You get a phone call from a debt collector. They say you owe money for a medical bill from six months ago. You're shocked. You never got a bill. You had no idea you owed anything.
Can hospitals really send bills to collections without telling you first? The short answer is no. But the long answer is more complicated. And understanding your rights could save you thousands of dollars and protect your credit score.
According to recent data, 36% of American households have medical debt. That's over 100 million people dealing with unpaid medical bills. About 15% of adults report being contacted by debt collectors for medical debt in just the past year. Many of these people had no idea their bill had gone to collections.
What the Law Says About Notice
Federal law requires medical providers to send you a bill before they can send your account to collections. They must also try to collect the debt themselves first.
The Fair Debt Collection Practices Act protects you from unfair collection practices. Under this law, debt collectors cannot report your medical bill to credit bureaus without first trying to collect from you directly.
This means collectors must contact you about the debt before they can damage your credit. They can't just silently report you to credit agencies without warning.
How Much Notice Are You Entitled To?
Different rules apply depending on where you live and what type of provider you owe money to.
Federal Rules: There's no specific federal law that says exactly how many days notice you must get. But providers must send you an itemized bill. This bill must include plain language descriptions of services provided.
State Rules Vary: Many states have stronger protections. California requires hospitals to wait 180 days from initial billing before reporting debt to credit agencies or filing lawsuits. During this time, they must notify you that the debt might go to collections.
Texas has a timely billing law. Providers must bill you no later than the first day of the 11th month after services were provided. If they don't, they lose the right to collect certain charges.
Nonprofit Hospital Requirements: Nonprofit hospitals must have financial assistance policies. They must inform you about these programs before sending bills to collections. Many are required to make reasonable efforts to contact you about payment options.
Medical Collections: The Real World Problem
While laws require notice, many people still get blindsided by collection calls. Here's why this happens.
Bills Get Lost in the Mail
According to industry reports, approximately 30% of medical bills contain errors. Some never reach patients at all. The bill might go to an old address. It might get lost in a pile of insurance explanation of benefits forms that look like bills but aren't.
You can't pay a bill you never received. But the hospital's system shows they mailed it. To them, you're ignoring the debt.
Insurance Creates Confusion
Your insurance processes the claim. Weeks or months pass. You assume insurance covered everything. Then suddenly you get a bill for the portion insurance didn't pay.
But by this time, you've forgotten about the medical visit. The bill seems random and unexpected. You might think it's a mistake and ignore it.
Meanwhile, the provider's clock is ticking toward collections.
Multiple Bills for One Visit
One emergency room visit can generate five or six separate bills. The hospital bills you. The emergency room doctor bills you separately. The radiologist sends a bill. The lab sends another bill.
You might pay the hospital bill and think you're done. But those other bills are still out there. When you don't pay bills you didn't know about, they go to collections.
Contact Information Problems
Providers use whatever contact information they have on file. If your address or phone number changed since your visit, their notices won't reach you.
A study found that many collection attempts fail because providers have outdated contact details. But this doesn't stop the collections process. It just means you never get warned.
The 180 Day Protection Rule
As of 2022, debt collectors must wait before reporting medical bills to credit bureaus. The law now requires a 180 day waiting period from initial billing.
This gives you six months to handle the bill before it can hurt your credit. During this time, collectors must try to contact you about the debt.
But here's the problem. They only need to try. If their attempts don't reach you because of address changes or other issues, the 180 days still count down. After six months, the debt can hit your credit report even if you never knew about it.
What Counts as Proper Notice
For notice to be valid, it should include specific information.
Itemized Bill Requirements: The bill must list what services you received. It should have dates of service. It needs to show what insurance paid and what you owe.
Generic bills that just show an amount due aren't enough. You have the right to request an itemized bill that breaks down all charges.
Verification Notice: When a debt collector first contacts you, they must send a validation notice within five days. This notice must include how much you allegedly owe, the name of the creditor, and your right to dispute the debt.
If you don't get this notice, the collector has violated federal law.
Plain Language: According to regulations in many states, bills must use plain language that regular people can understand. Medical codes and abbreviations don't count as clear billing.
No Surprises Act Protections
Since January 2022, the No Surprises Act provides extra protections. This law addresses surprise medical bills, especially from out of network emergency care.
If you receive care at an in network facility but get treated by an out of network provider without your knowledge, you shouldn't get a surprise bill. Bills that violate this act cannot legally be collected.
Debt collectors cannot report or try to collect debts that exceed amounts permitted by the No Surprises Act. Doing so may violate the Fair Credit Reporting Act.
According to the Consumer Financial Protection Bureau, collectors who pursue illegal surprise bills can face serious penalties. If this happens to you, you have the right to dispute the debt and file complaints.
Special Protections for Nonprofit Hospitals
Nonprofit hospitals get tax breaks. In exchange, they must follow strict rules before sending bills to collections.
The Affordable Care Act requires nonprofit hospitals to have written financial assistance policies. They must tell patients about these programs. They must make reasonable efforts to determine if patients qualify for help before starting aggressive collection actions.
Many nonprofit hospitals cannot send bills to collections without first offering you a payment plan or checking if you qualify for charity care.
Research shows that many nonprofit hospitals don't follow these rules properly. Some send bills to collections too quickly. Others don't properly inform patients about financial assistance.
If a nonprofit hospital sent your bill to collections without telling you about financial assistance programs, they may have violated federal law.
When Collectors Can Contact You
Even after your bill goes to collections, rules limit how collectors can contact you.
