According to a recent cost study conducted by researchers at Stanford University, the University of Minnesota, the University of California, San Francisco and the Ecologic Institute, the median charge for an emergency room trip in the U.S. comes in at $1,233. But where it really gets interesting is when you look at the specific reasons for those E.R. visits: The researchers found that the treatment price for a headache could range from $15 to a whopping $17,797. As for a sprained ankle, it could set someone back a paltry $4 or up to $24,110!
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So what gives with these wildly fluctuating price points?
For starters, most emergency room prices are inflated based on the rates at which insurance companies will reimburse the hospital on a patient’s behalf. That's why a single aspirin can cost $30 per pill in the E.R., which is more than six times the price for a bottle of them at the drug store.
On the flip side, patients will often contact the hospital or surgeon’s billing office to ask for a cost reduction, further adding to the inconsistency in pricing. It's a practice that often works in a patient's favor, says billing advocacy specialist Sharon Salters of Medical Cost Advocate, a professional medical bill negotiation service.
And then there's also the fact that most hospitals offer discounts to self-paying individuals—especially if there’s a risk that they might not pay at all.
So to help shed some light on the complexities of hospital medical billing for the average consumer, we asked three people to share their craziest emergency room stories, the even crazier bills that followed—and the steps they took to remedy them.
The Emergency: Severed Finger
The Bill: $83,000
Ryan Witten of Nyack, N.Y., was working in his garage one weekend last year when he severed his finger on a table saw. “Surprisingly, I stayed calm throughout the whole thing,” says the 54-year-old Witten, whose wife helped him pack his finger on ice and then drove him to the hospital.
Since Witten had recently gone to the emergency room for chest pains at a hospital that was out of his insurance company’s network—costing him $20,000 in out-of-pocket test fees—the Wittens drove to a different facility whose E.R. was in-network.
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“We thought we had learned our lesson the last time,” he says, “but it turns out the plastic surgeon who reattached my finger was out-of-network.” So the contractor got a second dose of sticker shock when he received the bill for his emergency digit surgery: $83,000. Gulp.
What This Patient Did: After contacting his insurance company, Witten was able to convince them to cover the out-of-network surgeon at his in-network rate, since insurers will often relax pricing rules for an emergency procedure. Witten's reduced bill: $5,000.
“Unfortunately, my deductible is $5,000, so we paid that out of pocket,” says Witten. “But it’s way better than $83,000!”
What the Expert Says: Salters applauds Witten’s decision to follow up with his insurance company to get them to cover the out-of-network doctor at the in-network facility. However, with regards to his earlier E.R. visit for chest pains, Salters says that he should have appealed the denied claim. “The diagnosis that appeared on the claim, more than likely heart burn or something along those lines, isn't considered an emergency,” she says. “But he went to the hospital under the impression that he was having a possible heart attack. Every insurance company has a list of what’s considered a true emergency requiring medical treatment at the nearest facility. A lay person suspecting they’re having a heart attack is on the list.”
I was too worried about my appendix bursting to think about the price—but it seemed unfathomable that my surgery could cost that much!
The Emergency: Severe Stomach Pain
The Bill: $24,000
In March 2012, Karen Nielson, 28, got a bad stomachache that she chalked up to food poisoning. But as the pain intensified, the Greenwich, Conn., resident made an appointment to see her primary care doctor, who recommended a CT scan.
So Neilson drove herself to the hospital—and just minutes after the results of the scan came back, she was rushed to the operating room for an appendectomy.
“I didn't think about the price at all because I knew that I had insurance, and I have savings to cover the deductibles,” says Nielson. “I was too worried about my appendix bursting to think about the price.”
It wasn’t until weeks later that she got the bill ... for $24,000.
“I was shocked," recalls Nielson. "It just seemed unfathomable that my surgery could cost that much money!”
What This Patient Did: Nielson fought the charges with her insurance company, which wound up covering all but $5,000 of the surgeon’s fees. Her next step was to call the surgeon’s office, where the staff helped her to resubmit the claim to her insurance company, which waived the rest of the fee. “In the end, I ended up paying about $500 out of pocket,” she says.
What the Expert Says: “Nielson worked her situation out like a pro,” says Salters of the negotiations with the surgeon’s office. “Providers understand that how they bill a service has a direct impact on how the claim is paid. Simply changing the code or adding a modifier to the code allows for additional payment.”
The Emergency: Head Injury
The Bill: $9,000
A few months ago, Amanda Harris, 27, of Morristown, N.J., fainted at work, hitting her head in the process. Due to liability concerns, her production company required Harris to take an ambulance to the emergency room, despite her refusal. “I didn’t even have a cut on my head, just a slight bump. No headache, no nausea, no confusion, nothing,” she says.
Harris waited for over an hour in the E.R. before her husband told the nurse that they were leaving. Minutes later, a doctor spoke to Harris for under a minute, confirming that she was fine to go. “He didn’t do any tests—no light in my eyes, no blood pressure,” says Harris. “I left thinking I wouldn’t even get a bill.”
But the bill did come—all $9,000 of it. The ambulance company charged $6,500, including a $300 fee for the linens and a $30 charge for aspirin. The E.R. billed the remaining $2,500. “My mouth literally dropped open when I saw the cost,” she says.
What This Patient Did: Harris called her insurer and fought the bill. Luckily, her insurance covered all but a $3,000 deductible—but she was too exhausted to push for more. “I’ve always heard emergency room visits were costly, but $9,000 for nothing more than a conversation that lasted one minute? That’s robbery,” she says.
What the Expert Says: Even though Harris didn’t want to take an ambulance, Salters says that her company’s suggestion was well-advised. “However, she should consider working with her employer to file the claim with her company’s worker's compensation carrier,” says Salters. “Employers often try to stay away from filing a claim under worker’s compensation, so it does not impact their experience rating or trigger an [occupational safety and health administration] review, but it would save her money.”
How You Can Avoid Outrageous E.R. Bills (Really!)
When it comes to a trip to the E.R., the reality is that there’s usually no time to shop around and compare prices in advance. But if you do some research before an emergency happens, you could potentially keep costs significantly down.
Consider Urgent Care for True Non-Emergencies
If your medical problem isn’t life-threatening (think sprains, minor cuts and fevers), you can visit an urgent care center instead. An Annals of Internal Medicine study found that the average urgent care visit from 2005 and 2006 cost $156—compared with $570 for the same visit to an emergency room.
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Double-Check Your Bill
Hospital billing systems aren't perfect, so it's wise to keep track of any treatments that you receive in the E.R.—including time spent in the operating room, which can cost up to $200 a minute! To prevent billing mistakes, ask for an itemized statement before you're discharged, so you can compare it with your own record-keeping.
Negotiate Your Health Care Costs
Most importantly, don’t be shy when it comes to bargaining. Two excellent resources—Healthcare Blue Book and FAIR Health—can give you estimates of how much health care services should cost in your area. Plus, your insurer's website may also provide a tool that will allow you to compare costs.
The negotiation can seem like a lot of extra work, but the payoff can be tens of thousands of dollars in savings shaved off a potentially outrageous E.R. bill.