You will be treated in any hospital ER regardless of insurance status — federal law (EMTALA) requires it. But expect a substantial bill. Without insurance, you're billed at the full chargemaster rate, which averages 4–8x what Medicare pays for the same visit.

What to do during the ER visit

  • Don't sign financial responsibility forms that waive your right to negotiate or apply for charity care. You must consent to treatment; you don't have to agree to pay any specific amount before knowing the total cost.
  • Ask about financial assistance while you're still there — nurses and patient advocates can start the paperwork.
  • Keep notes on what tests and treatments you actually received. This matters for auditing the bill later.
  • Ask for the itemized bill before leaving if possible — or request it immediately in writing afterward.

What to do when the bill arrives

  1. Audit the bill first. ER bills are among the most error-prone. Common issues: facility level upcoded (level 5 vs. level 3), duplicate charges for supplies, physician charge billed separately from facility. Use BillKarma to check every CPT code against Medicare rates.
  2. Apply for charity care. Nonprofit hospitals are required to have financial assistance programs. Income limits are often 200–400% of the federal poverty level — much higher than people expect. A family of four earning $75,000/year may qualify.
  3. Request the self-pay / uninsured discount. Most hospitals have a standing discount of 20–50% for uninsured patients who ask. You don't have to qualify for charity care to get this.
  4. Negotiate to Medicare rates. The Medicare rate for a level 3 ER visit (CPT 99283) is approximately $130 facility + $95 physician. If your bill shows $2,500 for the same, cite the CMS rate in a formal dispute letter.
  5. Set up a payment plan. Most hospitals offer 12–24 month 0% interest payment plans. This keeps your account current while you dispute and negotiate.

How ER billing actually works

An ER visit generates at least two separate bills: the facility fee (from the hospital) and a physician fee (from the emergency medicine group). You may also receive separate bills from radiologists, anesthesiologists, or labs. Each bill can be negotiated independently.

The facility fee is coded on a scale of 1–5 by complexity (CPT 99281–99285). Level 5 is the most expensive — a common upcoding target. Check your medical records to verify the documented complexity matches what was billed.

Bottom line: You'll get treated, but the bill will be large. Audit first (ER bills are error-prone), apply for charity care (free for many uninsured patients), and negotiate down to Medicare rates. Most uninsured patients who engage can cut the bill by 40–70%.