2022 BuoyFi Medical Debt Survey

It’s easy to assume that people with overdue medical debt wind up in that situation because they don’t have health insurance, but a new national survey finds that’s not the case. In fact, the survey of Americans with burdensome medical debt found that nearly all (94%) have health insurance. The survey was commissioned by BuoyFi, which provides tools to help people calculate an affordable settlement or payment plan based on their income.

A Will Without a Way

The survey found that three out of four Americans with overdue medical debt (75%) would like to pay it off. Almost half (47%) say they haven’t because they can’t afford to, and 41% say it’s because they have other bills that are more of a priority. For almost four in 10, overdue medical debt has caused them to have trouble paying for everyday necessities like groceries, transportation, childcare and clothing.

Making People Sicker

One of the most alarming findings of the survey is that, ironically, medical debt itself may be making people sicker. The survey found that having overdue medical debt led about a third of respondents to:

  • 32% avoid seeking medical care in an emergency
  • 31% delay preventive medical care
  • 30% skip filling a prescription or take less than the full prescribed dose

Limiting Opportunities

Survey respondents said their medical debt had many other negative effects on their lives, including being denied home and car loans (23%), not being able to invest in their own or a family member’s education (18%), and delaying starting a family (11%).

“As a company dedicated to helping consumers rise above medical debt so they can live freer, more fulfilling lives, BuoyFi commissioned this survey to gain new insights into not only the immense burden of medical debt, but to inform the development of tools and services that can help these patients resolve their medical debt and avoid it in the future,” said Steve Wright, president of BuoyFi.

Wright said one concerning finding was that a full 40% of respondents were not aware that they might be eligible for financial assistance or debt forgiveness, and 30% didn’t realize that it’s often possible to negotiate the balance down to an affordable amount that can be paid back over time.

“This data confirms that patients don’t always understand that they have options when it comes to paying off their medical debt,” said Wright. “Not only is it possible, but it can be more affordable than they think.”

Rising Above

BuoyFi offers free tools to help consumers calculate what they can afford and recommends settlement and payment plans based on income. BuoyFi team members, many of whom have experience working in account receivables and patient financing, are available to review users’ options and provide tips on how best to negotiate with collections representatives.

“BuoyFi’s Mission is to empower all Americans to free themselves from burdensome medical debt while building healthier financial futures,” said Wright. “Access to the right tools can be a powerful first step.”

For additional survey results, contact Todd Morgano at


The survey was conducted online by Falls & Co. from April 6 through April 14, 2022, among 517 U.S. residents ages 18 and older. Falls established the sampling quotas, designed the questionnaire, tabulated the survey responses, and managed the overall project. Falls used Dynata (Plano, TX) to administer the survey via the internet, including mobile devices, to Dynata’s captive U.S. panels who met the age, gender, racial/ethnic background, and regional demographic criteria. Respondents were required to have held medical debt at some point in their lives to qualify for the survey. The sample sizes for Age, Gender, Race/Ethnicity, and U.S. Census Region were weighted by U.S. Census Bureau estimates of the U.S. population as of the last decennial census (2010). While different sample sizes have different statistical margins of error, the estimated margin of error for any question with a sample size of 517 is +/- 4.3%.

Highlights from the Survey

How deep is the debt?

Almost 70% of respondents have medical debt balances between $500 and $5,000.

Insurance isn’t enough

Nearly all survey respondents (94%) say they have health insurance coverage.

High deductibles not helping

People with high deductible plans typically have more debt than people with high premium plans.

Try as they might

79% of all respondents have made a payment, including 72% of people making less than $10,000/year.

A bill-paying balancing act

The two main reasons people don’t pay their medical debt are that they simply can’t afford to (47%) or they have other bills that are more of a priority (41%).

Medical bill mistake?

16% of people who haven’t paid their debt say the original bill was incorrect and they’ve had trouble getting it corrected.

13% say the original bill was incorrect and they just don’t know how to fix it.

