Some of my: Inventions | Magazine interviews | Sheds | Favorite ER memories

Information for people contemplating
a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD


Want to save money on hospitalizations whether or not you're insured?

by , MD

Hospital bills can give
you more than a headache:
they can bankrupt you, too.

Dr. Pezzi explains in this page
how to save money, whether or
not you have medical insurance.

Even if you have medical insurance that covers hospitalizations, you may face astronomical co-payments and other charges. The situation is even worse for folks without insurance, who are typically billed far more than what hospitals accept from insurance companies.

Is there anything you can do about this? Yes, you can fight back, legally.

I'll explain. In my years as an emergency room doctor, I witnessed countless patients sign papers given to them by admitting clerks. Most patients sign those papers without reading or amending them in any way. By doing that, you are legally obligated to the terms of that contract. However, a few astute folks read them and crossed out ones not to their liking, or modified the contractual terms so they are more equitable. I never saw any clerk or hospital refuse those patients admission. I've sat in enough meetings with hospital administrators to know they want every penny they can get their hands on, so if they make only $16,000 from you instead of $20,000, then they'll accept that $16,000. It's far better than losing the money for the admission if you go to another hospital, and their ER doctors don't want the hassle of transferring you elsewhere.

Hospitals have many fixed costs, so adding (say) $10,000 of billable treatment usually costs them much less: often $500 or so. Do the math: accepting 100 such patients with $1 million of billable treatment might cost them only an additional $50K. If they get those additional patients by agreeing to treat them for half price, they'd still net a gain of $450,000.

So what do hospitals do? They accept your terms, instead of the other way around. The standard contracts that patients sign for emergency treatment and hospitalization are written by hospital attorneys who write one-sided documents favoring their clients, the hospitals.

Your financial health is imperiled by dirty tricks that hospitals often pull on their patients, such as charging for services, tests, medications, and procedures never rendered. (This and other hospital cons have been documented numerous times by 60 Minutes and other investigative journalists.) Try walking out of Wal-Mart without paying for a $5 item, and the store will call the police and prosecute you. In contrast, hospitals can fraudulently steal hundreds of times more from you and get off scot-free. Even if they are caught, they generally must only refund the overcharge. However, hospital bills are so difficult to make sense of that they can look like hieroglyphics even to doctors. Consequently, millions of patients have paid billions of dollars to hospitals that are, in my opinion, highly unethical for preying upon people when they are going through such vulnerable times in their lives.

How to fight back

Besides reading the hospital admission contract and crossing out or modifying any clause in it that is not agreeable to you, add the following:

For insured patients: You and all affiliated providers agree to accept my insurance coverage as payment in full for all charges related to this hospitalization.

For uninsured patients: As payment in full for all charges related to this hospitalization, you and all affiliated providers agree not to bill more than what you currently accept from any insurance company, Medicare, or Medicaid.

You may also wish to add the following terms whether or not you have medical insurance:

Don't overlook the tremendous bargaining power of the last clause. Hospitals are filled with overworked doctors and nurses who make mistakes in caring for most patients. I could fill dozens of books listing the errors I've personally seen and heard about. Even seemingly minor mistakes can have devastating consequences, as in this example.

Healthcare workers sometimes botch easy, routine procedures. For example, I went to a local hospital to have two lab tests performed. Even though they are supposedly one of the top hospitals in the United States, their phlebotomist made several errors in drawing my blood. He likely follows the same procedure on every patient, so not only is he incompetent, but he has incompetent supervisors, too. And what about his co-workers? Several of them worked together in one room; hadn't anyone noticed what he was doing wrong? Are they following the same inept procedure?

That same hospital committed multiple errors during a transvaginal ultrasound; the tech didn't even know the correct hand-washing procedure! I explained it to her, and she still didn't do it correctly!

Women (and men who care about them): In researching the infectious disease hazard of transvaginal ultrasounds, I found that even the CDC is alarmed by some of the risks. If you value your health, educate yourself on this and other risks; don't assume healthcare providers know or even care about what they are doing, because many don't. In my books and websites, I discussed some of these hazards, which include premeditated murder (such as racist healthcare workers intentionally killing black patients), nurses talking about assassinating patients they abhor by injecting them with HIV, and screwing other patients in ways that ought to make you think twice if it is wise to put blind faith in people you usually don't know well.

