What Happens If I Don't Pay My Medical Bills?

Quick summary

Medical bills are different from other debts

Medical bills in the US have special protections that don’t apply to most other debts:

• No Surprises Act (federal): Protects against many forms of surprise out-of-network billing
• State medical debt protections: Vary widely; some states cap interest, regulate collection practices, or prohibit certain reporting
• Credit bureau medical debt rules (Equifax, Experian, TransUnion): Per major credit bureau policy changes:
  • Paid medical collections are not reported
  • Unpaid medical collections under $500 are not reported
  • Unpaid medical collections of $500 or more are only reported after the debt has been delinquent for at least one year (vs. ~6 months for other consumer debt)

Source: Consumer Financial Protection Bureau (CFPB) medical debt guidance — consumerfinance.gov/about-us/blog/medical-bills-on-your-credit-report; No Surprises Act — cms.gov/nosurprises

Typical timeline for unpaid medical bills

The exact timeline varies by provider, but a typical pattern:

1. Service date: Medical service provided
2. 30–90 days later: First bill issued (often after insurance has been billed and processed)
3. 30–60 days after first bill: Reminder bills issued
4. 60–120 days past due: Provider may transfer the account to its in-house collections or refer to an external collections agency
5. 120–180 days past due: External collections begin contacting you
6. At least 365 days past due: Unpaid medical collections of $500+ may be reported to credit bureaus (per major bureau policy)
7. Within 7 years from delinquency: Credit report entry expires

What to do when you receive a medical bill

1. Verify the bill: Compare the bill against the Explanation of Benefits (EOB) from your insurer. Medical billing errors are common.
2. Check for No Surprises Act protections: If the bill is for emergency care or for in-network facility services where you saw an out-of-network provider unknowingly, you may be protected from balance billing.
3. Request itemized billing: You have the right to request a detailed line-item bill showing every service.
4. Apply for financial assistance: Hospitals (especially nonprofit hospitals) are required by federal law (Section 501(r) of the Internal Revenue Code) to have financial assistance policies for low-income patients. Ask for the financial assistance application — eligibility often extends to households earning up to several times the federal poverty level.
5. Negotiate the balance: Medical bills are often negotiable. Ask for a discount, a payment plan, or assistance program enrollment.

No Surprises Act protections

The federal No Surprises Act (effective 2022) provides protections against many forms of surprise medical billing:

• Emergency care: You can only be charged the in-network rate for emergency services, regardless of provider’s network status
• In-network facility, out-of-network provider: You can only be charged the in-network rate for ancillary services at an in-network facility (e.g., an out-of-network anesthesiologist at an in-network hospital)
• Air ambulance: Protected from surprise out-of-network charges
• Dispute resolution: A federal independent dispute resolution (IDR) process exists for providers and payers to resolve out-of-network payment amounts

If you receive a surprise bill that seems to violate the No Surprises Act, contact the federal No Surprises Help Desk at 1-800-985-3059 or visit cms.gov/nosurprises.

Credit reporting — the 2022–2024 medical debt rule changes

Important changes to how medical debt is reported on credit reports:

• April 2023: The three major credit bureaus (Equifax, Experian, TransUnion) stopped reporting unpaid medical collections under $500
• They also stopped reporting any paid medical collections, regardless of amount
• Wait period: Unpaid medical collections of $500+ are only reported after the debt has been delinquent for at least one year (vs. ~6 months for other consumer debt)
• The CFPB has continued to evaluate further restrictions on medical debt reporting

Some non-major credit reporting agencies may have different rules. The three major bureaus dominate consumer credit reporting and most lenders use their data.

Hospital financial assistance

Federal law (501(r)) requires nonprofit hospitals to have:

• A written financial assistance policy (FAP)
• Public availability of the FAP and a plain-language summary
• A process for patients to apply for assistance
• Limits on charges to FAP-eligible patients (cannot charge more than the amount generally billed to insured patients)

Many hospital systems extend financial assistance to households earning up to 200%, 300%, or even 400% of the federal poverty level. Eligibility depends on the hospital’s specific FAP.

For-profit hospitals are not federally required to have a financial assistance program, but many do.

Frequently asked questions

Should I pay a medical bill that I dispute? Generally no — paying a disputed bill makes it harder to recover the funds if your dispute is upheld. Send a written dispute letter to the provider (and to the collections agency if applicable) and request itemized billing. Pay only the portion that is undisputed while you work through the dispute.

Can a hospital sue me for a medical bill? Yes. Some hospitals sue patients for unpaid medical bills, which can result in a court judgment, wage garnishment (with a court order), and bank account levy. The frequency of hospital lawsuits varies enormously by hospital and state. Many states have begun limiting hospital collection practices.

Will medical debt affect my mortgage application? With the 2022–2024 credit reporting changes, medical debt has much less impact on credit scores than it once did. Paid medical debt and unpaid medical debt under $500 do not appear on major credit reports. Larger unpaid medical debt has a 1-year delay before reporting. This means medical debt has significantly less impact on mortgage applications than it did pre-2023.

Sources: Consumer Financial Protection Bureau (consumerfinance.gov), No Surprises Act (cms.gov), Equifax/Experian/TransUnion medical debt policy announcements. Last verified: May 2026. Medical debt policies have changed significantly in recent years and may continue to evolve. See our disclaimer.