Español 
Americans have staggering medical bill debt pending of $$140 billion, according to data from the Stanford University's Economic Policy Research Institute. In fact, a 2014 study by the Consumer Financial Protection Bureau found that 52% of collection activity was related to medical debt.
The average amount of such debt was $2424 in 2020. As medical bills increase, they can quickly become unmanageable.
"It can be tempting to not open the mail and let the medical bills pile up," says Katy Cook, who teaches financial planning courses at Southern New Hampshire University in Manchester. "They can be overwhelming and confusing."
However, if you stop making payments, it is very likely that your bills will end up in the hands of a debt collector.
Finding yourself saddled with a large amount of debt you can't pay is scary. But it often makes sense to face your fears and see if you can negotiate the debt down to something more reasonable.
What should a person do when a medical bill is about to go into collection?
Nationwide, 17.8 % of people with a credit report had medical debts in collections as of 2020, according to Stanford research. Another 13% of those people had accumulated medical debts in the previous year that were not yet in collections.
Your debt is more likely to go into collection if you are consistently and deeply behind on your payments. Once that happens, you are likely to receive many phone calls from the collector while trying to get you to pay.
To try to avoid this fate, take a proactive approach. "There may be more options if you act before an invoice goes to collections," Cook says.
For example, if you know a large bill is coming, try to talk to the hospital or provider right away.
"Tell them you want to resolve this and ask them to pause the account, so it doesn't go to collections," Cook says.
One strategy Cook recommends is to ask a hospital or provider to reduce the amount owed to the negotiated insurance rate or Medicare rate.
"Many hospitals offer 'charity care' and will reduce bills for people who meet certain criteria, usually low-income," Cook says. "You can call your hospital's billing department and ask about financial assistance or charity care. Hospitals may also be open to setting up a payment plan with you."
What to do if you cannot reach an agreement with the collectors
If you cannot reach an agreement with the hospital or provider, your unpaid medical debt may end up in a collection agency. An account that goes into collections can deeply damage your credit score.
In fact, Equifax says that having an account in collections is one of the most damaging events when it comes to your credit score. Plus, the toll on your score can remain for a long time. Therefore, it makes sense to do everything you can to negotiate, before you reach that point, or as soon as possible afterward.
What is the best way to negotiate medical bills in collections?
Continued harassment by a debt collector and damage to your credit score may motivate you to try to end the situation as soon as possible by negotiating your bill lower.
However, before you pay a medical bill that is in collection, make sure you definitely owe the money being requested.
"Ask for documentation of the debt and review names, dates, locations and procedures to make sure the bill is for you or your family," Cook says.
Also, check your health insurance explanation of benefits and any bills you have received from the hospital or provider.
If you are sure you do not owe the medical bill, call the hospital and your insurance company to explain the situation.
If you find you owe the money, you typically have three options, Cook says:
Pay in full
Ignore account
Negotiate a reduced amount to be paid
Of course, paying the bill makes more sense, if you can find a way to do so.
"If you can pay a small medical bill in collections, it may make sense not to bother negotiating," says Cook, who is also a principal with Abacus Financial Planning in Kirkland, Wash. "Just pay the bill and move on."
She points out that paying your bill on time can help protect your credit score. Most health care providers do not report medical debt to credit reporting agencies.
What happens when your account is turned over to a collection agency?
The situation changes when the supplier turns your account over to a collection agency. In such situations, the agency may report your nonpayment to the credit bureaus after 180 days. Therefore, you want to pay before then.
"Medical debt can be removed from your credit report when it's paid off, and it may not factor into your credit score," Cook says. "If you're thinking about applying for credit, such as for a home or a car, you want to keep your credit report in good standing."
On the other hand, simply dodging your bills in the hope that they will go away is often a mistake.
"Ignoring the bill can lead to a lawsuit, bankruptcy and even more stress down the road," Cook says. "So, I don't recommend it."
If you cannot pay your debt in full, negotiating a reduced monthly payment amount may be your best option. In many cases, the debt collector will be motivated to work with you.
"The collection agency will make a profit even if it pays the bill for less than the original amount," Cook says.
When negotiating medical bills is not an option
However, there may be situations where negotiating your debt is not an option. For one thing, not all collectors will accept such an agreement. Instead, the collector may continue to press for full payment.
But if the debt collector is tired of the time, money and effort required to pursue the matter, a negotiated settlement may become a possibility.
If you and the collector reach a negotiated amount, make sure both parties agree to the terms in writing. It is important that such agreements state that the debt will be paid at a lower rate than what is owed, but will still be reported as "paid in full" or "paid as agreed." debt settlement company
Agreeing to pay less than the full amount will hurt your credit score. But, over time, the damage will go away.
Obtain additional help
If you are not comfortable negotiating your debt, explore other options. A debt settlement company may be able to help you create a plan to repay your debt.
You can also consult with a nonprofit credit counselor who can help you design a negotiating strategy, according to Cook. She recommends finding a counselor on the National Foundation for Credit Counseling website.
If all else fails, bankruptcy may be an option to resolve your debt. "Bankruptcy is an option of last resort," Cook says. She adds that a credit counselor can offer crucial assistance in this process.
