What to Do About a Medical Debt Sitting with a Collection Agency
before even reading the rest, one thought comes to mind:

pay it


anything else?






-Was it legal for the collection agency to list my debt on my credit report?
sure. why do you even question this?

Was calling them to talk about it enough to validate debt?
you called? I'm betting that is what you would hear if you ask them but that doesn't affect it being reported in this case anyway.

-Does the time for the statute of limitations start when I was billed from the hospital, from when it was placed with collections, from when I called them about it, or from when it was updated on my credit report?
it is from the date the debt was incurred

-Should I wait for the statute of limitations time to pass before I attempt communicating with them again? I haven’t received any contact from them since the day I called them to talk about it in Dec 09. It has been over 4 years since the accident and nearing 4 years from the date they sent me a bill to pay in full.
it's up to you. Apparently you simply do not intend to pay this bill so why do anything? If they sue, respond with a defense the SOL has run.

-Why wouldn’t I have received any communication from the collection agency since the day I contacted them?
You would have to ask them

Realistically I’d like to negotiate to settle the debt and have it removed from my credit report, but I am not sure when to begin that process.
extremely unlikely that is going to happen but to start the process, you contact whomever owns the debt at this time and say; I would like to have this removed from my credit report. What would it take to have that happen?

take note that if this is reported by the hospital and an entity that purchased the debt subsequent to your default, accept that it is not going to be removed from your credit report by both entities, even if you can negotiate its removal with the current owner of the debt.

Any advice for what to do?
well, again, paying it because you owe it comes to mind but apparently you aren't to keen on that idea.