Foreign tourist in the U.S.: $9,200 ER bill from Swiss collection agency

Hi all,

I’m a tourist from the Netherlands and I could really use some legal advice about a situation that’s becoming quite stressful.

In August last year, I was visiting the U.S. and had to go to the ER for a minor injury that required a few stitches. I provided my personal details and my Dutch health insurance information at the hospital.

In the Netherlands, our basic insurance covers emergency care abroad, but only up to the standard Dutch rates. Unfortunately, I now realize that additional coverage is required to be fully insured for the higher costs in countries like the U.S. Based on what I’ve learned, my insurer may only reimburse around $500.

At the time, I had no idea how expensive U.S. medical care could be — and nobody at the hospital warned me or gave me any estimate of costs. Had I known, I would have reconsidered going to the ER entirely.

After the visit, I never heard anything again. No bill, no follow-up, no contact from the hospital.

Then, out of the blue, I recently received a letter from a Swiss debt collection agency saying I owe $9,200 on behalf of the U.S. hospital.

A few things feel really off:

• The hospital never contacted me directly — not even once.
• The amount is huge, I am not able to pay this. It might be normal for US standards, but for Europeans standards its way off as we can see how much the Dutch insurance will cover.
• They never reached out to my insurance provider.
• Why was my personal information sent to a foreign third-party agency without prior notice?
• The letter includes no itemized invoice, just a reference number, the hospital name, and the total amount.
• They’re asking me to submit my insurance information again (which I already provided at the hospital), along with my phone number and email.
• They state that if I believe I must pay the bill myself, I should contact them before paying.
• In small print, it says if I don’t respond within 30 days, they’ll assume I accept the charges as valid.

Frankly, I find it strange and alarming that this case was immediately passed on to a foreign collection agency without any prior communication or billing attempt by the hospital. If I’d known the treatment would cost nearly $10,000, I never would’ve gone through with it. But in the moment, I had no idea and was never warned.

I’m now afraid that if I engage with the collection agency, they’ll start pressuring or harassing me. On the other hand, I don’t know if I can legally ignore this.

My questions:

1. Can a U.S. hospital legally send a foreign tourist’s bill to a foreign collection agency without ever contacting the patient?
2. Am I required to pay without receiving an actual itemized invoice or original bill?
3. What are the potential legal consequences (in the U.S. or EU) if I ignore this?
4. What should my next step be?

Thanks so much in advance for any guidance. This whole situation feels wrong, and I don’t want to make it worse by handling it the wrong way.

Location: Netherlands, US, Switzerland