Outrageously Expensive ER Bills, Explained – Andrew Miller


Now that you’ve seen the astronomical bill you agree with me: ER care is expensive. But what exactly are all the items on your bill? Where did they come from? Here are some of the most common charges:

The ER charged you a Facility Fee.

This is one of the largest line items on your bill. It goes by a few different names but this item has a price of hundreds or thousands of dollars, depending on how sick you were and which facility you went to.

Think of the facility fee as a cover charge at a club or resort. This is the hospital’s charge to keep the lights on and the doors open. It covers your nurse’s salary, the bed underneath you, and the monitors and equipment in the room. This fee covers readiness, ie: it helps support the ER so that it is available for patients 24/7/365.

This fee may vary based on how severe your symptoms were. Just a sprained ankle? Lower fee. Having a heart attack? Higher fee. The range reflects how much nursing time and space you’ll take up, how many resources and attention you’ll need based on the ESI algorithm.


You were also charged to see a Provider.

This is a relatively big ticket as well. Whether you saw an MD or PA, it’s still a high priced line on your bill, referenced by a CPT code in the range of 99282 to 99285. Different facilities charge more or less for their ER doctors, but this is likely a few hundred dollars of the total. In some facilities, the doctor actually gets paid this charge, but in my experience, the hospital is usually pocketing the majority.

The different CPT codes are intended to reflect risk, acuity, and decision making. Simple ankle sprain: lower CPT. Knife stabbed into the belly: higher acuity and higher CPT code. Thus, the Doctor gets paid less for the easy cases, and more for the complicated ones.

You pay for the Stuff that was used in your visit.

IV supplies, bandaids, medications, a sling, disposable monitor cords, etc — the list can get quite long. Plus, there is often a range of charges for delivering these items: was the EKG performed by a tech or a Respiratory Therapist? Were the medications given as a pill or an injection? Fair or not, all of these prices are marked up from regular prices, much like a bottle of wine in a restaurant.

And then there are the Medical Procedures.

Did you need your dislocated shoulder reduced? A laceration sutured? These each carry an additional billing code, because they are hands-on interventions from your Doctor. Lacerations less than 2.5cm are one charge, while over 2.5cm is a higher charge. Shallow wounds are cheaper, deeper wounds requiring layers of stitches will cost more. While you might not agree with the high prices of these procedures, we can probably agree that some procedures are minor and some are very involved, thus the range of charges

But wait, there’s more!

Be prepared for when other bills arrive separately, because this big hospital bill may not be your only bill. Depending on what you were seen for, you may get separate bills for anesthesia, from a Radiologist, Orthopedics, etc.

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