--- title: Why You Can Get Slapped With a Surprise Medical Bill description: While the vast majority of emergency room patients went to hospitals in their coverage network, 22% were treated by an out-of-network doctor canonical: https://time.com/4574917/surprise-emergency-room-medical-bill/ author: Mandy Oaklander article:opinion: false article:content_tier: free article:published_time: 2016-11-17T16:39:08.000Z article:modified_time: 2026-08-04T07:54:56.737Z article:section: Health og:title: Why You Can Get Slapped With a Surprise Medical Bill og:description: While the vast majority of emergency room patients went to hospitals in their coverage network, 22% were treated by an out-of-network doctor og:url: https://time.com/4574917/surprise-emergency-room-medical-bill/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt037a2d17d29dd9c3/69877894cd684867a1098f5e/health-first-aid-kit-1.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 og:image:width: 2560 og:image:height: 1440 og:image:alt: TIME.com stock photos Health First Aid Kit og:type: article twitter:card: summary_large_image twitter:title: Why You Can Get Slapped With a Surprise Medical Bill twitter:description: While the vast majority of emergency room patients went to hospitals in their coverage network, 22% were treated by an out-of-network doctor twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt037a2d17d29dd9c3/69877894cd684867a1098f5e/health-first-aid-kit-1.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 ---  # Why You Can Get Slapped With a Surprise Medical Bill > Sponsored content. 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Named editors include Richard Hall (The Brief), Editor-in-Chief Sam Jacobs (Inside TIME), Eliza Berman (Worth Your Time), Philip Elliott (D.C. Brief), Justin Worland (Future Proof) and Harry Booth (In the Loop). Health Matters is written by TIME's health desk. #### How do I sign up for a TIME newsletter? Go to time.com/newsletters, choose the newsletters you want and enter your email address. There is no cost and no subscription requirement. ### Sources * TIME Newsletters: [time.com/newsletters](/c/time-nl-network-2026q3/newsletters?i=14b191f2-6ffe-451e-8740-f63a4c469024&cr=time-nl-network-2026q3-v1) ## Video: Mannes on the Street: Medical Bill Sticker Shock [Watch (HLS stream): Mannes on the Street: Medical Bill Sticker Shock](https://cdn.jwplayer.com/manifests/3pxoqRJm.m3u8) (1:30)  _Published 2014-06-07. What's the biggest shock you ever got on a medical bill? People tell our Mannes on the Street._  by [Mandy Oaklander](https://time.com/author/mandy-oaklander/)  ## Mandy Oaklander Oaklander is a senior editor at TIME. Nov 17, 2016 4:39 PM UTC  Elizabeth Renstrom for TIME  by [Mandy Oaklander](https://time.com/author/mandy-oaklander/)  ## Mandy Oaklander Oaklander is a senior editor at TIME. Nov 17, 2016 4:39 PM UTC When you land in the emergency room, navigating your complicated health insurance is often the last thing on your mind. But even if you have to foresight to go to a hospital covered by your plan, not every doctor who interacts with you may be in that same network, potentially leaving you with a surprise bill later on. In new [research](http://www.nejm.org/doi/full/10.1056/NEJMp1608571?rss=searchAndBrowse) published in the _New England Journal of Medicine_, a pair of Yale University economists wanted to find out the scope of surprise emergency room billing in the U.S. They looked at 2014-2015 claims data from an unidentified large commercial insurer, capturing 2.2 million visits to ERs across the country for people under age 65, totaling about $7 billion in emergency care. They found that while the vast majority of patients visited hospitals within their coverage network, 22% were treated by an out-of-network doctor. Many incurred sizable surprise expenses as a result, the researchers say. “It turns out to be something that’s happening way more frequently than I would ever have guessed,” says Zack Cooper, one of the authors of the study and assistant professor of public health and economics at the Yale School of Public Health. “These bills can be hundreds, thousands or even tens of thousands of dollars.” Assuming that the insurer would only pay the in-network rate, Cooper and his co-author calculated that those treated by an out-of-network doctor might receive a bill averaging $622. Not everyone agrees that coverage discrepancies between doctors and hospitals are to blame. In a statement, the American College of Emergency Physicians (ACEP) took issue with the study, saying that people often don’t realize how little coverage they have until a big medical event like an ER visit. “Most emergency physicians prefer to be ‘in-network,’ as long as insurance companies pay fairly,” says Dr. Rebecca Parker, president of ACEP. “The study does not discuss that insurance companies are misleading patients by selling so-called ‘affordable’ policies that cover very little until large deductibles are met—then blaming physicians for charges.” The problem is worse in some parts of the country than in others, the authors of the new study found; in certain geographic areas, like parts of Florida and Texas, so-called “surprise billing” was rampant, but in some parts of Colorado and Indiana, it was nearly non-existent. “If there are places where this just isn’t occurring, it means that this is something that doesn’t need to be occurring anywhere,” Cooper says. “We need to do more research to figure out where and why this is happening.” ## Transcript [ MUSIC ] We ask people on the streets of New York. What's the biggest shock you ever got on a medical bill? Ambulances. Just to go one mile down the road will cost you $ 750. Going to the dermatologist I had a you know there was a crazy bill that I got but I went to the doctor's office and you know asked about it and complained and they took off like $ 250, just like that. Usually, I think it is, when you get an itemized bill and it shows like $ 10 for a Band- Aid, that kind of thing. Or the insurance. The price of how much the insurance is a month. It was actually in college. The doctor just didn't, didn't read my labs correctly and they sent us to the hospital just to kind of, just check us out. And it was, ended up being like $ 5, 000 cuz we didn't have insurance at that time, and it was just kind of like a common cold type of thing. My dad had a heart attack last year, the overnight hospital stays were a little more than I would have thought that they would be but then again, you know, we're prepared for the fact that hospital bills are gonna be high and. Mine was, with the switch over to the Affordable Care Act. Yeah. We were looking at just a astronomical increase in our monthly premiums. Well, were, we're Canadian, so our health care is covered through. [ LAUGH ] So we don't really have anything you know that, I've never had an experience where I've got a bill that I couldn't pay or that was unreasonable. 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