In my experience, they sell the debt to a collection agency and you start getting nasty phone calls. That, on top of the other stuff you would expect like credit history hits. These charges I got insurance to figure out they were bogus, like billed for receiving treatments my grandmother never got, medications never administered, you name it. Took a lot of phone calls and getting a lawyer though. The whole system is irredeemable.

TrueAnon rules for life rule #2: always pick Minister of the Interior position.