How To Avoid An Emergency Room Bill That Sends You Back To The E.R.

Emergency room bills bring a special sort of sticker shock, because they don’t usually show up until weeks later, and then come packed with all sorts of over-inflated fees and add-ons. The New York Times calls them “notoriously high and perplexing,” and although it’s unlikely you’ll ever end up paying the full amount listed on the bill, there are strategies you can use to bring that initial figure down.

First, don’t go to the E.R. unless it really is an emergency. The Times writes, “If your situation is not dire — you twisted your ankle or have a persistent sore throat, say, or your child receives a small burn — call your doctor first and ask for advice.” If you can’t reach your doctor, try calling your insurer’s nurse triage hotline, or else go to an urgent care center where the prices should be considerably lower. (You can find these places at www.itriagehealth.com.)

You should also look over the bill to make sure you weren’t charged for unnecessary treatment, or billed at a higher treatment level than your injury called for.

And finally, call the hospital quickly and negotiate a lower payment–many hospitals will be eager to work with you, since that helps ensure that they’ll actually get paid.

“Demystifying, and Maybe Decreasing, the Emergency Room Bill” [New York Times]

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  1. FatLynn says:

    If you have insurance, read the rules very carefully before going to the ER.

    Actually, read them now, so that you know them if an ER situation comes up.

    • RStormgull says:

      Agreed. I can only go to certain hospitals. So, make sure you know which ones are “allowed” by your plan if you don’t like getting the sandpaper condom treatment.

    • coren says:

      Agreed. Forewarned is forearmed. Not to be confused with being four armed – in which case that ER visit is going to be pretty interesting.

  2. scoccaro says:

    I love urgent care, its really a great solution if you arent on the brink of death. However last time i was in the ER it cost me $11,000, but i would have paid twice that for how they helped me.

  3. travel_nut says:

    The last time I went to the emergency room, I called the nurse advice hotline first.

    Nurse: So let me get this straight. You’re pregnant…and you can’t breathe? You can’t catch your breath, feel like there’s a weight on your chest, and you can’t get a full breath?
    Me: Yes…
    Nurse: GO TO THE EMERGENCY ROOM, NOW.

    Good thing, too. I had a pulmonary embolism that was cutting off my air supply.

    In bad news, even though I have insurance, I’ll be paying off that hospital bill for another 2.5 years. Pregnant + emergency room + 4-day ICU stay = big money.

    • pokinsmot says:

      I had one of those a few years ago, apparently it’s because I have factor 2 and 5 blood clotting disorders. A weeks stay in the hospital set me back $54,000, but thank goodness I was eligible for assistance.

      Either way the medication that saved my life, Alteplase or something close to that, was $10,000 for a SINGLE dose. I don’t know how ANY medicine can be $10,000, but I guess it was worth every penny.

      • redbess says:

        There are thyroid-related injections I need to get from time to time (Thyrogen) and the injections are something like $3-4k each, it’s bloody ridiculous.

      • travel_nut says:

        They never found any sort of clotting disorder, clotting factor, nothing. The best they could figure was that it was a rare side effect of the pregnancy.

        I had to take high-dosage blood thinner injections that were $6,000 for one month’s supply. I had to be on these suckers for 10 months. (The rest of the pregnancy + 2 months postpartum.) It was ridiculous.

  4. HogwartsProfessor says:

    If you have to go to the emergency room by ambulance, that is pretty pricey. BUT:

    If you think you or someone else might be having a heart attack, DON’T drive. Call the EMS because you might need supportive care on the way, which could save your life. That’s one situation where it’s money well spent.

  5. frank1569 says:

    Had a major tooth infection, no health insurance, last resort – Baylor ER.

    A doctor looked inside my mouth – didn’t touch me, no instruments, just looked – confirmed I had a major infection, prescribed antibiotics and painkillers.

    Two days later, the infection went ballistic – fortunately for me, my friend Sister Mary Rose Lopresta hooked me up with her dentist who literally saved my life – and didn’t charge me a dime.

    3 weeks later, I get a Baylor ER bill for over $1,200 – including charges from some surgeon’s group in Phila and $440 for ‘speech therapy.’ 18 months later, still fighting over it.

  6. mobiuschic42 says:

    I’ve had trouble finding urgent care facilities near me (Boston) – maybe because there are so many hospitals with ERs?
    One Sunday morning, I woke up and was vomiting every time I moved my head. I spent a couple hours trying to find some urgent care clinic to go to, but finally just went to the ER of one of the hospitals I work for (I do computer stuff for a group of hospitals).
    I paid my $35 ER co-pay and went through intake (the intake nurse saw me and said “you actually need to be in the ER, don’t you!”), sat through a couple of hours of an AMAZING nurse (he held my hand, etc) and a squeamish resident (who left the room every time I started heaving), and I never paid another dime beyond tiny amounts for my anti-nausea prescription. Maybe I just got lucky, or my hospitals are awesome? :)

  7. cmdr.sass says:

    Also, check to see if certain procedures are covered before deciding to go to the ER versus the urgent care center. For example, many plans do not cover an emergency MRI as part of your emergency room copay. You may have to pay the higher hospital deductible instead. However, if your plan covers urgent care centers, that MRI will be included in your regular copay.

