BillSherpa · Patient Advocacy · Updated 2026

Hospital sent my bill to collections — what are my rights and options

Getting a call from a debt collector about a hospital bill feels threatening. But the law is firmly on your side. The Fair Debt Collection Practices Act gives you powerful rights — and knowing them can pause collection activity, give you time to dispute the bill, and protect your credit while you work through the problem.

Your rights under the FDCPA — in plain English

The Fair Debt Collection Practices Act 15 U.S.C. § 1692 regulates what third-party debt collectors (not the hospital itself, but collection agencies) can and cannot do:

• They must send you a written notice within 5 days of first contact, stating the amount owed and the original creditor.
• You have 30 days to dispute the debt in writing. If you send a written dispute within 30 days of receiving this notice, the collector must pause all collection activity until they verify the debt and send you that verification.
• You can request they stop contacting you. Send a written "cease and desist" letter and they must stop contacting you (though this doesn't eliminate the debt).
• They cannot call before 8am or after 9pm.
• They cannot threaten actions they can't take.
• They cannot disclose your debt to third parties.

What to do right now

1. Send a debt validation letter immediately. Write to the collection agency (certified mail) requesting validation of the debt — the original amount, the name of the original creditor, and proof you owe it. If you haven't received the required written notice yet, send your letter as soon as you do.
2. Pull your credit reports. Check annualcreditreport.com for free. Note whether the debt has been reported. Medical debts under $500 no longer appear on credit reports. For larger amounts, there's now a one-year waiting period before reporting.
3. Request the itemized bill. Even at this stage, you can go back to the original hospital and request an itemized bill. You need to check whether the amount in collections is even correct.
4. Determine if you were eligible for charity care. If your income qualified you for the hospital's financial assistance program and you never applied — or were never told about it — you may be able to apply retroactively. Many hospitals will pull a bill back from collections if you qualify for assistance.
5. Dispute errors in writing. If you find billing errors, dispute them with the collection agency in writing and also notify the original hospital. A collection account based on an incorrect bill can be disputed with the credit bureaus as well.

Medical debt and your credit score — the new rules

Significant changes have happened since 2023:

• Paid medical collections no longer appear on credit reports at all (all three bureaus removed them)
• Unpaid medical collections under $500 no longer appear on credit reports
• The waiting period before reporting unpaid medical collections was extended to one year (from 6 months)
• The CFPB has proposed a rule to remove all medical debt from credit reports entirely — as of 2026 this is pending finalization

When to consider settling

If the debt is valid and you can't eliminate it through financial assistance, collection agencies often settle for significantly less than the face value — sometimes 30-50 cents on the dollar. Before settling, get any settlement offer in writing. Make sure the letter states clearly that the payment constitutes "payment in full and final settlement" of the debt. Never settle over the phone.