At least in US you get the medical treatment first and then they hand you a large bill to pay. In poor countries the hospitals will turn you away until you pay a significant sum in advance (not exaggerating it has happened to me).
A large bill which, if you're uninsured, you can almost always negotiate down to 10% or less of the original.
Of course, most people don't know this, but those large bills aren't what the hospitals expect uninsured patients to pay. They just legally have to present them the same initial bill that they present private insurers.
But having to play that damn game when you life is on the line is inhumane. There's no time out zone.
How does one do this? Where do you learn it? Is there a book you suggest? The fact that I'm even asking this feel weird (I'm insured).
You can't do this if you're insured, because then the terms of your insurance apply. You can still get bills reduced, but the reasons are different and it's a bit more involved.
If you're uninsured, it's simple. You literally just tell them, "I have no insurance. I can't afford $45,000. It would take me years to pay that, and I'd probably default on the bill beforehand. However, if you reduce the billed amount to $500, I can pay that in full today, in cash.".
Substitute appropriate values in as needed, but that's the general idea. It's actually not all that different from what private insurers do, except they do all this up-front in bulk, so their rates are set in long-term contracts.
I've known people to successfully negotiate to 40-50% of original bill, usually with proof of (lack of) assets.
Maybe if you really are basically broke, they'll write you off rather than carry it on their books until they sell the debt. On the other hand if your bill is 45,000 and you have even meager assets : say a couple of cars and equity in a house, I'm guessing their going to try hard to see a good chunk of that.
In general, they only negotiate hospital bills because they are the only bills large enough. I would say that the typical final negotiated rate they get from the hospital is about 3-20% of the billed amount. It depends on how high the original bill is, and it also depends on whether you need to make payments and how long the series of payments is.
Hospitals will certainly claim that you need to send in the proof of assets, usually you have to refuse about 6 or 7 times and they will relent.
However, things have changed in the last few years and professional medical bill negotiators have told me certain hospitals are completely unreasonable and refuse to negotiate. They advise these people to file bankruptcy.
You're wrong either way. I've seen some bills my insurer pays around 2% of what is billed, but not most things. Hospitals will ofter sue, and they are aggressive about judgements. If you can pay something, they will take more.
What? No, that's not how it works.
Good luck finding a 90% off coupon for a surgery prior to the event.
It doesn't. It's not a debt yet. You don't have to pay taxes on the difference.
I have never had health insurance. Where I live many people don't have health insurance. I have never heard of this happening. I've seen peoples, my own included, wages garnished before this will happen. I currently have a $20k bill for an emergency appendectomy I had 4 weeks ago. The hospital will seriously take payments for 30 years before they'll lower any cost. If you want to negotiate, you'll have to wait until the collection agency has their account removed from your credit report 7 years after the first reporting. Any time before that you are in no position to negotiate with anybody.
EDIT: Unless your income is less than 1.5x the poverty level. In which case you qualify for aid in paying your bills.
It happened to a friend of mine who was hiking in Canada a year or two ago. Her son cut a big gash in his foot and they couldn't get online, so I had to call around to find an emergency room they could go to. The local emergency room basically said in lieu of proof of (internationally-accepted) insurance they would need $800 up front if he wanted to be seen. I think they wrapped a towel around it and drove back to the US.
It sounds like it was the Canadian insurance provider who screwed them, though. They said[2] that since she had a bladder infection prior to getting the travel insurance, it was a pre-existing condition and therefore wasn't covered. So basically, if you get your travel insurance and come across the border, don't expect it to cover anything like a heart attack, an abcessed tooth, a prescription refill, etc.
[2]https://www.change.org/p/blue-cross-blue-shield-pay-for-jenn...
As someone who lived in Canada for 10 years, I can understand that. The blindness Canadians have to the severe problems in their own healthcare system is amazing. Take a look at the massive problems in autism care in Canada. Let me put it this way, it was cheaper (free), faster, and superior in every way in the US as opposed to Canada, where it was far more expensive, years in waiting times, and in the end got no autism assistance. To be fair, this was back in 2011 when we finally left, but having kept an eye on the system (what with having family there still), it hasn't really improved.
It should be noted that the bill won't be different from an insured person bill, the prices are "posted".
To complete the picture, in the truly civilized countries when you're sick you just go to the hospital, and they take care of you, no strings attached.
The whole world is not made just of the USA and some banana republics.
This as a legal mandate applies to emergency stabilization (including assessment as to need for same) only. It may happen with other things, but that varies a lot and is mostly a matter of what the particular provider finds most convenient.
Mayo Clinic in Scottsdale AZ, November 2017.
edit: I'm a bit off topic, that was for an appointment, not ER.