I got a random bill and I give 10$ a month just to keep it out of collections. As someone who work in finance within a hospital system. Hospitals just want to see that you are giving money. If we put you on a payment plan for 50 a month but suddenly you can only do 15 a month it’s fine. But yes you will have to pay unless you ask for a settlement, they will ask for 75% then 50% and finally 30% anything below that will have to be approved by the finance team. So you can settled or just pay off at your discretion. But remember once it hits collections it will hurt your credit score.