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5 things you can do to lower your ER bill — or avoid one in the first place

Shelby Livingston   

5 things you can do to lower your ER bill — or avoid one in the first place
  • Plenty of people in the US have faced unaffordable ER bills.
  • Fortunately, patients have leverage when negotiating with hospitals.

Huge ER bills seem to be a defining feature of the US healthcare system. No one's immune.

Even former US Surgeon General Dr. Jerome Adams, who's well aware of the high costs of the US healthcare system, was surprised by a nearly $5,000 ER bill earlier this year.

These big bills contribute to the enormous amount of medical debt Americans shoulder. Nonprofit health policy organization KFF estimated that people in the US owed at least $220 billion in medical debt in 2021.

The good news is there are things you can do to fight a big bill. Deb Gordon, co-director of the Alliance of Professional Health Advocates and cofounder of Umbra Health Advocacy, said patients have leverage when negotiating with a hospital since so many bills go uncollected.

"The hospital would rather have you pay something than nothing," she said.

Business Insider spoke with Gordon and two additional experts who shared tips for how patients can lower a big medical bill — or avoid one altogether.

Review your bill for possible errors

It sounds obvious, but searching your bill for inaccuracies can lead to big savings.

Mistakes are common, according to Gordon and AnnMarie McIlwain, CEO of Patient Advocators. Look for discrepancies like tests you didn't receive, provider names you don't recognize, and incorrect dates of service.

"Make sure that medically what happened is aligned with what you were charged with," McIlwain said, adding that in her experience about a quarter of the time a bill contains a mistake.

If you spot a potential error or don't understand why you were billed a certain amount, start asking questions of the healthcare facility's billing department.

"Sometimes just asking the question will shake loose a discount," Gordon said.

Know your insurance policy

Read your health insurance policy to know what's covered and how much you're responsible for paying. Try to match your policy to the bill you got, Gordon said.

"You may actually need to be the one who crosswalks between what your coverage is and what they billed. You can't assume that that happened correctly," she said.

Furthermore, there may be benefits you didn't know were covered in your policy. "There's gold in there," McIlwain said.

Use a benchmark to negotiate

Find out if the charges you were billed were reasonable compared with a benchmark. If they aren't, use the benchmark to negotiate your bill.

McIlwain suggested using a resource like Healthcare Blue Book to look up average fees for a particular service in a patient's location.

Dr. Virgie Bright Ellington, author of Crush Medical Debt, recommended using an AI search tool like ChatGPT to look up what Medicare pays on average for a certain service based on the service's unique medical code, called a CPT code. (You could also Google for this information, though it might take longer, she said.) Medicare pays lower rates than private health insurers.

Take that Medicare rate and tell the hospital's billing department that it's what you're willing and able to pay under an interest-free payment plan within your budget, she said.

"It's more profitable for them for you to pay something, and they're still able to make a profit at Medicare rates," Ellington said.

Prevent a bigger bill by questioning all those tests

Doctors might order a bunch of costly medical tests, but you may not need them all, McIlwain said.

A 2015 survey published in Academic Emergency Medicine found that 85% of doctors who responded said they believed too many diagnostic tests were ordered in their emergency departments. Almost all of them said at least some imaging studies they ordered were unnecessary.

All those tests add to the bill. McIlwain said patients can avoid unnecessary tests by participating in the doctor's care decisions. Ask: "Can we discuss what the options look like so I can make a smart decision for myself?" she said.

It's tough to think clearly when you're in pain or afraid. Gordon suggested bringing a friend or family member to the hospital who can be level-headed and ask hard questions for you.

"Sometimes all it takes is someone asking the questions to give the provider pause and reason to consider what they're doing, explain it and make sure you're on board with it," Gordon said.

Be smart about where and when to get care

There are a few other things you can do to avoid a big medical bill.

If it's not a true life-and-death emergency, shop around for care. Urgent care centers are cheaper than emergency departments. For planned services, hospitals tend to offer price estimator tools you can use to get an idea of what a visit or procedure could cost.

Be sure to visit a doctor in your health insurer's network, as going out of network can lead to higher costs. The No Surprises Act, which went into effect in 2022, protects US patients from surprise out-of-network medical bills for most emergency services, and when patients inadvertently see an out-of-provider at an in-network facility.

McIlwain also said patients should try to get the healthcare procedures they know they need in one calendar year to maximize insurance benefits.

McIlwain, for example, said she recently was cycling in and out of the ER because of a heart condition. A cardiologist in September recommended an ablation — treatment for an irregular heartbeat.

McIlwain insisted the procedure be done by the end of the year, as she had met her insurance policy's out-of-pocket maximum, the most a person can be required to pay for covered health services in a year. Had she waited until the new year, when her insurance policy's limits reset, she'd have to pay thousands for the procedure.

"We really have to become more sophisticated about the complexity of our healthcare system, so it doesn't tank us financially," she said. "It's complex, but we can be smarter about the boundaries and optimize our use of it."