    • Interpol says:

      There is no such thing as an “emergency” MRI. X-rays and CT scans, yes, but there’s nothing an MRI can tell you that can’t wait to be scheduled electively. Many hospitals don’t even offer MRI services after hours or on weekends.

  8. heart.shaped.rock says:

    My sister took my neice to the ER for a cut on her finger. The doc determined it didn’t need stitches, cleaned it out and put a butterfly bandage on it. The bills came and my sis thought it was way high so she requested a detail. The hospital coded the cut-cleaning and bandage application as “surgery” and the charge for that was $864!

    • NHpurple says:

      If you don’t see bone, call your pediatrician first, even if it’s after hours. For some doctors, business is slow and they will go into the office to treat versus sending the dollars to the ER.

  9. Happy Tinfoil Cat says:

    My sons were playing with our dog, jumped off the two story play structure and landed on the lawn just in front of a speeding Husky. Their heads collided and a canine tooth tore a small gash in his eyebrow. My wife was mortified when I said we should just put a bandaid on it. I told her “Boys will be boys.” She stared at me with murder in her eyes and mentioned “divorce”. So I suggested we go to the doc-in-the-box a block away. But noooooo, she rushed him to the hospital emergency room. As my son tells it, his mom was very upset he was disfigured and kept asking the nurse questions, which she responded, “Boys will be boys.” He asked me what that meant but I was laughing too hard to answer. The wife pointed out that there were FOUR stitches and not just a bandaid. Our insurance doesn’t pay for non-life threatening ER visits.

  10. Span_Wolf says:

    About a year ago I got rear-ended and went to the emergency room just to get checked out and make sure I’m okay. I did not have health insurance at the time, so I cleared it with the other person’s insurance to cover the costs. After I got the bill and went back to the hospital to get an itemized bill, went back one more time to make sure that everything was covered and that no further bills or charges would be coming, I signed paperwork with the insurance company stating that they would pay for the bill and that the issue was closed. The hospital swore up and down that the bill was final and I wouldn’t hear back from them again after it was paid, and when I signed the document with the insurance company, I am now not able to come back and ask for more money later.

    Flash forward a year, I just got another bill from the hospital. They already took 1600 bucks for me to sit for hours in the emergency room only to get seen for a total of 5 minutes by a doctor, who looked at me and said you look fine to me, and to get a couple x-rays. Now they are saying I’m on the hook for another 3ish hundred bucks. I called them up, and they said that the 1600 bucks was the hospital bill, the 300 bucks is the doctor bill, and they have no idea why it has taken a year for it to get to me, but I need to pay it. I informed them that I had the due diligence to call and visit the hospital multiple times to verify that the bill had been paid in full, and made absolute sure of it with the hospital swearing up and down that I had nothing to worry about, because I had a document to sign making sure that was all that would have to be paid. They got confused at that, and said they couldn’t imagine why the hospital would say that because the doctor still needs to be paid and that they would look into it and to call them back in a MONTH.

    What do I do?

  11. BigSlowTarget says:

    You’re screwed. In all probability among the things you signed when you were admitted was a blanket “I’ll pay for anything from anyone” type of authorization. If you have, in fact, signed that then nothing verbal is likely to count. It’s a bit hard to tell from your post, but if they have provided you something written that says you are paid in full that’s great, but the exact wording on the document matters. If they haven’t said you have paid in full for all services from them and all affiliates they are going to say “We aren’t charging you anything. That’s for you and those guys who you agreed to pay and who we didn’t cover in our waiver because we have really no idea or care about who bills you besides us.”

    You can complain. You can try to get the insurance company to pay more for the bill. You can take the insurance company to small claims court. None of these are likely to work but all depend on the exact specifics of your situation. Good luck.

  12. thelauhingsun says:

    I got a shot for yellow fever for a trip to Africa 6 months ago. I was warned that if I experienced a rapid heart beat I should see a doctor immediately because it could be a rare and serious side effect (50% of people who get it will die, etc.).

    Sure enough, I begin experiencing an extremely rapid heart beat the next night and a feeling like a weight on my chest that made it hard to breathe. It was late so I had to go to the ER. We just switched insurance, so we had to do some panicked research but we eventually found an ER that was covered. They did an EKG, lung X-ray, and a blood test. Ends up it wasn’t the side effect I was afraid it was and I was in no immediate danger so they sent me home.