For all the lip service they give to "quality assurance," hospitals remain places in which errors remain a routine occurrence. Perhaps it isn't fair to have 100% of your bill forgiven if one error is made, but for years hospitals have been the sole arbiters of fairness. It's time to level the playing field and give patients the same power that hospitals enjoy. Since virtually all admissions can be shown to be imperfect, you can use that last clause as a bargaining chip in negotiating a reduced fee with the hospital.

Contact me to get it

My sixth-grade teacher called me "slow" and
I was a struggling student until tenth grade.
However, I graduated in the top 1% of my
class in medical school and one of my former
bosses said that I was the smartest doctor he
ever met. In From Dunce to Doctor, I will
explain how I achieved such a remarkable
improvement in my intelligence and memory.
In Boosting Brainpower, I present countless
tips to further heighten your IQ, memory,
creativity, concentration, and motivation.

How you can help hospitals improve their quality of service

I reviewed countless medical records during the years that I served on a hospital's Quality Assurance Committee. If I spotted an error, such as not doing something that should have been performed, I'd let the guilty doctor know about it. However, I'd see the same docs making the same errors month after month, year after year, in spite of numerous notices from me. Is there a better way to force them to improve? Yes. If they were not paid for cases in which they made a potentially serious error, it wouldn't take them long to shape up. Hospitals are so hidebound that they won't utilize money as a motivational factor, but consumers can use their power to send a strong message to them: We won't pay for subpar performance.

Regarding the clause about collection agencies: There is a limit as to how mean and nasty hospitals can get, so when they want to be more thuggish and still seem to be a lily-white institution that's a warm and fuzzy part of your community, they let collection agencies do the dirty work for them. That's when the teeth come out and are sunk into your flesh.

One of my relatives listed me as a reference on some credit card that he subsequently defaulted on. Since then, bill collectors have phoned innumerable times—sometimes every few minutes—hounding me, even though I don't owe them a penny. I've found that many bill collectors behave like atavistic, knuckle-dragging Neanderthals. If you think you have health problems now, just wait until you and your relatives suffer months of stress after hospitals sic a collection agency after you.

Exactly how can you add those clauses to the hospital admission contract?

You could:

For more information, and to see a real-life example of how one person used my advice to save money, see Saving money on ER & hospital bills.

Disclaimer: I am not a lawyer and cannot give legal advice. However, modifying the terms of a contract before you sign it seems to me to be a God-given right that no court could deny. You may wish to consult a licensed attorney in your state, who may give you additional recommendations to make the hospital admission contract more equitable. If so, please let me know about his suggestions so I can add them to my list. Thank you!

UPDATE: In a long conversation with a hospital's director of patient billing, I learned that they bill everyone the same but what they accept varies greatly, so people effectively pay different prices depending on their health insurance status. People without insurance often pay much more than folks who are covered. In my opinion, that isn't fair, so even though they bill everyone the same, they make some patients pay more. This is analogous to a grocery store setting their price for a gallon of milk at $5, but allowing Mrs. Smith to have it for $2.50 while Ms. Jones pays $5.

Most hospitals and doctors go out of their way to make price comparison so difficult that most patients don't even try. As a fan of price transparency, I encouraged the billing director to post their prices online, but she said it would be too difficult. And why would it be difficult? Precisely because what they accept from various insurers, the government, and uninsured people is so different!

I think they don't want anyone to know what others pay, because if they did, every insurer and uninsured patient would want the lowest price they accept. If Smith and Jones get the same milk, how is it fair to charge Jones twice what Smith pays? It's not. Obviously. In fact, it violates the Golden Rule ethic of reciprocity and the rule of law—the basic principles of fairness expressing something we all know intuitively: that treating everyone the same and holding them to the same standards is ethically justifiable; anything else is not; it's preferential treatment, favoritism, and—in this case—a clever but dastardly system for helping the rich stay rich and the poor stay poor.

