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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?

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  • Negative impact on credit score is not the only consequence of unpaid dept -- you can also be sued for the money (either by the original creditor or a collection agency). It is more challenging to sue someone abroad, though possible. Also they might serve the lawsuit to your last known address in the US, and get a default judgment if you don't respond. While you might be able to challenge the validity of service later, it is a pain, especially if you don't know about it until it affects something unexpectedly.
    – user102008
    Aug 15, 2022 at 17:06
  • @user102008 OK, the lawsuit gets served to a hotel, and then a default judgement results--then what? Can the debt and ensuing lawsuits lead to criminal charges? Hence this question, I'm wondering what might actually happen.
    – Aqualone
    Aug 15, 2022 at 17:54
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    @Aqualone most countries have agreements that allow enforcement of foreign judgements. If a default judgement is issued against you, a debt collection agency in your home country will collect and you won't be able to defend in local courts since a court has already decided.
    – littleadv
    Aug 15, 2022 at 19:07
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    Anecdote: I have not paid a few hundred US dollar ER bill in a decade. Visited more than a few times since, renewed my NEXUS card... So far, I have not been thrown into a debtor's prison...
    – user4188
    Aug 15, 2022 at 20:31
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    @jcaron Provided you actually have a credit card. They are much less common outside of the US. The only reason I might think to get one is to be able to rent a car abroad, but it is often somehow possible even without. Aug 16, 2022 at 13:46

2 Answers 2

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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.

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  • Comments are not for extended discussion; this conversation has been moved to chat.
    – Willeke
    Aug 17, 2022 at 4:00
  • I’d like to stress that those extremely low cost travel insurances are generally NOT for really long trips. Do not assume you’re covered if you’re out for more than 3 months or so. I have an actual international health insurance (as opposed to travel insurance) and the one I have from the Netherlands is more than a factor 10 times more expensive than that, and is still considered cheap by international standards. Aug 18, 2022 at 6:27
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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.

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  • Re: wage garnishment. I feel you're conflating debt collection agencies (which have legal standing, but are not any sort of law enforced) and collection by court order. For example, over here wage garnishment can only happen with a court order. We have the harassing type of debt collection agencies as well.
    – jaskij
    Aug 16, 2022 at 12:35
  • Continuing, if a debt is sent to a collection agency in the US, but don't actually go through the court, they will have little power over you.
    – jaskij
    Aug 16, 2022 at 12:36
  • @jaskij in my home country there's no such thing as "debt collection" other than by court order. The debt collection is handled by the government, not private entities.
    – littleadv
    Aug 16, 2022 at 19:57
  • In many countries, there are "debt collection agencies" which have no governmental power - they will simply harass you until you pay. Thankfully, our government said that they can't tack on to the debt for said harassment, so they toned down a lot. I'm from Poland, not US. This usually happens when the debt is small and not worth going to court over.
    – jaskij
    Aug 17, 2022 at 14:03

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