That depends on the level of collections. The first level for people who are likely to pay. Some doctors send all bills to collections for example - nearly everyone knows they need to pay the bill and will pay it, and the collectors need to be polite about this so the doctor keeps sending bills their way. The levels after that though are for people who either can't pay, or won't pay and you get the jerks of the collections business here because that is your best chance of getting you to pay.