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Different kinds of debt have different kinds of impact on your reputation. I read that hospitals are slow to report unpaid bills to the credit rating agencies. I owe $6000 for an emergency room visit in 2009. Guess what. It has never been reported to the credit reporting agencies. (The radiologist bill was reported promptly when I didn't pay it. A bill collector is contacting me about that. I do hear from a debt collection service that is collecting for the hospital, but they don't bother me very much.)
No debt is fun to have, but I've heard financial analysts say that the least damaging debt you can carry is money owed to a hospital. Now, in your case, we're talking about a copay. I agree with Fresia above that it is unlikely that they will forgive you the debt. Recently, I saw forgiveness of debt extended on a hospital bill, but the patient was very low income and 75 years old and handicapped.
In your case, they are likely to figure that, because you are relatively young (since you are in school, I infer that.) you will eventually have a better income. The hospital isn't going any place, so they can plan on getting more from you down the line.
You have more power now than you might realize. Fresia is right about it being wise to figure out what you could handle before talking with them. I would go a little further than Fresia, in that, they sort of are in the position of pretty much having to take what you give them. In the negotiation over the monthly payment, you have more power than they do. It is good to look at this a bit cynically to see your options. They can't repossess what they sold you, as a car dealer can. It is unsecured debt. You probably don't have assets they could get a lien on. Your job probably isn't so high-paying that a judge is going to grant that much of your wages can be garnished.
So you are in the power seat on this one (at least until you get a higher paying job.) Figure out what you can afford, but offer them less. Then reluctantly agree to pay what you figure would be manageable. Caution: once you agree to a deal, you are under even more pressure to come up with the payments than you are now.
The main leverage they have now is that they count on you being intimidated by the collections department saying things like "This has to resolved today!" and calling you often. NOTHING has to be resolved "today." I strongly advise against trying to evade their phone calls. However, the caller does not have any authority to control the conversation. You can be the one to make them listen to your tale of woe to the point that they will dread calling you more than you will dread hearing from them. I know that sounds smart-alecky, but I'm here to tell you that it works. (I've been through bankruptcy and have dealt with lots of collectors.) Part of what they say to you is stuff they are reading from a script. You don't have to be tied to their script. What I find works is to be very cordial and respectful, but make them listen to the problems of your life in great detail. I get a call once every 2 months now about my hospital bill.
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