Negotiating the High Cost of Emergency Care: My $1,015 Bill
Key takeaways:
One year after he walked out of the emergency room, Steve Anderson received a $1,015 bill for “emergency services.”
Despite having health insurance, the hospital and his insurance didn’t want to pay for it.
A nonprofit organization called Dollar For settled the claim for slightly more than 10% of the original fee.
My Bill of Health is a series of stories about the financial strain of healthcare. To share your story, email patientstories@goodrx.com.
Steve Anderson had pretty much forgotten about his summer 2021 trip to the emergency room for what turned out to be a kidney stone.
“I was in the ER for just a couple of hours,” recalls the 34-year-old township employee, who called 911 for intensive abdominal pain and was transported to the hospital closest to his home in Schaumburg, Illinois.
“They gave me some fluids and something for the pain and told me it was probably a kidney stone that I’d pass on my own,” Steve recalls. “Once my wife arrived and I was discharged, they didn’t even wheel me out in a wheelchair. I walked out of the ER on my own.”
Steve thought his work insurance would cover the bill for his care.
But a full year later, the hospital sent a bill for $1,015 for “emergency services.”
At the time, his wife was facing more medical bills related to a car accident and seizure. Even with their combined incomes, they did not have the extra $1,015 to pay the year-old bill. And the bill provided very little information about what it was for.
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For several months, he tried to figure out who was responsible for the unexpected fees. He went back and forth between his insurance provider and the hospital. He discovered that:
When insurance providers and hospitals can’t agree on payment responsibility, you may get stuck with the bill.
Nonprofit hospitals offer charity care to help those who can't pay unexpected medical bills.
Wading through the insurance-hospital bureaucracy and applying for charity care can be time-consuming, frustrating, and eventually, successful.
You can get help from an independent service that lobbies on your behalf to negotiate medical debt.
Steve’s advice? ‘Play hardball’
Steve’s attempts to negotiate a reasonable settlement with the hospital on his own included numerous phone calls and forms to fill out. Yet the same bill kept arriving in the mail month after month. Eventually, he was told he had filled out the wrong application.
Even with solid health insurance, Steve says it felt as if the hospital relied on existing barriers that made it difficult for patients to understand and navigate the system. “My advice to other people in the same situation is just to play hardball.”
Steve finally got results when he connected with Dollar For, a national nonprofit organization that helps people access charity care to lower medical bills.
Within several months of reaching out to Dollar For, his $1,015 medical bill was reduced to about 10% of the original amount — a far more payable $115. People often turn to nonprofit organizations or financial assistance programs that negotiate medical debt with hospitals, healthcare providers, and insurance companies.
How to reach an agreement over medical debt
What does Steve recommend to reach a reasonable settlement?
Contact the hospital or provider who sent the bill and ask about the process for applying for charity care.
Be persistent by demanding answers and responses.
Consider working with an advocacy group like Dollar For to help you negotiate your bill.
Be prepared to be frustrated.
If you qualify, apply for charity care
Persistence can pay off, Steve says.
“Dealing with bureaucracy isn’t fun, but it worked,” he says. “Just be prepared for a bunch of curveballs, for a lot of bureaucracy, for calls to phone numbers that don’t go anywhere, for phone calls that don’t get returned. A lot of these hospitals say they have an option for charity care, but they basically make it impossible to follow through.”
He and his wife are now negotiating a $2,800 bill for the emergency room visit related to her car accident and unexplained seizure.
“In the back of your mind, you’re trying to pay all your other bills and get through life,” Steve says. “You just hope the hospital will accept your application and not make you start over.”
Dollar For is working on the couple’s behalf again. Steve says he hopes that persistence — and a bit more hardball — will result in another successfully negotiated bill that he and his insured wife can afford.
Know your rights
In 2022, new legislation made the medical billing process more transparent for consumers. The No Surprises Act helps people avoid surprise medical bills if they have insurance or a group health plan. According to the Consumer Financial Protection Bureau, the law bans:
Surprise bills for emergency services from an out-of-network provider or facility and without prior authorization
Out-of-network cost-sharing, such as out-of-network coinsurance or copayments, for all emergency and some non-emergency services
Out-of-network charges and balance bills for supplemental care, like radiology or anesthesiology, by out-of-network providers that work at an in-network facility
The act also protects consumers from balance billing. If wrongly billed, you can file a complaint.
DISCLAIMER: This article is solely for informational purposes. This article is not professional advice concerning insurance, financial, accounting, tax, or legal matters. All content herein is provided “as is” without any representations or warranties, express or implied. Always consult an appropriate professional when you have specific questions about any insurance, financial, or legal matter.
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