If this discrimination against poor people were extended so they also paid more for their food, energy, housing, clothing, transportation, and education, who in their right mind would blame them if they declared war on a corrupt system engineered to keep them down? If you care about fairness for all, as I do, are you willing to look the other way just because poor people often are asked to pay more only for their healthcare? One below-the-belt punch is better than seven, but it still is not justifiable.

Hospitals know what different insurers reimburse for various billing codes. That information is already in a database, so it would be easy to put that information online. Gee whiz, I could do it, and I'm a database novice.

I understand that average hospitals may write off millions of dollars per year as debt they cannot collect, but as stated above in the section discussing fixed costs, not collecting $1 million costs them much less. Here in impoverished Michigan, some not particularly large hospitals pay their CEOs so much they make the President of the United States seem like a pauper. So are those hospitals really hurting?

The billing director initially struck me as intelligent and nice but inflexible and doing her best to bring in as much money as possible for the hospital (which is her job, after all), but when she let her humanity slip out, it was clear to me that she had a heart of gold and really cared about people. Hence, if I get rich, I plan to donate a lot—hopefully millions—to fund their program so that people in the area who are down on their luck can get the care they need without worrying about their ability to pay for it.

As a doc, I've seen people worried about the cost of care delay it so they end up much worse off or dead. I want to help prevent that. An MSU college student, Carly Glynn, died from meningococcemia after she waited too long—perhaps concerned about money. I've done the same thing, from doing my own surgery (dermabrasion, finger laceration repair without anesthesia [ouch!], and removal of gangrenous tissue) and self-treating my cardiac arrhythmia, spending Christmas Eve in an ER waiting room one year frightened out of my mind after asking the triage nurse to treat me only if I collapsed.

I also want to give a small fortune to the hospital in Tawas City, Michigan. Of all the places I worked, that was my favorite. The people there—from the nurses I harmonized with as if they were beloved sisters, to the warm and friendly CEO—were gems.

My related articles:

How I saved my brother from an outrageous hospital bill

Setting your own terms of sale


  1. “60 percent of the nearly one million personal bankruptcies filed in the United States last year resulted from medical bills.”
    — Journalist Steven Brill, author of America's Bitter Pill, in I Experienced America's Broken Healthcare System While Looking Up From a Hospital Gurney
  2. May 7, 2024: Missouri man admits to strangling hospitalized wife to death because he couldn't afford her medical bills
  3. New survey reveals 57 percent of Americans have been surprised by a medical bill
    Comment: Not 100%?
  4. Medical costs create hardships for more than half of Americans
  5. Hassan files bill aimed at addressing surprise emergency room bills: ER patients say they're shocked by bills of thousands of dollars
  6. Girl’s $143,000 bill for snakebite treatment reveals antivenin price gouging: The average list price for the antivenin is $3,198. The hospital charged $16,989.
  7. Information Technologies Could Remove 'Shroud of Secrecy' Draped Across Private Health Care Cost
    Excerpt: “"The idea that American patients should 'shop around for cost-effective health care' so far has been about as sensible as blindfolding shoppers entering a department store in the hope that inside they can and will shop smartly for the merchandise they seek," said Reinhardt, James Madison Professor of Political Economy and professor of economics and public affairs at Princeton's Woodrow Wilson School. "In practice, this idea has been as silly as it has been cruel."”
  8. What Hospitals Charge the Uninsured
    Excerpt: “With few exceptions, private insurers tend to be relatively weak when bargaining with hospitals, so that hospitals can extract from them prices substantially in excess of the full cost of treating privately insured patients, with profit margins sometimes in excess of 20 percent. Finally, uninsured patients — also called “self-pay” patients — have effectively no market power at all vis-à-vis hospitals, especially when they are seriously ill and in acute need of care. Therefore, in principle, they can be charged the highly inflated list prices in the hospitals’ chargemasters, an industry term for the large list of all charges for services and materials. These prices tend to be more than twice as high as those paid by private insurers.
    Comment: Read the rest of that article to find one of the most brilliantly incisive questions ever asked—a question bound to give nightmares to greedy hospital big shots.
  9. She didn’t get treated at the ER. But she got a $5,751 bill anyway.
  10. Shocked, Shocked, Over Hospital Bills
    Excerpt: “As these earlier reporters and Mr. Brill underscore, all manner of amazing behavior can hide under the pious label of 'nonprofit.'”

