What are the consequences of a foreigner acquiring medical debt in the US?

Question

Suppose someone travelling in the US is involved in an accident, gets treated in an emergency room, and then recovers. They are presented with a bill of thousands of dollars, which they are unable to (or refuse to) immediately pay, and then return to their home country. What happens afterwords?

If this situation happens to an uninsured US citizen, what typically happens is that the bill get sent to a debt collection agency, and may well never be paid, but at least the person is incentivized to pay or settle with the debt collector, as debts can negatively impact one's credit score.

But what happens if the person is a foreigner who never intends to live or work in the US? I imagine that there are potentially two kinds of practical consequences:

1. the usual issues with debt, i.e. credit ratings and getting harassed by a debt collector,

2. immigration-related issues, i.e. potential problems with entering the US in the future.

For (1), certainly the person's credit rating in the US will be severely impacted, but that is a non-issue if they never intend to live in the US. But perhaps if the amount owed is large enough, the hospital will put extra effort into finding a debt collector who operates internationally?

Answer 1

This depends a lot on your countries of residence/citizenship.

the usual issues with debt, i.e. credit ratings and getting harassed by a debt collector,

Your local laws apply, so whatever means of debt collection exist in your country can be applied to you. There are international debt collection agencies that specialize in that sort of thing. Or the hospital can simply hire one in your country (if they exist). How exactly that would play out varies a lot from country to country.

immigration-related issues, i.e. potential problems with entering the US in the future.

That's more murky. Nothing in the ESTA questionnaire would require you to disclose this information. Typically, civil debt in itself doesn't impact your eligibility to enter, unless it is related to some criminal activity. The Department of Homeland Security "may consider a noncitizen’s assets, resources, and financial status as one factor when determining whether the individual is likely to become a public charge" when evaluating a visa application. You may get in trouble, you may not.

If the hospital engages an international collection agency, they may do everything they can to make travel to the US more difficult and use that as a leverage. What that might be I don't know.

Another side note: If the hospital decides they can't collect and writes off the debt, it becomes taxable income. Depending and what mutual tax agreement exists between the countries, that may also create problems.

Long story short: It's highly advisable to have medical travel insurance. It covers a considerable risk and is typically very inexpensive. Example: Germans can get one year of worldwide coverage for 12 Euro.

Answer 2

As said before, consider your home country laws. We don't know what it is, so I'll add another generic answer. Keep in mind that while this is a "worst case", the risk is easily mitigated with any reasonable travel insurance.

the usual issues with debt, i.e. credit ratings and getting harassed by a debt collector,

This is usual to the US. In my home country, for example, a debt collector can garnish your wages, seize your assets, and block you from leaving the country until you pay. I.e.: not only won't you able to go to the US on vacation - you won't be able to go anywhere for any reason. Imagine being turned around at the airport on your way to a business conference or for a family vacation, just the embarrassment of it, let alone the costs.

Many countries have agreements to enforce foreign judgements, so if you lose (by default or by trial) in a US civil court and a judgement is issued against you - it will be enforceable in your home country if your country has such an agreement. Even if it doesn't, your local court may issue a judgement against you based on the same facts and circumstances, adding the legal costs in both countries to your debt.

immigration-related issues, i.e. potential problems with entering the US in the future.

Unless there's a criminal case against you, it is unlikely that the US immigration will care. But, if the debt collector learns of your intent to get to the US - they may wait for you at the airport to serve you with a lawsuit or a court order to seize assets.

However lack of travel insurance may be a violation of your visa, so from that perspective you may have troubles if the DoS or USCIS/ICE learn about it.

One additional thing to remember: emergency rooms are for emergencies. If your condition is not (or becomes no longer) life threatening, a US doctor or hospital will not treat you without providing financial responsibility assurances beforehand (insurance or payment methods). If you have a life threatening condition, the ER will stabilize you and then will send you home. If your condition is not life threatening, they'll diagnose you, and if you're lucky give you some minimal treatment - and then will send you home.