What happens if you can't pay medical bills? (USA)

[RedDeadReflection]

What happens, as a tourist, if you can't pay your medical bills?

I know as a resident depending on the state they can bankrupt you, seize assets, get priority during probate if you die, sometimes your spouse is responsible after that too.

But what happens if you aren't American? Assuming no (or poor) health insurance.

Reading about the woman who went to Florida without health insurance and has now been in hospital for five weeks. Repatriation not yet possible, and even if it was it's £130k. The gofundme has "only" raised £38k. If she recovers well enough to leave the hospital what happens? There must be a fairly robust procedure in place or nobody would get travel insurance if they could just walk out and fly home with no consequences. In this case the woman is a pensioner with few assets so I've no idea what they could do.

No, major economic theories have names.

According to Google his three economic principles were apparently:

1. Aggregate demand is the driving force
2. Government intervention is necessary
3. Consumption is key

So are you saying it's not possible to recognise or understand the above without knowing they were "Keynesian theories?" In my opinion it's totally possible to already understand these ideas without realising they were a type of economic theory named after someone who died almost 80 years ago.

John MILTON Keynes 😂😂 This is the best typo I've seen in ages. The wish.com version 😂

I'm not sure what else you could reasonably expect in a foreign country, uninsured and with no ability to pay.

If I were traveling in the UK would I be eligible for an elective surgery on the NHS? I highly doubt it! Physical therapy for back pain? Of course not. I imagine I'd be patched up at an A&E and sent packing as soon as possible. And of course there'd be an attempt to get payment from me because why on earth would UK taxpayers be expected to fund my medical care?

Milton Friedman and John Maynard Keynes.
Two economists that Milton Keynes takes it’s name from.

Wonder if Milton Friedman is another one we're all supposed to know then, or whether we're without a reasonable level of education if we don't.

Debt is debt, it can be collected internationally. It’s a little harder but you have firms that specialise in international collections.

All debts worldwide count if the creditor takes the appropriate legal action, it doesn’t have to be a domestic case/ domestic lender.

Yes but unlike in the states they won't be able to continue collecting from your spouse if you died. But in this case it sounds like she'll never pay it back because she'll not have the assets to cover any of it.

No, very likely she’ll go bankrupt.

Companies sometimes make a point of claiming even if there’s very little chance of recovery to send the message that they’re serious.

Sad really, public health cover isn’t that hard to figure out, all developed countries aside from one have somehow managed.

Many years ago in 1998 I did Camp America and was fully insured which was a condition of employment. I had to go to the emergency room for something so minor I can’t even remember what it was ( I think some sort of weird rash ) and they wouldn’t even look at me without seeing my insurance ( fair enough ) i was in and out in a couple of hours.

imagine my surprise a few months later when I was back home to receive a bill from
the hospital for all kinds of “extras” that I knew nothing about. I ignored it and never heard another thing. Think they were trying their luck.

i heard it costs approx $12,000 to use an ambulance which is ridiculous. We are so lucky with the NHS.

Apologies for the derail OP.

And 'post code lotteries'. Can't figure out why where you live has anything to do with what treatment or meds you can get.

The NHS isn't one single huge business. Each area will have its own Health Board, a business that makes decisions about how to spend it's budget, including making rules about who can have what treatments and in what circumstances.

ETA: I've no idea who JMK was either. And the only aggregate I'm aware of is the rubble-type stuff used in the building trade. I can still draw up a budget, make my expenses match my income and stay out of debt no matter how poor I may be. Which is all the financial information I need to exist in society as an ordinary human being.

i heard it costs approx $12,000 to use an ambulance which is ridiculous

😂That would be ridiculous (if it were true).

With insurance an ambulance will cost anywhere from $250 - $1,500 depending on level of care required (life support etc) and how far the transport is. If you're in an auto accident your auto insurance usually covers the entire cost. Health insurance will cover if medically necessary but you might have to pay an out of pocket deductible depending on your policy.

Cut a very long story short I ended up in hospital in USA. I had insurance.

when I left
hospifal I didn’t have to pay as they had my insurance details. I was to sort the money/paperwork out once home.

fast forward my insurance refused to cover me for not declaring something. (Didn’t know I had to, wasn’t a medical condition, was a one off thing, completely unrelated to what I was seen for)

so I had to foot the medical bill.

decided to try and ignore it… some may say it’s a stupid thing to do. But I was here and USA is far from here right?

9 months later I started getting letters and phone calls through from a debt collector based in Switzerland…

some people said ignore it… I decided to settle as I don’t know what would of happened… I don’t think anything would of come of it. But in comparison to what the lady is going through at the moment, my
situation was minor. And I’m able to travel to the USA without this coming back to me.

Whilst I don’t know the answer to your original question, her problems are big.

There’s the matter of her current ongoing care bill, but the family want her repatriated home which involves huge expense and medical assistance. She’s not well enough obviously to leave hospital and get on a flight. So what’s the solution under these circumstances?