Sick of their debt

Medical debt may be making people sicker. Carrying medical debt led about a third of respondents to:

  • 32% avoid seeking medical care in an emergency
  • 31% delay preventive medical care
  • 30% skip filling a prescription or take less than the full prescribed dose

A medical debt ripple effect

When asked what they’ve experienced as a result of their overdue debt, respondents said they:

  • 35% delayed a significant purchase (appliance, home repair, technology, etc.)
  • 23% were denied a home or vehicle loan because medical debt lowered credit score
  • 18% were prevented from investing in education for themselves or a family member
  • 15% were not selected for a job and/or their application for an apartment was denied after a credit check

Negotiation knowledge gap

30% of respondents were not aware that it may be possible to negotiate with a care provider or billing/collections representative to reduce their debt.

40% were unaware that depending on their income, they may be eligible for financial assistance programs to reduce or forgive their medical debt.

People most likely to qualify for income-based assistance (earning $75,000 or less) were less likely to know or explore options for assistance or debt reduction than people earning more than $75,000.

Let’s make a deal

75% of respondents would be more likely to pay their medical debt if they could arrange a reasonable payment plan, and 74% would be more likely if they could negotiate what they owe based on their income and ability to pay.

How to Negotiate Medical Bills in Collections

An industry insider offers tips on how to negotiate with medical debt collectors and pay off your medical debt.

According to the Consumer Financial Protection Bureau, a staggering one in five Americans has medical debt that has gone to collections. If you’re among them, chances are you’re looking for information on how to negotiate medical bills in collections—or more specifically, how to negotiate with medical debt collectors.

You may find yourself in this difficult situation for any number of reasons that are beyond your control. It could be that you lack health insurance, or you are insured, but your insurance company didn’t cover some or any of the services you needed. You may have been hospitalized with a serious health issue but have no experience negotiating hospital bills. You may have consulted with a medical bill advocate and tried to work out a payment with the debt collection agency, but it didn’t pan out.

Regardless of the circumstances that got you to this point, as someone who has spent more than 20 years in the healthcare debt industry, I can tell you that the reason most people with medical debt in collections haven’t paid it off isn’t because they don’t want to—in fact, BuoyFi’s research data shows that more than 75% of people with burdensome medical debt want to pay their debts but simply can’t afford to, or they don’t know where to start.

One thing to know from the start – especially if the amount of your debt is so high that you feel like it would be impossible to pay off – is that hospital representatives and debt collectors know you didn’t plan to have a medical crisis and that you have other important financial obligations to take care of like food, housing, transportation and child care.

Because of this, your account holders will often settle a medical debt for a reduced amount or provide for partial payments over time. This is particularly true if the debt has gone delinquent . In fact, through actively working with millions of patients to resolve their medical debt, we’ve found that most patients can afford to pay something as long as the solution is customized to fit their unique and individual needs.


Four Steps to Negotiating Healthcare Bills

So how do you get from here to there – from having burdensome medical debt hanging over your head to the relief you will feel when it’s resolved so you can focus on more important things? Here are four steps you can take now to begin the journey out of medical debt and into financial wellness.

  • Verify that what you received is a bill.
  • Make sure the bill is accurate.
  • Ask about financial assistance programs.
  • Offer a reduced settlement or propose a payment plan you can afford.


Verify that what you received is a bill.

Medical Explanation of Benefits (EOB)Before you dive into how to negotiate a medical bill, it’s important to first verify that what you received is actually a bill. You may receive an Explanation of Benefits (EOB), and while it may look a lot like a bill, it’s not. An EOB is a statement from your insurance company about which medical services or products you received are covered by your healthcare plan. It will outline the services that were provided, who provided them and when, the amount the insurance company will pay, and the amount that you may be responsible for. You don’t have to make any payments based on an EOB. The hospital or healthcare provider is required to send you an itemized bill separate from the EOB.


Make sure the bill is accurate.

If you do receive a bill, your first step should be to review it closely line by line and verify that it’s accurate. Comparing your bill to the EOB from your insurance company is a great way to determine accuracy. Billing errors can happen for any number of reasons. It could be as simple as a typo in the spelling of your name, or a clerk entering the wrong code for a particular procedure, or billing for a test that was scheduled to happen during your visit but didn’t.

