Companies can try to collect on medical debt virtually forever. Although old debt is easier to escape in court, little prevents debt collectors from trying to collect on it. “Debt never dies,” says Craig Antico, a former medical-debt collector and a co-founder of RIP Medical Debt, an organization that buys and eliminates medical debt. Only Wisconsin, North Carolina, and Mississippi clear certain debts once they are past the statute of limitations.

Generally, hospitals seeking to get bills paid place accounts in a “waterfall” of collection attempts, Antico told me. At first, hospitals, or the collections agencies they hire, will approach debtors with a “soft” collection: Did you misplace your bill? Maybe you qualify for charity care. “But then if people aren’t responding, it will get more stressful,” Antico said. A collection agency might report the amount owed to a credit bureau, or the account might be sent to an attorney to enforce collection. (A new proposed federal rule would prohibit debt collectors from calling more than seven times weekly about a debt, but consumer advocates told me this could still result in more than seven calls in a week, since each doctor’s bill can count as a separate debt.)

Eventually, collectors might opt to sue you, in which case they might be able to garnish your wages or put a lien on your property. Antico estimates, based on an ADP report, that about 1.5 percent of American employees have a garnishment on their wages for a medical reason.