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."""
"It's your business to pay what you owe but it's not your business to determine what you owe.  The ""Fair Debt Collections Practices act"" FDCPA proscribes certain steps creditors must go through to contact you.  You appear to not have received any active contact or demand, but you can still cite the FDCPA to make it their problem. Write to the creditor's address (I assume its the hospital, the OP isn't clear), use USPS Certified Mail Return Receipt Requested, asking them to validate that you owe this debt by mail in 5 days, as is your right under the FDCPA.   If they get back to you and you agree (or its reasonably plausible) you do owe it, pay it especially if it's on the order of $100.  At least you will know it is settled at the source.  Cross reference to your insurance claims to be sure its not double billed or a miscredited copay, but you may see many legit separate charges from one ER visit (hospital,  doctor, anesthesiologist,  etc) and it would not be the first time a medical billing system crapped the bed. If you don't hear anything after a few weeks, use the credit report protest process (or write to them, cc: the Federal Trade Commission) contesting the validity of this report.  The creditor did not respond to your FDCPA request for validation (copy of the Return Receipt); and you otherwise believe you are current with the hospital.  Per the Fair Credit Reporting act,  they must investigate.  Fight bureaucratic fire with fire: conduct all business by mail, and make liberal use of certified mail return receipts.  Its a $6 way to telegraph you know that they have specific federal law timeliness requirements; and you have a federal timestamp signed by someone in their organization." Some of the expenses you describe may be eligible to be paid off by a 401(k) without incurring a penalty. As long as you do not mind paying tax on the extra income. If your tax bracket does not go up, then using your IRA may not be a bad idea. You should consult a tax expert and see which expenses can qualify for a withdrawal without penalty.  I believe medical bills and medical insurance costs are eligible to be withdrawn without penalty in some instances. As a non-resident, you need to file a form 1040NR in any year that you have a distribution (withdrawal) from your HSA. From the Instructions for Form 1040NR, Who Must File: You also must file a return if you received HSA, Archer MSA, or Medicare Advantage MSA distributions. You file a form 8889 with your 1040NR, and on that form you report how much money you took out of the HSA and how much of that was used for qualified medical expenses.  If these distributions are used for qualified medical expenses, even in your home country, they are tax free.  Any part of the distribution that is not used for medical expenses is taxable, and you would need to send in a tax payment with your 1040NR. If you just cash out your HSA with no medical expenses, you will pay tax on the amount plus a 20% penalty.  If you have no other U.S. connected income, your tax rate will be based solely on the amount of your distribution (probably 10-15%), so you are looking at a total tax of 30-35%. It may be worth your while to leave the HSA in place and just withdraw it as you have medical expenses.  You'll need to file a tax return each year you take money out until the HSA is gone, but you won't pay any tax. The simple answer is that you have to read the terms and conditions when you sign up for a checking account at the bank. The process of fraud investigation varies from bank to bank.  Ultimately most banks will refund the money if you are not deemed negligent. Some banks offer quick reimbursement during fraud claims, but many will not refund the money until the investigation is complete (which can take several weeks). Checking accounts are terrible security problems. If you're looking for ways to avoid a hassle, stop writing checks and using ATM/Debit cards. If you must send checks to pay bills, use the bill-pay system that is now common with most banks (they use a service to send checks on your behalf and don't even charge you for postage unless you ask for expedited processing). "The general answer to this is ""yes"".  When you're dealing with single-digit millionaires, the answer is that their insurance habits and needs are basically the same as everyone else.  When you get into the double digit and triple digit millionaires, or people worth billions, they have additional options, but those basically boil down to using ""self-insurance"" rather than paying a company for an insurance policy.  The following is based on both what I've read and a fair deal of personal experience working for or with various stripes of millionaire, and even one billionaire. Addressing the types of insurance you mention: This is generally used to provide survivors with a replacement for income you can no longer provide when dead, in addition to paying for costs associated with dying (funeral, hospital/hospice bills, etc).  Even millionaires and billionaires have this, yes, but the higher your net worth, the less value it has.  If you're worth 9 or 10 figures, you probably already have trust funds set up for your family members, so an extra payout from an insurance policy is probably going to represent a small fraction of the wealth you're leaving your survivors, and as has been noted, insurance makes a profit, so the expectation by the insurance company is that they'll make more money on the policy than they'll have to pay out on death.  That being said, the members of the 9+ figure club I've worked for all had multi-million dollar life insurance policies on them, which were paid for or heavily subsidized by the companies they owned or worked for.  I doubt they would have held those policies if they had to pay the full cost, but when it's free or cheap, why not? Absolutely.  