What to do when you can't pay the ER bill

An Unaffordable Emergency Room Bill

by Gary Foreman


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I just got an emergency room bill, and I almost fainted when I saw how much it was. What can I do? I don't have insurance for it. It'll take me years to pay this bill! Is there anything that I can do to get it reduced? Or get payment terms? Something? Anything?
Desperate Deanna

This is an interesting question, and you're not alone. According to the Center for Disease Control (CDC), 129.8 million people visited the ER in 2013.

How much did they spend? The American Hospital Association resource center reports that the average cost for an ER visit in $1354 in 2011. That seems low, but don't let the average fool you. If the visit includes scans and complicated tests, you can run up a bill very quickly in the ER. Let's see what we can do to keep Deanna from having another fainting spell.

Begin by getting an itemized statement. This isn't like buying a house where one big price covers everything. It's more like your grocery bill. It will include a lot of smaller purchases that add up. Most of us have little or no idea how much an ER visit should cost, so we don't know whether a bill is too high or not. The only way to tell if it's reasonable is to break it down into the individual services rendered.

Next, question items on the statement. A lot happens in an emergency room. Sometimes life hangs in the balance. The staff doesn't keep a running total on the supplies and services used as they occur. They rely on memory. It's easy for errors to occur.

You'll probably have a tough time understanding the bill. Ask a friend who works in the medical field to look at your bill. They might identify items on it that were unlikely to be used in your visit. Better still, if you have a good relationship with your family doctor, ask them to review the bill.


Call the emergency room billing manager. Get an explanation of any charges you don't understand. Ask what various abbreviations mean. Go over each item until you understand what they represent. You might find it worthwhile to do this step in person.

Compare the bill to your recollection of the visit. If you had someone go with you to the ER, ask that person to walk through the bill with you. If there are items on the bill that you don't remember, be prepared to question them.

Ask if the hospital accounting or billing department audits bills. If so, volunteer your bill for audit. Audited bills have the advantage of insiders who know the system looking for mistakes. They'll see things that you won't.

Talk with the billing department about removing disputed items. Some hospitals will be more willing to do so than others. Items that couldn't be used in your case should be removed. Other charges that could have applied might be harder to negotiate.

Once you feel that you have an accurate list of what items you should be billed for, it's time to see if you can't lower the amount that you pay for those items.

Don't hesitate to tell the hospital billing department that you don't have insurance (if that's true) and can't afford the bill that you received (we'll assume that's true!). Explain that you know that HMOs and others pay less than "full price" for services. Ask that you be given their rates.

Many hospitals will be willing to work with you, especially if you agree to pay it all now. It's sort of a "cash" discount.

In many cases, paying it all now isn't even remotely possible. In that case, ask about some type of payment plan. Most hospitals are happy to extend payment terms, especially if the option is not getting paid at all.

You might find a patient advocate helpful. Many hospitals have them on staff. Their job is to make it easier for you to understand your bill and to help with any dispute that you might have with the hospital.

You may find that you'll need to talk with people in a number of different departments, especially if it's a big hospital. Don't lose patience. Your goal, which is a reduced bill, is important. Stick to the task.

Here's a final note for everyone on avoiding large emergency room bills. It's a good idea to see what urgent care centers are available near your home. Some things that can't wait for your family doctor don't require an emergency room visit. Staying out of the ER is one way to avoid their high bills.

Updated December 2014


Gary Foreman

Gary Foreman is a former financial planner and purchasing manager who founded The Dollar Stretcher.com website and newsletters in 1996. He's been featured in MSN Money, Yahoo Finance, Fox Business, The Nightly Business Report, US News Money and he's a regular contributor to CreditCards.com. You can follow Gary on Twitter or visit Gary Foreman on Google+. Gary is also available for audio, video or print interviews. For more info see his media page.

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