    3 months later a bill comes to me (the insurance was NOT in my name) and it is for over $4000. Apparently the insurance would not pay it because although the ER was covered, the specific doctor working that night was not (?????). There were about 10 different drug tests listed (they only drew one vial, I don’t know how they did all those tests…anyhoo if I ever have blood taken at the ER again I will ask them specifically what they are testing me for). Even then, $1500 would be alot but I could see how they could somehow come up with it, and the bill added up to about $1500 except for a $3000 charge that was tacked on with absolutely no explanation whatsoever. Seriously, there was nothing listed next to it, it just said “$3000″.

    My dad fought it for 3 months and eventually the random $3000 was taken off and the insurance paid the rest. Phew. Meanwhile my credit was hit hard (argh).

  13. jiminim says:

    I married an RN who works in an ER and is now an NP so I bask in free medical attention.

    However the true medical advice usually comes down to “take some ibuprofen and quit doing what you just did to hurt yourself.”

  14. Bob the Builder says:

    I married an RN who works and I previously worked in several hospitals. While the ER is expensive, it’s mostly the hospital attempting to recover costs of those who do not pay. Hundreds, if not thousands of people in each city go to the ER for minor injuries that could be taken care of at a clinic or home. Others are drug abusers and seekers people who have no means to pay, as most of their money is tied up in their latest substance of choice. Then there are those who are poor and homeless who cannot pay. The hospital knows this, yet will treat them anyway at a loss. Go to the ER as your last option, and you’ll avoid the expensive bills. If you do have to go, make sure you have health insurance which will defray most of the costs of going. I deep fried my hand several years ago, and thanks to my insurance, a $7,000 was knocked down to $500. Well worth the investment.

  15. Fest says:

    I just got out of the hospital 3 days ago. 1 week earlier (7/29) I had a spontaneous collapsed lung. I am 30 years old and in pretty good shape, eat pretty good and in overall excellent health. I was not expecting anything like this but as soon as it happened I rushed to my doctor (it was hard to breathe) because I knew that the emergency room would mean big $$$$. All the doctor could tell me is I needed to go the the emergency room right away. So I paid them my $35 copay and rushed over to the ER. They diagnosed me and ended up putting a chest tube in which hit a nerve and caused severe pain so they had to take it out and put another one in (and of course i had to be awake both times). I stayed at the hospital that night. Went home the next day. Waited several days and went back to my doctor to have the tube removed. After that I had several complications and ended up back in the ER for a total of 4 times until they finally said I needed surgery which I had on 8/6. So in the last 2 weeks, I have been in the ER a total of 4 times and stayed overnight 4 times. I also had a surgical procedure to seal a hole in my lung. I’m on Vicodin 24/7 for pain and it’s slowly getting easier to breath. I am so scared to get the bill for all of this and it was constantly on my mind with everything that they did as I could see the numbers adding up.
    It truly is sad that money is on everyone’s mind when considering medical treatment but it is truthfully outrageously expensive to have to go to the hospital for anything. My wife and friends just kept saying just worry about the expenses later, which is true, but honestly we should not have to WORRY about the expenses. I am grateful for what the doctors did for me and it was the scariest moment of my life so I am more than willing to pay for what I need to, I just hope it is not over the top.

  16. kromelizard says:

    Only suckers pay ER bills.

  17. vdragonmpc says:

    Im dealing with my son’s broken arm visit to the ol ER. Imagine getting a check from your insurance company for less that the amount owed because a doctor in the ER ‘doesnt take your insurance. I have told them when I get the adjusted bill money will flow. They can drop the bill to the adjusted amount but refuse to. They can also give a cash discount but refuse also.

    Whats cool is that I asked them many times in the ER if there would be a problem with my insurance as there had been issues on the news with another hospital pulling a fast one on people. The hospital took my insurance and I paid a deductable for the visit, Then I start getting separate bills from people. I told them the deductable was paid see the ol hospital. Then 2 were fine and they accepted the payment. Yet one wants a large amount of money. The insurance sent half. I guess I know how people go bankrupt now. I have savings and credit cards but I have insurance for this. They dont care and wont pay the correct amount. The doctors office wont lower the amount.

    Nice. I pay a ton for insurance and used it once. The bill is no where near what I pay for insurance and they are not covering it.

  18. Tankueray says:

    Okay, help a girl out here. I fell and broke three ribs, went to the ER, I have good insurance… I payed my copay, few weeks later I’m getting bills from 6 different providers. Mostly ~$20 here and there, fine. But I get the bill from the doc, it says she billed me $1500 and my insurance paid $900, so I owe $600. While sitting around in pain for 3 hours, I saw her a total of 15 min and she never physically touched me. Her bill doesn’t say so, but the insurance EOB says they paid for surgery.

    I swear I went to the ER 3 years ago and actually did have emergency surgery and paid less with the same insurance.

    How do I attack this? I’m going to start by asking for an itemized bill. And reporting any overcharges to my hmo, but this bitch could ruin my great credit. This is why insurance, national healthcare, non of it will work; because we can’t cap the costs.