According to data from Kaiser Family Foundation (KFF), a significant portion of medical debt may be caused by billing errors. A KFF survey found more than half of adults with healthcare debt (53%) and 43% of all adults received a medical or dental bill they thought contained an error. Some of the errors included being billed for things people thought should have been covered by insurance, but in other cases, people said they had been billed for services they never received.

While many were able to have the errors corrected, half were not able to or didn’t even try. And, about one in three (32%) of adults with health care debt who received a bill they thought had errors said they had a disputed bill sent to collections.

This is a problem because having debt in collections often affects your credit. It can show up on your credit report and hurt your credit score, which impacts other aspects of your financial health. A low credit score can make it harder to get approved for a personal loan or a mortgage, or result in higher interest rates on a credit card and other loans.

On the positive side, under new policies that took effect in July 2022, the three major credit reporting agencies, Equifax, Experian and TransUnion, will remove any record of a medical collection debt from a credit report once the debt has been paid in full, instead of the previous seven years. In addition, rather than adding medical debt to a credit file only six months after it goes to collection, the credit reporting bureaus will wait one year, giving consumers more time to address the situation. Finally, medical debt balances under $500 will not impact your credit report.


Ask about financial assistance programs.

If the amount of a medical bill is more than you can pay, you can ask your healthcare provider or a patient advocate at the location where you received care about financial assistance programs. Depending on your income, you may qualify for help with medical bills from the federal government, such as through Medicaid, CHIP (the Children’s Health Insurance Program), or Medicare. Many healthcare providers also have their own financial assistance programs, and there are many non-profits and charitable foundations dedicated to helping people get out from under medical debt.


Offer a reduced settlement or propose a payment plan you can afford.

Healthcare Repayment PlanIf you haven’t been able to pay your bills, oftentimes your medical provider will send the account to a collection agency to try to collect on their behalf, or they will sell the account to a healthcare asset management company. Some collections organizations earn a percentage of the collected debt, but others who buy the debt have more flexibility to negotiate or forgive the balance based on your income and other factors.

When considering how to settle medical debt in collections, one thing we have found to be particularly effective is to come to a settlement conversation armed with a reasonable offer based on your income and other assets. To make this easy, BuoyFi offers free tools to help you calculate what you can afford and recommends a settlement or payment plan based on your income and the total amount of your medical debt. Using a tool like BuoyFi when negotiating with a healthcare provider or collections agency can help you move from confusion to confidence and take the right steps toward debt resolution and financial freedom. Hospitals and collections professionals may also be more likely to accept an offer or plan recommended by a tool like BuoyFi because it’s based on your verified income.


How to negotiate a hospital bill – additional considerations

If the settlement options and payment plan recommendations are still not possible due to competing bills, you can try offering a partial payment based on the balance. Start by offering .25 for every dollar owed, or $500 for a $2,000 debt, and negotiate until you find an amount that’s acceptable to the hospital or collections representative. If you do not have the savings to pay this all at once, propose a payment plan that breaks the balance into affordable monthly payments. For example, $500 paid back monthly over two years is a much more affordable $20/month. At BuoyFi, team members are available to review users’ settlement and payment plan options and counsel on how best to negotiate . Finally, be sure to always get any agreements in writing and request written confirmation when you’ve settled your debt.


A path toward financial freedom

A path toward financial freedomThe high cost of healthcare is a burden on many families and many organizations are working to make the system more affordable and easier to navigate. While approaches to solving the problem of high healthcare costs differ, one thing people across the spectrum seem to agree on is that people should not be bankrupted with overwhelming medical debt. If you are in a situation that feels hopeless, know that there is a way out.

Simply download the BuoyFi app or set up an online account today to calculate a personalized and affordable settlement and payment plan to rise above medical debt.


About the Author

Peter Thompson leads BuoyFi client services, which is responsible for ensuring the best possible user experience for consumers wanting to negotiate healthcare accounts. Peter has more than 20 years of experience working with healthcare consumers as a solutions architect, revenue cycle strategist, and director of client services, focused on helping resolve medical debt and accessing payment solutions.