Big ER Bills for Little ER Visits

Ed Tobias avatar

by Ed Tobias |

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trauma activation


A couple weeks ago, I wrote a column about medical bills suggesting that you trust, but verify those charges.

A few days ago, I read about a type of emergency room fee that’s hard to trust. It’s being charged by many hospitals, seemingly without consistency, and it can add tens of thousands of dollars to your bill for even a minor ER visit. It’s called a “trauma activation” or “trauma response” fee.

You wouldn’t think that someone would be charged a “trauma” fee for going to an emergency room for MS-related treatment. After all, MS symptoms aren’t the serious injuries that you or I would associate with trauma. Neither did the Jang family from South Korea. Their 8-month-old son had fallen off a hotel room bed and onto the room’s carpeted floor in San Francisco a few years ago. Their story, reported in an article in the Kaiser Health News (KHN) e-letter, may change your mind about that.

$18,836 for formula and a nap

The baby wouldn’t stop crying, so his parents called 911 and he was taken to San Francisco General Hospital. The KHN story continues:

“The doctors at the hospital quickly determined that baby Jeong Whan was fine — just a little bruising on his nose and forehead. He took a short nap in his mother’s arms, drank some infant formula and was discharged a few hours later with a clean bill of health. The family continued their vacation, and the incident was quickly forgotten.

Two years later, the bill finally arrived at their home: They owed the hospital $18,836 for a visit lasting three hours and 22 minutes. …”

Of that total, $15,666 was billed as a “trauma activation” fee. This fee has been around since about 2002 and hospitals add it to emergency room bills to cover the cost of activating a trauma team, the medical specialists who handle very serious injuries. According to the KHN story, that fee frequently tops $10,000. Reporters Jenny Gold and Sarah Kliff also say that fee often seems to be applied arbitrarily.

“It’s like the Wild West. Any trauma center can decide what their activation fee is,” said Dr. Renee Hsia in the article. Dr. Hsia directs health policy studies in the emergency medicine department at the University of California, San Francisco.

Medliminal, a company that helps insurers and employers around the country identify medical billing errors, told KHN that trauma activation charges can range from around $1,000 at a hospital in Missouri to over $50,000 at a hospital in California.

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Trauma centers argue that these fees are necessary to maintain their expensive trauma teams, 24/7. A spokesman at San Francisco General, where the baby was seen, put it this way:

”We are the trauma center for a very large, very densely populated area. We deal with so many traumas in this city — car accidents, mass shootings, multiple vehicle collisions. … it’s expensive to prepare for that.”

What can you do about it?

According to an ER billing consultant quoted in the article, if a trauma team is alerted but the patient doesn’t need at least 30 minutes of critical care, the trauma center is supposed to downgrade the fee to a regular emergency room visit, which is a lot lower. So, it would seem to be worthwhile to dispute such a charge if you get billed for one if you visited the ER for something that wasn’t a traumatic injury.

The Jang family is using a patient advocate to try to negotiate its $15,666 bill. The New York Times wrote about these billing consultants several years ago, and a quick Google search turned up several other articles.

So, trust, verify, and then if necessary, fight.

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RCG avatar


I was in the ER, supposedly all covered by my insurance. I then received a bill for the ER physician who was contracted by the hospital to work that shift. I refused to pay the bill saying, "my insurance covers ALL ER bills for doctors, tests, medication, etc. If your doc chose to work at that ER, it's his choice. I did not go to your facility and will not pay his additional bill." They went away! So, DO fight any bill you feel is unwarranted.

Iinda avatar


The e r. Charged $52,000 . I wasn't seen for at least 15 minutes after a car accident. I was never treated as a trauma patient. I will fight this bill. I had X-rays to make sure all was ok and after several hours , most layi g there alone , I was sent home.

Shelia avatar


We where hit by someone in Feb 2019. I was the only one injured, I received stiches in my right elbow. EMS took me to Austin(apprx 30 min from Bastrop). I was in the ER a TOTAL of 2HR 6MIN. They ordered labs, xray and ct scans. Billed me for $66,683.00. I reviewed my records against the bill(after it was pd by my attorney)there was 6 lab tests I was charged for, a total of $2137 that where not ordered or in my chart. St Davids agreed to 3, for $1323 that they would adjust and include into the discounted amount. AND charged $11,169n for an abd/pelvis ct scan that when I called them for price they quoted me $1409, a difference of $9670. The "TRAUMA FEE was $24831.00 plus ER FEE of $3975.
$66,683.00 for 2hrs 6 min. Released after stitches.
Note*I had to return twice for stitch removal, they left in stitches. FINALLY I dug into area and removed remaining stitches(2) instead of returning a third time.


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