    Comment: Nonprofit hospitals are very eager to profit from you, as I discussed in my blog, but their avarice is so strong they don't distribute profits to shareholders; instead, they pay inflated salaries and benefits to their big shots who run hospitals as money-making machines for themselves.

    To justify the loot they extract, many CEOs learn to play the buy-an-award game: schemes in which hospitals buy awards from organizations who use complicated schemes to hide the money trail. I spent months investigating that scam. Some of the awards are so transparently fishy it is truly a wonder why journalists don't see obvious fraud, such as a hospital I once worked in that claimed it was one of the top heart hospitals even though we didn't have a single cardiologist working there! We didn't have a cath lab or a CCU—and we're a top heart hospital? Really!
  11. Surprise Medical Bills: ER Is In Network, But Doctor Isn't
    Excerpt: (quoting health policy analyst Stacey Pogue) “No other consumer services are sold to us this way. It would be like going into a restaurant, and ordering a meal and then getting a bill from the waiter, and from the restaurant separately, and the cook separately and the busboy separately. And some of them will negotiate with you on the price, and some of them will accept coupons, and the others don't.”
  12. Emergency room patients routinely overcharged, study finds: 'Price gouging' is worst for minorities and uninsured
  13. Time magazine: Why Medical Bills Are Killing Us
  14. Emergency Room Patients Ask: How Much Will I Be Charged?
    Excerpt: “It's a basic, reasonable question: How much will this cost me? For patients in the emergency room, the answer all too often is a mystery.”
  15. Save Big: Negotiate With Your Doctor
    Excerpt: “61% of people who negotiated with a doctor were successful in getting a lower fee [but] only 12% of people surveyed had ever even tried.”
  16. How You Can Haggle for Health Care: Web site in Washington state lets users negotiate with doctors and dentists
  17. Why Are Patients Racing Out of America for Healthcare?
    Excerpt: “Americans are paying a stunning amount for procedures that would be considered routine — and are highly affordable — in places like Australia, Spain, France and South America. … it should not cost $2,800 for MRIs that cost $118 in Argentina.”
    Comment: Agreed. The American medical system shamefully rips off patients and ignores ways to economize. Five-minute procedures often cost as much as many people make in a week (example). This is ridiculous. I agree that doctors and other healthcare providers should be well-paid to attract the best and brightest, but having a medical license should not be a license to rip people off. But doctors are not the primary problem—it's hospitals and their executives, many of whom are paid much more than the President of the United States. They run hospitals as their personal money-making fiefdoms. Guess who pays them to make up to almost 40 times as much as the President? Patients who are robbed so a few entitled fat cats can live like kings.

    Patients are financially bled and sometimes bankrupted so hospital CEOs can buy fancier airplanes, bigger boats, and more vacation homes—you know, all the essentials of life. One big shot I knew was surprisingly open about how he was sleeping with a much younger and very pretty employee who seemed to be his assistant, but from what little she did, I suspected that if her job title were accurate, it would have been prostitute.

    This hanky-panky is easy to camouflage, and even the participants can deceive themselves about what it boils down to. Women needn't be rocket scientists to figure out they can get a cushy, high-paying hospital job by making big shots happy. In their minds, they're not whores; they're a Director of Community Relations, or whatever.

    Doctor and nurse wages are falling (adjusted for inflation and expenses) while hospital CEO pay is going through the roof. This topic rankles me because patients pay a big price for this highway robbery. Many people cannot afford healthcare so they stay at home and suffer or die. Or if they obtain care, a single hospitalization can financially ruin them.

    Now for a personal revelation: One of my relatives suffered a devastating birth injury that ultimately stemmed from a very greedy hospital CEO. Had the millions (and millions and millions and millions) paid to him instead been used to improve care and increase staffing, my relative could have escaped that birth injury that will haunt her the rest of her life. An article about that SOB said he is obsessed with winning—apparently at any cost, even to patients, who must suffer so he can win.

