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Why Are ER Bills So High?


Vox’s Sarah Kliff recently sat down with PBS to discuss some of the common, hidden costs in consumers’ emergency room bills. Kliff is currently working on a project that collects, examines and reports on consumers’ ER bills, and exposes their hidden costs.

Kliff, who has collected more than 1,300 medical bills, discussed what is hurting consumers the most when they go to the ER. Kliff says thus far she sees three major trends:

First, ER’s facility fees are expensive fees that many consumers do not know about and can’t easily find information about.

“[B]asically, every emergency room visit has something called a facility fee. This is the price of walking through the door, seeking care… We know that those facility fees are really high. They’re usually the majority of the bill in those cases that you were mentioning, and we also know they vary a lot. One hospital across the street from another hospital, they may have facility fees that look nothing like each other. But it’s really hard to find information about them.”

Second, many in-network emergency rooms have issues with out-of-network billing.

“[I]t turns out this is pretty common… to have out-of-network providers workings at in-network emergency rooms. And, again, it’s really difficult for patients to find that information. You might think you’re safe… and then get a bill a few months later which shows you really weren’t safe.”

Third, deductibles are skyrocketing.

“I think one key factor here is that deductibles are rising very, very quickly. So, a lot of us, most of us who have insurance at work now have a deductible above $1,000. And that means we actually see our health care costs, instead of the insurance just kicking in everything. We’re expected to pay for more.”

Hospitals behave like monopolies, which in turn leads to higher costs for consumers. Patients that find themselves in the ER often have no other options – and therefore no opportunity to comparison shop.

Kliff says the best way to avoid surprise hospital bills is to ask questions. Unfortunately, it is often difficult for consumers to get the information necessary to protect themselves.

“But I think one of the frustrating things I have seen for a lot of the patients I have covered, a lot of times, there just aren’t good ways to protect yourself, that it is very, very hard to put this on the consumer, as their responsibility to kind of be a good shopper in this case.”


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