Yes the collections does not have the bill either...
I had the same issue, I sent the request for validation thinking that the collection agency won't have it and they won't be allowed to collect the debt.
Surely enough I received a stack of papers in the mail from the collection agency including the itemized bill.
- Bottom line -They can get it from the hospital if they really want to.
(And if they don't, they may not be allowed to pursue the debt- consult an attorney)
Make sure to send it certified mail.