    One hospital I worked in had so many gorgeous employees I knew they must hire on the basis of beauty—but why? Were all those hot women the best applicants? That is statistically so improbable we can exclude that as a plausible explanation. Perhaps the men who did the hiring reasoned that having so many foxes around gave them more chances to sleep with them—office affairs are common, after all.
  18. 5 Ways to Avoid Getting Ripped Off at the Doctor's Office
  19. Getting Lost in the Labyrinth of Medical Bills
  20. Get Drug Prescriptions Filled for Free
  21. NC high court to hear case of $14K hospital bill
  22. Medical Bills: Sticker Shock and Confused Consumers based on Health Care as a "Market Good"? Appendicitis as a Case Study
    Excerpt from first article: “Much of the issue stems from the complex and often arcane practice of medical billings in which patients are not necessarily billed for their actual cost of care. Insured patients "are shielded from charges, while the underinsured or uninsured see staggeringly high numbers without understanding what the charges mean, let alone if they are appropriate,'' the authors said.”
  23. Appendix removal: Huge sticker shock in study: Hospital bills for appendix removal may range from cost of a refrigerator to cost of house
  24. Snake-bite victim socked with $55K bill
  25. Uninsured heart attack, stroke patients face ‘catastrophic’ costs
    Excerpt: “Heart attack and stroke patients without medical insurance face “devastating” health care costs that can bankrupt them …”
  26. 7 Ways You Can Protect Yourself From Outrageous Medical Bills
  27. “We Eliminate Billing Errors from Hospital Bills”
  28. 1 in 5 operations may lead to surprise bills, even when surgeon & hospital are in-network
  29. Do hospitals tell patients about charity care options? Study finds room for improvement: As Affordable Care Act requirements take full effect next year, patients with no insurance or big bills should ask about available help, team says
  30. U.S. Hospitals Have Little Incentive to Improve Patient Care
  31. Debt Collector Is Faulted for Tough Tactics in Hospitals
  32. Medical bills drive many U.S. women into debt, report finds
  33. W. Va. Woman Fights to Collect $10 Million from Debt Collectors
  34. When Debt Collectors Call: What You Need to Know
  35. Debt Re-aging Dangers: Use Caution When Contacted About Old Past-Due Bills
  36. What to do if a Debt Collector Calls
  37. What to Do When a Debt Collector Demands a Full Payment
  38. Debt Collector Allegedly Makes Bogus 911 Suicide Call on Elderly Oregon Woman
  39. Is Medical Debt Wrecking Your Life? (Help May Be Coming)
  40. Aetna CEO and 30-Year-Old Bond Over Staggering Cancer Bills
  41. Scorpion sting leaves Arizona woman with huge bill (the $83,000 bug bite)
  42. Man threatens to bomb Alpena hospital over billing issue
  43. Man billed for ambulance that arrived too late
  44. Maine Doctor Able to Slash Prices in Half After He Stops Accepting Insurance
  45. The $2.7 Trillion Medical Bill: Colonoscopies Explain Why U.S. Leads the World in Health Expenditures
    Comment: More than $3,500 for a colonoscopy? Nuts!
  46. Pay for Nonprofit Hospital CEOs Varies; Average More Than $500k
  47. Simple tasks help protect your credit
  48. $8.9 million in medical debt to be abolished: MNA, nonprofit partner to buy and pay off debt for about 9,200 families, individuals
  49. Having Cancer Is Bad. Having Cancer When You're Poor Is Worse: People without resources have higher death rates
  50. Dispute EVERY Hospital Bill
  51. 3 Ways Hospitals Overcharge You (And What Can Be Done About It)
  52. Doctors aghast at Groupon deals for medical care: The deals are actually pretty good, even if they show how broken the system is.
  53. Sky-high surprise bills from air ambulance flights possible for many patients: Ground ambulance rides also put majority of patients with private insurance at risk for unexpected out-of-network bills, study finds
  54. September 18, 2020: Many Hospitals Charge More Than Twice What Medicare Pays for the Same Care: The gap between rates set for private insurers and employers vs. those by the federal government stirs the debate over a government-run health plan.
  55. January 26, 2021: New data on Americans crowdfunding medical expenses shows 'how bad the situation is'
  56. February 18, 2021: Setting hospital prices would save more than increasing competition or price transparency: But price regulations face the greatest political obstacles
  57. May 4, 2021: Opinion: Here’s why local hospitals, not insurance companies, are to blame for exploding healthcare costs
  58. May 18, 2021: 'There's no way I can pay for this:' One of America's largest hospital chains has been suing thousands of patients during the pandemic
  59. May 20, 2021: Health care in America 'is completely out of whack' as millions face medical debt collections
  60. May 21, 2021: Buoyed by Federal Covid Aid, Big Hospital Chains Buy Up Competitors: The pandemic barely dented the financial outlook for some major networks, which continued to acquire weaker hospitals and ailing doctors' practices. Critics worry consolidation leads to higher prices for medical care.
  61. May 21, 2021: Covid Killed His Father. Then Came $1 Million in Medical Bills.: Insurers and Congress wrote rules to protect coronavirus patients, but the bills came anyway, leaving some mired in debt.
  62. June 11, 2021: Financial toxicity impacts nearly 50% of women with gynecologic cancer: To cope with costs, patients report medication non-adherence which may lead to worse health outcomes
  63. June 15, 2021: Financial distress similar, or greater, for patients with heart disease compared to cancer
    Comment: The American healthcare system is largely predatory, feeding like vultures off patients with problems. American healthcare gives lip service to prevention, but if they truly valued that, they would not ignore over 99% of possible preventive measures: an assertion I prove beyond a reasonable doubt in an upcoming book that I have worked on for years, currently 3647 pages and growing daily. Instead, the focus is primarily on waiting until problems develop, then financially raping patients, often bankrupting them in the process, with the healthcare system then patting itself on the back, pretending to be the good guys.
  64. July 2, 2021: Hospitals Have Started Posting Their Prices Online. Here's What They Reveal
  65. October 6, 2021: An Elbow Injury Exposes the Exorbitant Costs of Health Care: Bills totaling $287,365.08 provide insights into the dysfunctional economics of American medicine
  66. November 1, 2021: Woman gets $688.35 ER bill for spending 7 hours in the waiting room — without being treated
  67. June 16, 2022: Sick and struggling to pay, 100 million people in the U.S. live with medical debt
  68. July 1, 2022: How to get rid of medical debt — or avoid it in the first place
    Comment: How to avoid it? Stay healthy. Here's the catch: that requires an assiduous focus on prevention but primary care physicians and their patients overlook over 99% of possible preventive measures. If you don't understand every facet of your exposome and know how to mitigate those factors, you cannot possibly understand how broad prevention truly is. However, few people even know what the exposome is, and doctors who do generally pick a few of their favorite topics and omit the rest.

