about which is better to do, though the consensus seems to be to call the hospital and negotiate a payment that I'm capable of making each month.

Maybe I should have been more clear when I said that the bill is equal to one quarter of my yearly income, maybe it helps also to know that I'm 23 and had never been hospitalized before this. It's not a matter of being crafty or unscrupulous, it's a matter of inexperience (which is why I posted here). Sorry if I've increased your blood pressure at the though of more potential burden for you to bear.
posted by inoculatedcities at 10:58 AM on April 8, 2007

The only assistance program in Massachusetts for the uninsured is called MassHealth and the only way I would be eligible would be if I had three kids, no income, etc.

Free Care is a separate program that specifically pays already-incurred bills (i.e., it's not insurance) and has single-working-person-friendlier eligibility criteria.

Instead of looking into such programs yourself, though, call the billing department and tell them your situation. They will know the available programs and will work to find some way for you to qualify, since that will get them paid sooner rather than later/never.
posted by backupjesus at 10:59 AM on April 8, 2007

This is BS:

>In my EMT program we were repeatedly told that. . . people, by law, do not have to pay their ambulance bills and -- as everyone knows -- for the tens of millions of uninsured people in this country, the emergency medics, nurses and physicians are their only choice for treatment.

There is no such law. What the law says is that medical services for emergency conditions must be provided without consideration of ability to pay (that is, uninsured patients cannot be turned away or required to pay in advance). But the uninsured patient does have to pay for the services he receives.
posted by megatherium at 10:59 AM on April 8, 2007

Hospitals will often negotiate for half of the billing amount to be paid, so long as it is actually paid on.... Expect to be eligible for dozens of credit card offers irregardless.
posted by buzzman at 11:01 AM on April 8, 2007

Nthing what everyone says about negotiating down whatever you can, then setting up a small payment plan that you know you can afford to pay religiously. Seriously, unless you know for a fact that you absolutely will not buy a car, get a credit card, rent a new apartment (much less buy a home), etc. for the next decade, you do not want to willfully destroy your credit rating like this. (Believe me, I speak from experience.)

Listen, $6000+ can be scary and overwhelming (I don't blame you for being freaked), but you can make it manageable. A friend of mine broke his neck about 10 years ago and was in the hospital for months. At the time he was a musician with only an ultra-basic health insurance plan and very little income; after insurance paid out what little they would, his own initial bills were totaled in the hundreds of thousands. The hospital and docs still gladly negotiated the bills with him and set up small (like $50/mo.) payment plans.
posted by scody at 11:05 AM on April 8, 2007

Good reply, scody. The comparison to your friend's situation made me feel much better.

And megatherium: I was speaking of the practicable reality; the bills might be sent, but they aren't necessarily paid, and we're talking mostly about the kind of people who aren't going to be buying houses or cars anytime soon. "...the uninsured patient does have to pay for the services he receives," sounds to me like you are implying they'll be locked up if they don't. I'm not sure that's true.
posted by inoculatedcities at 11:14 AM on April 8, 2007

Since when has NOT PAYING for something you've received even been an OPTION?

probably since the invention of credit, which not being an ANTHROPOLOGIST, I would guess took place around the time man first stopped beig exclusively NOMADIC and settled in VILLAGES.

Anyway, lots of good advice here. Negotiate it down, get on a payment plan. You are, from most of points of view, ethically obligated to pay your debts, but there is absolutely nothing wrong with negotiating the best deal possible. Corporations and rich people do it every single day, so I'm not sure why some of the Marie Antionettes here would label it "wrong" for someone who is struggling financially to do the same.
posted by drjimmy11 at 11:40 AM on April 8, 2007 [3 favorites]

second, third and fourth what many have said before: talk to them. tell them you are drained, have paid whatever you could, need to work something out. show that you want to resolve the issue and with a bit of luck, they will find a payment plan that doesn't gangrape you. not doing anything on the other hand suggests you have no intention to cover the cost you incurred and is sure to get you on their shitlist.

little tip: if you are uninsured and poor, don't give your real info.
posted by krautland at 11:47 AM on April 8, 2007

Just another data point. I contracted malaria about five years ago, and thought I had been completely cured, but apparently was infected with two strains at the same time--the docs never saw the second strain because the first was more virulent and plentiful in my blood stream. Because they never saw it, I went about a year thinking I was "all better."

