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), set by the bureaus' own policy changes:
  • Paid medical collections are not reported
  • Unpaid medical collections under $500 are not reported
  • Unpaid medical collections of $500 or more only appear on a credit report after one year (the bureaus raised this from six months in July 2022)^[4]

Source: Consumer Financial Protection Bureau (CFPB) medical debt guidance^[5] ; CMS No Surprises Act page, cms.gov/nosurprises

Typical timeline for unpaid medical bills

The exact timeline varies by provider. A typical pattern looks like this:

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. Roughly 7.5 years from the original delinquency: Once reported, a medical collection runs on the same FCRA clock as any other collection account. The seven years are measured from 180 days after the delinquency began, not from the delinquency date itself ^[6]

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) protects 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 and the 2022–2023 bureau policy changes

No single policy. Reporting to the credit bureaus is voluntary, so each hospital, practice or billing company decides whether to report an unpaid bill or send it to a collection agency. What can then appear on your credit report is shaped by the three nationwide bureaus' own medical-debt policy, set out below.^{[1] [2]}

What federal law actually sets

Reporting to the credit bureaus is optional. The CFPB puts it plainly: "Reporting to credit bureaus and other consumer reporting agencies by creditors is voluntary and historically has been. Not all creditors report information about their borrowers."^{[1]: p. 15} The Fair Credit Reporting Act's rules for the companies that do report cover accuracy, disputes and dates. They don't set a minimum number of days late before an account can be reported.^[7]: (a)

The "30 days late" figure you see everywhere comes from the data format, not from a law. Most furnishers send data to the bureaus in Metro 2, which reports "the level of delinquency such as 30-59 days past due, 60-89 days past due, and up to 180 days or more past due."^{[1]: pp. 3, 16} Experian's list of payment-status codes has no code for anything less than 30 days late: the late codes start at "Account 30 days past due date" and go up in 30-day steps to 180.^[8] So a payment 10 or 20 days late has no late code to be reported under, though a late fee can still apply.

A third-party debt collector can't report a debt until it has either spoken to you about it in person or by phone, or mailed or electronically sent you a message about it and waited "a reasonable period of time to receive a notice of undeliverability."^{[9]: (a)(1)}

How long it can stay on a report

Medical collections follow the three nationwide bureaus' own policy on top of the general law. In 2022 the bureaus said that from July 1, 2022 "paid medical collection debt will no longer be included on consumer credit reports", and that the wait before an unpaid medical collection can appear would go "from 6 months to one year".^[2] In April 2023 they announced that "medical collection debt with an initial reported balance of under $500 has been removed from U.S. consumer credit reports."^[3] This is the bureaus' policy, not a regulation, so they can change it. A CFPB rule that would have kept most medical debt off credit reports never took effect: on July 11, 2025 a federal court in Texas vacated it, at the joint request of the Bureau and the plaintiffs.^[10] Once a medical collection is reported, the general clock applies: an account placed for collection can be reported for seven years, counted from 180 days after the delinquency began.^{[6]: (a)(4), (c)(1)}

Direct reporting vs. collections

A company can report an account it still owns, or it can hand or sell the account to a collection agency, which then reports under its own name. The two can show up as separate items on your report for the same bill, and "consumers generally are not required to be notified when debt is sold or assigned to a collection agency."^{[1]: p. 30} Which of the two you're dealing with decides which rights apply. The Fair Debt Collection Practices Act covers people collecting debts owed to someone else, and it excludes a creditor's own staff "while, in the name of the creditor, collecting debts for such creditor." A creditor that collects under a different name is covered, though: the law "includes any creditor who, in the process of collecting his own debts, uses any name other than his own which would indicate that a third person is collecting or attempting to collect such debts."^[11]: (6)

If the account reaches collections

A debt collector must send you validation information (what you owe, to whom, and how to dispute it) in its first communication or "within five days of that initial communication".^{[12]: (a)(1)} If you dispute the debt in writing within 30 days, the collector "shall cease collection of the debt, or any disputed portion thereof, until the debt collector obtains verification of the debt" and mails it to you.^[13]: (b) Disputing the credit report itself is a separate process. A bureau that gets your dispute must, "free of charge, conduct a reasonable reinvestigation" within 30 days (up to 45 if you send more information during that time),^{[14]: (a)(1)} and the company that reported the item must investigate and then modify, delete or block anything it finds inaccurate, incomplete or unverifiable.^[7]: (b)

This section describes federal law and industry practice in general terms. It doesn't cover state law, which can add protections, and it isn't legal advice. It describes a company's own policy only where that company is quoted above. See the disclaimer.

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. How often hospitals sue varies a lot 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. As a result, medical debt now weighs much less on mortgage applications than it did before 2023.

Source checked September 2026. Medical debt policies have changed a lot in recent years and may change again. See our disclaimer.