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I wanna say part of the stipulation was that it couldn't be a surprise bill. Like I had a surgery that the insurance said they would cover 100% after my deductible. I have the surgery, and get bills from every mf in the building that day, basically, 'cause everyone billed individually as contractors in some way. Some contractor nurses they had called in to fill in, the anesthesiologist, supplies used by a doctor, the homeless guy panhandling outside, I forget what else, all billed separately. None of it pre-authorized, and I had already contacted the hospital and my surgeon's office previously to try to prevent some nonsense like this. Anyway, I called and bargained some of it down, as insurance gets a higher bill, which they passed onto me as it wasn't pre authorized, then spent months trying to save up to pay this additional burden of debt. I was looking into getting cheap legal counsel 'cause it was gonna be near impossible, it was a struggle, etc. etc. So I called them back one day seeing if I could negotiate further, got transferred a few times, until someone was nice enough to explain to me what I said earlier, and that if I just ignore it, they'll write it off before the end of the year, but if I could make any kind of payment, as everyone put work in and it leaves "them" high and dry. Just to highlight the gouging, one of my bills before the surgery was over a thousand bucks for some gauze, bandaids, and a cane from my initial emergency visit (also billed separately from the rest of the visit). I saw how much insurance had already paid the surgeon and hospital, and shrugged my shoulders and slept fine that night not giving them another cent. I thanked the Ctulhus for liberals.

Edit: some further advice for the commenter and anyone else, Reddit was a good place to learn tactics on how to negotiate medical debt down, it also gave me a bit of hope, knowing there were plenty of "success" stories. I've been able to negotiate other medical bills down by massive percentages.