The way debt collection works in the US is the debt collector has to prove you owe the debt, not the other way around.
Pay to delete is a sensible option in the case where you know the debt is legitimate.
In court, he claimed the hospital never provided proof of debt. The hospital claimed it did. The judge asked if they had proof of debt with them, right now. They did. The judge asked my friend if he was willing to pay it with proof of debt presented. He said he was.
Done and done. Orders were guarantee the debt is deleted upon payment, bunch of other weird legal stuff protecting my friend if it should appear on his credit report ever, etc.