    I've spent years writing a book discussing some of the many overlooked exposome factors; it is now 4108 pages and growing daily. If I had more time to devote to that project, it would total well over 100,000. So what is the chance that people ignorant of the exposome can maximally protect their health? Zero.

    The science is clear on this topic. Considering only one of the many exposome factors overlooked or minimized (the latter in this case), average people lose at least two years of life from that alone. Human lifespan would probably average two decades longer if we did a reasonable job of prevention instead of fooling ourselves that the few things we do in that regard are sufficient.

    One of the greatest impediments to longer and better lives is our hardheadedness in which we substitute our opinions for science and hard data. Example: many Americans have trivialized the COVID-19 pandemic and its effect on us. With that and other infections, the common misconception is that if we survive an infection, our health is fully restored. Increasing evidence instead suggests that infections slowly chip away at health, damaging us physically and mentally, accelerating aging, and reducing lifespan.

    This is unquestionably true in the case of COVID-19, which has triggered an unprecedented upsurge in death rates and disability claims. I summarized some of the alarming effects near the top of a website on which I posted videos of one of my innovations to block the primary driver of this pandemic: the fact that we inhale air and germs recently exhaled by others. If broadly implemented, my technology would protect us substantially better than vaccines, masks, social distancing, and therapeutics combined, not only from SARS-CoV-2, but all airborne pathogens.
  69. August 15, 2022: This group's wiped out $6.7 billion in medical debt, and it's just getting started
  70. Cara Pressman March 28, 2023: Commentary: Healthcare system in the US is a scam
    Comment: The system is rigged to enrich those at the very top, such as hospital executives.