Paraphrase however you want, this patient or someone legally tied to him is still responsible for paying that amount. If they do not pay, then they suffer, e.g. their credit score tanks, meaning their ability to purchase property or other assets is severely diminished. Ownership of property is a key measure of wealth.
Collection agencies may speculate which debt may or may not be paid, but they have no way of knowing. Bottom line is: The patient or his legal guardian are paying the bill, if not monetarily then by their quality of life. If not, then it is taxpayers who are paying for it via DSH payments made by federal government to hospitals, or consumers via price hikes.
This is anecdotal, but my brother took his girlfriend, who was an alcoholic, to Vegas, (against our strong insistence that he not), and she got so wasted and out of her mind, that she ended up in the hospital. They just gave her an IV, and fluids and did a number of tests, but the bill was about $4000+ US, anyway, my brother told me, they were somehow able to get a hold of her pertinent financial information, right then, and just said "forget it, let her go", when they saw she had nothing. She has parents, (with whom she lives), who both have reasonably good incomes, and own a house, but the hospital didn't pursue it beyond that, they released her and she didn't pay anything. My mom also had a friend who was an ER doctor in Arizona, and I don't remember exactly what he said, but it was something to the effect of, "if you have nothing, we'll treat you, and you don't pay, but we always check insurance before doing anything".. which I took to mean, they provide a life-saving, immediate procedure, even if you can't pay, but you have to land in ER, its a one shot deal, they'll only meet the minimum treatment requirements. Incidentally, I need to phone him about something else, I should clarify that..