Medical collection date of last activity. Pay off

I have worked very hard for the past 6 months getting my credit report fixed. All I have left is a $373 medical bill (that I think should have been paid by insurance company). None the less, I have called and ask them to remove if i pay in full. "NOPE". Well, this bill is 5 years old. And if I pay it off my score will drop due to activity. And right now for me every point counts. I am wanting to get a new car. If they drop me 10 points, that stops me in my tracks. What should I do?
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I like to pay off everything no matter what. Having it paid helps too. So many times a re date will offset by having a zeroed balance.
The 10 points will be back in a matter of 6-12 months if you have good open credit now.
Some lenders turn people down for just one outstanding collection.