As health insurance in America is an untaxed employment benefit, owing to regulations from World War II, all the wealthy folks I've had contact with got outrageously good plans as part of the companies they work for or owned.  Having said that, even their trust fund beneficiaries held health insurance, because this type of insurance (in America, at least) is actually not really insurance, it's more of a pre-payment plan for medical expenses, and as such, it provides broader access to health care than you'd get from simply having enough money to pay for whatever treatments you need.  If you walk into a hospital as a millionaire and state that you'll definitely be able to pay for your open-heart surgery with cash, you'll get a very different response than if you walk in with your insurance card and your ""diamond-level"" coverage.  So, in this case, it's not as much as about the monetary benefits (although this is a type of ""insurance"" that's generally free or heavily discounted to the individual, so that's a factor) as it is about easier access to health care. Although this is required by law, it's one of the common forms of insurance that the very wealthy can, and often do handle differently than the rest of us.  Most (if not all) US states have a provision to allow motorists to self-insure themselves, which amount to putting up a bond to cover claims against them.  Basically, you deposit the minimum amount the state determines is required for auto insurance with the responsible state organization, get a certificate of self-insurance and you're good to go.  All the high wealth individuals I know when this route, for two reasons - first of all, they didn't have to deal with insurance companies (or pay sky-high rates on account of all the speeding tickets they picked up) and secondly, they made their deposit with government bonds they had in their portfolios anyway, and they could still collect the interest on their self-insurance deposits.  Of course, this meant that if they wrecked or dinged up their Maserati or Bentley or whatever, they'd be out of pocket to repair or replace it... but I guess if you can afford one $200,000 car, you can afford to buy a second one if you wreck it, or get by riding one of your other luxury automobiles instead. Since someone else mentioned kidnapping insurance, I'll point out here that what Robert DeNiro did in Casino when he put a couple million dollars into a safety deposit box for his wife to use if he was kidnapped or needed to pay off a government official is essentially the same thing as ""self-insurance"".  Putting money away somewhere for unexpected events in lieu of buying an insurance policy against them. In real life, the very wealthy will often do this with US treasuries, government bonds and other interest-bearing, safe investments. They make a little money, diversify their portfolios and at the same time, self-insure against a potential big loss. This is another insurance area where even the very wealthy are remarkably similar to the rest of us, in that they all generally have it, yes, although the reason is a little different.  For normal folks, the home they own is generally the largest part of their net worth, or at least a very substantial fraction, for those older folks with retirement savings that exceed the value of their homes.  So for us, we have home owners insurance to prevent a catastrophic event from wiping out the lion's share of our net worth. If you're an ultra-wealthy individual who can afford an 8 figure home, that's not really the case (at least with the ones I've dealt with, who made their fortunes in business and are good managing their wealth and diversifying their assets - could be different for sports stars or the entertainment industry), and these people generally own multiple homes anyway, so it's not as big a deal if they lose one. However, no one actually buys a multi-million dollar home by writing a multi-million dollar check.  They get a mortgage, just like the rest of us.  And to get a mortgage, insurance on the property is a requirement.  So yes, even the ultra wealthy generally have insurance on their home(s).  There is an element of not wanting to shell out another 20 million if the place burns down, or someone breaks in and steals your valuables, but the bigger part of the reason is that it's required to get a mortgage in the first place, which is generally done for financial reasons - interest on your mortgage is a tax deduction, and you don't want to sink millions of dollars all at once into buying a property that's not going to appreciate in value, when you can get a mortgage and invest those millions of dollars to make more money instead." Better suited to /r/personalfinance, but you definitely owe the money. Unless you had something in writing that they were going to send a bill to a certain address, it's your responsibility to pay. Hell, even if you did have something in writing that said they'd send the bill somewhere else it's still your responsibility to pay even if the bill doesn't show up. You know you owed them money.  When your parents didn't get the bill, you should have called the company to ask about it. It's your responsibility to follow up since you're the one that owes the money.  What did you think would happen when you went 5 months without paying $312 that you knew you owed? "check the DATE OF SERVICE on all your invoices carefully.  It's possible you actually DID pay already. Sometimes when a medical provider gets ""mostly"" paid by a third party insurer, they just drop the (small) remainder, as it's more cost than it's worth if it is a trivial amount.  Alternatively, they wait until you show up for another office visit, and ""ding"" you then!" 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.