Written by Mark San Juan
You may have already forgotten about your appointment, and then, weeks later, the medical bill shows up.
You glance at the total and tell yourself you’ll deal with it later because your day is stressful enough as it is. ‘Later’ turns into next week, then next month, and, at some point, there’s nothing but silence on your end.
And that’s how people ghost their medical bills.
It’s not like someone deliberately chose to ignore their responsibility, but life is stressful, and they hope the bill will just take care of itself… Somehow.
Medical debt isn’t like other bills because it’s tied to vulnerability and health. There are numbers that don’t make total sense, and the fine print from the insurance you need to deal with, so all in all, it’s a lot. And remember that you still have your everyday expenses to take care of, so avoiding medical expenses seems almost automatic.
It’s not even just about the money. It’s about trust and about the fear of being trapped in a conversation you can’t control.
This type of behavior follows predictable patterns, and once you know about it, you can see what brings patients back instead of pushing them away.
Why Patients Delay or Avoid Medical Bills
Stressing over money changes how your brain works.
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When a medical bill feels too big or too unclear, the natural response is usually to avoid it.
That’s not being lazy, it’s simply a reaction to stress.
When the nervous system feels overloaded, it looks for the fastest way to reduce pressure, and the quickest relief comes from not engaging with what’s stressing you out. Opening the bill is stressful, as is logging into the portal or calling the office. Best to just deal with it ‘some other time’.
As previously mentioned, medical debt doesn’t feel the same as a utility bill, so that’s another thing to think about.
| The most common type of debt in collections in the U.S. is medical bills. – Consumer Financial Protection Bureau |
A phone plan is tied to service, but a medical bill? That’s about health and fear.
It comes from a moment where you already had little to no control, and even patients who can afford to pay the bill right away feel unsettled when they’re looking at a charge connected to their body and diagnosis.
Embarrassment is another factor.
A lot of people don’t want to admit that they’re confused by the bill or unable to pay it immediately, which is perfectly understandable. The figure, if they ask for help, they have failed, regardless of how common their situation is. So they don’t reach out because it feels safer to stay away from the whole thing.
Then there’s decision overload, which is something everyone can relate to.
Large numbers here, unclear insurance coverage there, and a bunch of unfamiliar terms are a lot to take in. If it feels complicated to move forward, doing nothing is the default choice.
In the short term, you calm your anxiety when you ignore the bill. In the long term, though, avoiding it means that the stress is always somewhere in the background.
Where Billing Communication Breaks Down
Usually, billing communication goes on the fritz long before a bill is overdue.
Most patients don’t ignore their balance because they’re trying to avoid responsibility, but because they don’t quite realize what’s happening.
| In the U.S., the most common reason for delayed/avoided payments of medical bills is that patients frequently misunderstand them and/or the insurance terminology. – Yale School of Medicine |
Medical codes and insurance terms are insanely confusing (some would go as far as to say this is done on purpose), and anyone outside these systems has a hard time understanding even the basics, let alone something more complicated. When you’re faced with terms that don’t clearly explain what you’re being charged for, it’s only normal to feel reluctant to pay.
Timing makes matters worse.
Sometimes, it could be months between the treatment and the first bill, so by the time the bill arrives, the patient hardly remembers the details of their appointment. There’s no real connection between the care they received and the cost of it, so it all feels sudden and awkward when the bill gets to their address.
| Medical bills that come delayed or are unexpected increase mistrust, lowering the likelihood of a timely payment from the patient. – Institute for Healthcare Policy & Innovation, University of Michigan |
This makes patients suspicious and hesitant.
And on top of all that, it’s not uncommon for the patients to receive mixed messages.
The insurer says one thing, the clinic’s billing office says something else. One document clearly states that part of the cost is covered, the other suggests it’s not.
How can you not be doubtful with this kind of inconsistency? People start to question if the amount is correct, and once that doubt creeps in, a lot of them choose to wait rather than act. And it makes sense.
Some clinics use structured digital billing systems to keep communicating with the patient instead of doing that through statements, portals, reminders, and tools like medical billing merchant account solutions, which are systems designed to stabilize the entire payment flow, which helps reduce delays caused by unclear/delayed charges and/or slow confirmation steps.
But even with helpful systems in place, communication still depends on whether patients get clear answers when they ask questions.
