would seriously damage our credit rating.

Right, of course that is part of it. But have you looked into the option of asking your doctor if they can work with you for a lower fee? An office visit may "cost" an uninsured person $75 while they bill an insured person for just $30. Maybe they would cut you some slack. Sometimes you can offically be seeing the nurse practioner, for instance, who calls the MD into the exam room for some consultation, but you're only charged for the nurse visit.

The folks who work in those practices are just as pissed off about managed care as the patients. Sometimes just asking them how to work their system really WORKS.

And again, my experience of rural ER care is that it has been really quite wonderful MEDICAL care. Because they know their population and they do what they can, when they are not overloaded with car crash victims.

~Susan