They cannot call before 8 AM or after 9 PM in your time zone. They cannot call you at work if they know your employer doesn't allow personal calls. They cannot contact you more than seven times in seven days about the same debt.
Collectors must identify themselves. They cannot pretend to be from the government or a law firm if they're not. They cannot threaten actions they don't intend to take or cannot legally take.
The Debt Collection Rule from 2021 added new requirements. Collectors can now contact you by email and text, but they must give you a way to opt out. If you opt out and they keep contacting you that way, they're breaking the law.
What to Do If You Get a Collection Call Without Notice
Don't panic. And definitely don't pay immediately. You have rights and options.
Request Debt Validation
You have 30 days from the first contact to request validation in writing. Send a letter asking the collector to verify the debt. Ask them to prove you owe it and that they have the right to collect it.
The collector must stop collection attempts until they provide verification. This gives you time to investigate whether the debt is real and accurate.
Check Your Records
Look through your insurance explanation of benefits forms. Check bank statements for payments you already made. Pull up your medical records if needed.
According to consumer protection data, many medical debts sent to collections contain errors. The amount might be wrong. Insurance might have already paid. You might have already paid but the payment wasn't recorded properly.
Demand an Itemized Bill
Even in collections, you have the right to see exactly what you're being charged for. Request a detailed, itemized bill from the original provider.
Check every charge carefully. Look for duplicate charges, services you didn't receive, or amounts that seem inflated. Healthcare billing errors are extremely common.
Dispute Inaccurate Debts
If the debt is wrong, dispute it immediately. Send written disputes to both the collector and the credit bureaus if it's on your credit report.
The collector must investigate your dispute. They cannot continue collection efforts while investigating. They cannot report the debt to credit bureaus while it's disputed.
Know Your Timeline
Medical debt can only stay on your credit report for seven years from the date it first became delinquent. Some states have shorter statutes of limitations for medical debt lawsuits.
If a collector threatens to sue over very old debt, check your state's statute of limitations. In many states, they cannot sue to collect medical debts that are more than three to six years old.
New Credit Reporting Rules
Recent changes offer more protection for people with medical debt.
As of July 2022, credit bureaus stopped reporting paid medical collections on credit reports. If you pay off a medical debt in collections, it should come off your report entirely.
Starting in 2023, the three major credit bureaus stopped reporting medical collections under 500 dollars. These small debts no longer appear on credit reports even if unpaid.
The Consumer Financial Protection Bureau attempted to ban medical debt from credit reports entirely in 2024. Courts halted this rule, but it shows the direction of consumer protection efforts.
These changes mean that smaller medical bills in collections cause less damage than they used to. But debts over 500 dollars can still seriously hurt your credit.
How to Prevent Bills From Going to Collections
The best approach is stopping the problem before it starts.
Update Your Contact Information
Make sure every medical provider has your current address, phone number, and email. Update this information if it changes.
If you move, contact any providers you've seen recently to give them your new address. Don't assume mail will forward properly.
Open Every Medical Bill
Don't confuse explanation of benefits forms from insurance with actual bills. EOBs show what insurance processed. Bills show what you owe.
Open and read everything from medical providers, even if it looks like junk mail.
Set Up Payment Plans Immediately
If you can't afford to pay a medical bill, contact the provider right away. Don't ignore it and hope it goes away.
Most providers offer payment plans. Even small monthly payments show you're trying to pay. This can prevent the account from going to collections.
Ask About Financial Assistance
Before your bill is due, ask if the provider has financial assistance programs. According to federal requirements, nonprofit hospitals must have these programs.
Many people qualify for reduced bills or even complete forgiveness. But you must apply before the debt goes to collections.
Keep Payment Proof
Save confirmation numbers, receipts, and bank statements showing you paid medical bills. Healthcare billing systems make mistakes often.
If a bill you already paid ends up in collections, your proof of payment can clear it up quickly.
Your Rights When Things Go Wrong
You have strong legal protections against unfair debt collection.
The Right to Stop Contact: You can tell collectors in writing to stop contacting you. They must stop except to notify you of specific actions like lawsuits.
The Right to Sue: If collectors violate the Fair Debt Collection Practices Act, you can sue them. You can recover damages plus attorney fees.
The Right to Complain: File complaints with the Consumer Financial Protection Bureau, Federal Trade Commission, and your state attorney general. These agencies track patterns of abuse and can investigate collectors.
The Right to Accurate Credit Reports: Under the Fair Credit Reporting Act, information on your credit report must be accurate. You can dispute errors and demand corrections.
The Bottom Line
Medical bills cannot legally go to collections without notice. Providers must bill you first. They must try to collect the debt themselves. Collectors must contact you before reporting to credit bureaus.
But the reality is messy. Bills get lost. Contact information gets outdated. Insurance creates confusion. Collections happen faster than many people expect.
According to recent research from Health Affairs Scholar, about 194 billion dollars in medical debt is currently in active collection in America. Much of this debt involves people who never got proper notice or didn't understand their bills.
Protect yourself by staying organized with medical bills. Keep contact information updated. Open every bill and EOB. Ask questions when charges seem wrong. Request payment plans before bills become overdue.
If debt goes to collections despite your best efforts, know your rights. Request validation. Dispute errors. File complaints when collectors break the rules.
Medical debt is overwhelming enough without unfair collection practices making it worse. Understanding the notice requirements and your legal protections can help you fight back when collectors overstep their bounds.