A medically assisted flight home is a big undertaking at great expense.

Our education system is clearly failing when folk haven’t heard of Keynesian economics or JMK.

She definitely won’t be able to re-enter but that’s a very unlikely scenario at this stage anyway.

I know who JMK is, but I didn’t learn it at school. We didn’t study any economics at all (bog standard Midlands comprehensive in the 90s). I think some posters are being a bit pompous about the gaps in other people’s knowledge. There’s no need for dramatic pronouncements of shock and horror; just provide a brief explanation or a Wikipedia link 🙄

I live in the US and we have ambulance insurance provided by the city, which is an extra $3 a month on our utilities bill. It seems like a good deal to me, but thankfully we haven’t needed to test its limitations. Maybe they strap you to the roof unless you pay extra…

Hospitals and most doctor’s offices in the US have financial aide for uninsured or people who can’t afford their medical needs. Usually, the patient or their representative has to pursue it. The medical staff don’t have anything to do with the financial stuff, so you have to contact the billing department.

I’ve lived in several states in the US and it wasn’t legal in any of them for medical debts to transfer to a surviving spouse unless the spouse filled out and signed paperwork agreeing to be financially responsible. There may be states where this is legal, but I’ve never heard of it actually happening. Also, they can’t seize your assets, like your home or car, for medical debts.

Most cities in the US have what is referred to as a county hospital. These offer the most financial aide and lowest costs for medical procedures and are at least partially tax supported. Most places also have free clinics that will provide non-emergent care. You just have to look them up and wait times will usually be longer than going to a corporately owned hospital or private doctor.

In the case of something emergent but not life threatening, like a broken arm, an emergency room is legally required to stabilize you. Then, if you refuse to do paperwork for financial responsibility, they can discharge you or transfer you to a county hospital. If it is life threatening or catastrophic, the emergency room must treat you and stabilize you whether you can pay or not. If you require hospitalization or ICU care, they must provide it until you are stable enough for them to arrange transport to a county hospital. Some corporately owned hospitals have closed their emergency departments so they can choose to only provide services to those with adequate medical insurance.

In my experience, as long as you make the effort to contact the billing department, express a willingness to make payments and work with them, they will also work with you. In most states, making payments, even $25/month, will keep them from even calling you about medical debt. Also, unless you’ve agreed to it in writing, they can’t charge interest. I’ve known a lot of people who have racked up large, scary medical debt and every one of them got almost all of it covered with financial aide and got reasonable payment plans because they contacted the billing department and worked with them.

That's probably the intention. We're not really supposed to understand it, rather, we're meant to blindly accept that this is the best/only way to structure things.

Slightly off topic but when you buy your insurance actually read the policy.

A friend did a working holiday trip to Australia. There are special insurance policies for working holidays.

We looked at a few, and I read the small print (I'm that type of person) a lot of them excluded manual labour, which is something many people do.

In the end we picked the one that looked the best and the only thing that was only partially covered was dental

My friend had a dental nurse for a mother so his teeth are pretty good (although he had veneers where his front teeth were smashed in a hockey match), no fillings until 20+ so that didn't seem too bad.

Day one in Australia, he took a bite of a chocolate bar and broke a veneer!

He had to pay and got 50% back.

Another example was in the 1980s. Pregnant British woman on a visit to New York, no where near due date. She had medical insurance, when she went in to labour the insurance easily covered her bill, but not her very premature baby.

Milton Keynes is named after a village in the area, not the economists.

My dfil is almost 90 and refuses to pay holiday insurance as it costs so much. They go on holidays about 5 times per year. I keep saying to dh that one day his luck will run out.

The UK has debt treaties with a number countries that allow the judgements of foreign courts to be enforced in the UK. The main ones being The Hague Convention (which is a number of different treaties, despite the singular name). But the US isn’t a signatory so US courts’ judgements on debt are not recognised in the UK. However, under UK common law, a creditor can ask UK courts to recognise and enforce a debt contracted abroad. The court would have to be convinced the debt was valid to make a judgment in the creditor’s favour, but if they do then the hospital can enforce the debt or force the patient into bankruptcy here just like they could to a patient who can’t pay in the US.

That someone has no significant assets isn’t an issue in the sense that the reason so many people go bankrupt over medical debt in the US is because they don’t have assets and owe thousands. In that sense the UK woman would be no different to millions of US citizens. The difficulty of pursuing in the UK courts for a company that’s only really familiar with US courts might mean they are less likely to pursue, though.

(And as PPs have mentioned, the hospital could sell the debt on to a collection agency - which they do for US patients sometimes too - not sure how that changes the position of pursuing in UK courts but can’t see a reason it would make a difference. I think debt sale is pretty normal).

Can the older tourist woman sue an American business for injury and have them pay the medical bill? Did she have an accident? Can any blame be attributed to another entity other than herself?

If it’s the person I’ve read about, she got Covid. So unlikely there’s anyone else to be held responsible.