A year later, working only part-time and without insurance, the second strain gathered enough strength to finally rear its ugly head. I went into Mass General, told them how I felt, told them that I had malaria before but it couldn't possibly be the problem since I was cured, and two hours later was informed that, "Yes, Virginia, you still got it."

Because the hospital didn't see that many cases of malaria, and because it was a teaching hospital for Harvard, I had about a hundred specialists and students come and visit me while I was in recovery. The total bill would have been absolutely crippling (if you'll pardon the pun), but thankfully Mass General offered their "Free Care" program to those who are uninsured. The fee was waved, and an additional year of free insurance was given to me.

Were I in your shoes, I'd talk to the hospital, explain your situation, thank them once again for saving your leg and possibly your life, and see what they can do to help you out. Be reasonable, but don't forget that were it not for them, you'd have far worse things to worry about.

Fuck the telephone company, fuck the cable company, fuck insurance companies and fuck the bank. But don't fuck the hospitals. They don't deserve it.
posted by Civil_Disobedient at 12:45 PM on April 8, 2007

Chiming in to tell you that medical billing have been incredibly flexible and kind in all of my interactions with them, even dealing with debts of several thousands of dollars. They've expressed appreciation to have any contact or effort.
posted by moira at 1:18 PM on April 8, 2007

[comment removed - please do not derail this with a health insurance discussion. take that to metatalk or email.]
posted by jessamyn at 1:21 PM on April 8, 2007

I am a healthcare executive. What you describe is frighteningly common, and a real indictment of our healthcare system in America.

They will have a person at the hospital that their entire job is negotiating repayment discounts and payment schedules for people who cannot pay their bills. The hospitals and the doctors want SOME money. Some is better than none. They will work with you if you explain the situation. Understand that commercial insurance heavily discounts what their charges are already. Discounting is the norm, not the exception.

Echo what people say above about payment plans. They are routine. We have "little old ladies" who pay $5 per month on their hip replacement. We know it'll never be paid off. In many cases, after a few years, the docs will forgive that debt if they have been good about paying.

If the hospital can recoup $2000 of that $6000, they will consider that a success.

Here is precisely what you do. Ask for a heavy discount as a low-income, non-insured patient. Your hospital is likely to even have a worksheet showing how much to discount based upon your income. Again, this is common. Further, ask to pay this heavily discounted amount via a payment plan.

You may be shocked at how much they discount. If they do not discount enough, then simply tell them that amount is still out of reach for you and what more can be done. Reinforce that you WANT to pay, and want to be a good patient, but that financially you simply CANNOT pay what they are asking. And pay over time. Let the hospital be your credit card. It would be unusual for the hospital to charge interest on your payment plan. Usually, interest is only tacked on when someone refused to pay at all, when it is going to be sent to collections. AND IT WILL BE SENT TO COLLECTIONS if not paid at all.

This is very important: if you work out a payment plan with the hospital, then you are effectively managing this debt, and it is NOT delinquent, and is NOT a hit on your credit score. As long as you pay your $50-$100 a month or whatever, every month, you will not get any calls, and collectors will never contact you. Pay them 30% of the charges over 2 years. Everyone will be happy, and well served. The hospital is getting some compensation for their fairly rendered services, and you are not being bankrupted.
posted by Ynoxas at 1:48 PM on April 8, 2007 [9 favorites]

Ynoxas - Thank you so much for that thorough and well-informed response. Exactly what I was looking for. I can't thank you enough.
posted by inoculatedcities at 1:56 PM on April 8, 2007

6 years ago we received a large discount for emergency hospital intensive care for our infant, and we own our home, are not low-income and have insurance. Based on our experience, you should be able to get your bill reduced by quite a bit.

In fact, we now routinely ask every doctor, hospital, specialist, etc. for a discount on the bill, and most of the time we get it.
posted by LadyBonita at 4:43 PM on April 8, 2007