Issues Within the System That Increase Avoidance
Some patients pull away out of fear or confusion, but others do it because the system makes them. Even if you fully intend to pay the bill, the billing process can be long and frustrating.
Here’s how the system makes this harder on the patients.
Insurance Not Covering as Much as Expected
Insurance is supposed to cover most of the cost, or at least that’s what people think.
Then the bill arrives and says otherwise. Deductibles, co-insurance, and services that aren’t fully covered leave patients owing way more than they expected. And it’s not just the amount that makes this hard, but the surprise, as well.
Imagine a person thinking they did everything right, and they still get hit with a huge balance. It feels unfair, even if the charge is technically correct.
Multiple Providers and Separated Billing
One visit doesn’t always mean one bill, which adds to the confusion even more.
| In the U.S., a major source of patient confusion and billing disputes is fragmented billing. – Centers for Medicare & Medicaid Services |
Let’s say you went for a routine appointment.
That one appointment can mean one charge from the clinic, one from the lab, one from imaging, and one from the specialist. The bills all arrive at different times and look nothing alike, and sometimes they even have unfamiliar names.
So instead of dealing with one situation that’s relatively clear, you’re left with several bills all looking and sounding off. You can hardly keep track of what you paid and what’s still open.
It’s all so scattered that it’s easier to avoid the whole thing altogether.
Income Timing and Competing Expenses
Since people (usually) earn a fixed amount each month, they usually tend to know how much money they have to work with in terms of spending/saving. When it comes to spending, it’s all about priorities (e.g., utility bills, food, rent, childcare, etc.). On this list of priorities, medical bills don’t rank as high.
Sure, people will want to pay them, but if they don’t have enough money that month, it’ll have to wait. Besides, they may show up late, like after the rent has already been paid, and money is tight.
When that happens, people push the bill aside, and they think they’ll handle it ‘later’, which means that there’s no clear timeline or plan.
What happens is that the bill just sits there. Unpaid. Waiting. Stressing everyone out.
Technical Barriers to Online Billing
| Lots of online tasks (billing included) tend to get abandoned due to issues with login, layouts, and/or portal errors. – Pew Research |
You expect to manage your bills online, but that’s not always simple.
Problems with logging in, confusing layouts, missing information, error messages popping all over the place…
If you’re already stressed with the bill itself, this seems like a dead end. Instead of calling for help, you click out and, you guessed it, decide to deal with it ‘later’.
How to Help Patients Deal with Unpaid Bills
The biggest difference can be made before the bill is even sent.
If a patient has a clear idea of what they’ll have to pay upfront, they’re a lot less likely to shut down later. The number doesn’t necessarily have to be small; it just shouldn’t take patients by surprise, and they’ll already react to it better. When they know what to expect, they have a sense of control over the situation, which is a huge deal.
Also, talking about costs early changes how people react when they receive the bill.
Money should (in an ideal world) be treated as a normal part of the conversation, not something awkward that everyone tries to avoid. That way, it loses a big chunk of its emotional charge and causes patients not to panic as much.
Another thing that helps a lot is a predictable payment schedule.
A clear plan turns an intimidating amount into something that’s doable, and that alone can lower resistance and make patients more willing to stay in contact.
Of course, you can’t forget about the importance of the way the staff communicates with the patients. A calm, respectful tone is always a must because, apart from other things, it makes everyone want to cooperate.
A rush, dismissive tone does the opposite. Patients should never feel judged or pressured, and when they do, they start ignoring their responsibilities. Make them feel understood, and they’ll respond properly.
Then there’s the follow-up.
How you frame it makes all the difference, so what you want to do is send messages that sound supportive, not something that feels like a demand. A reminder that offers help or answers questions can do a lot.
Conclusion
It’s rare that a person ghosts their medical bill because they’re careless and irresponsible like that.
But the stress over it is very loud, and when you add confusion to that, it becomes exhausting, so silence is the easiest exit. For a while, at least.
What usually changes this story is how you approach it. Endless reminders and notices won’t do anyone any good because all they do is stress people out more. Clarity is what cuts through all the fog and anxiety, so focus on that.
Treat every patient like a real person instead of an account number. Give them clear information from the get-go.
Author’s Bio
Mark San Juan is a distinguished author and health care professional with a passion for transforming health care delivery through innovative approaches. With over two decades of experience in the field, Mark has established himself as a leading voice in health care reform and patient-centered care.
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