I spent a night once in the ER for observation. I never got anything but Tylenol, though I think the concern that led to the overnight stay was reasonable. The bill was $16,000.

This was certainly a defensive, risk-averse treatment, but I think it was a reasonable decision. I think my insurance paid about 8,000. The magic words on the bill were "Patient is nor responsible for the difference between the amount paid by insurance and amount billed". This is because I went to an in-network hospital with a contract.

I talked about this with some of my physician friends, and they told me this is typical. In fact, the original bill doesn't represent what they expect to be paid. It represents an extreme position taken to start negotiations with an HMO or other insurance company.

Here's the trap: if you don't have insurance, you are not just hit with the high bill that represents what the hospital would pay an HMO, you're hit with he wildly inflated bill they send to an HMO in anticipation of being paid much less.

So if you don't have insurance in the US, you're doubly hosed. I know I'm supposed to hate my HMO and all, but to me, this is a bit like belonging to a union. As part of a powerful group, I have someone not just paying the bill but knocking it down for me. I may not like being part of a group plan, but on my own, I'm toast.

Unfortunately, this story shows that you can still end up on the wrong side of this billing practice even if you do have insurance, because some hospitals remain out of network for all insurance, and if you're incapacitated or simply don't have the plan in front of you and a couple hours to research the billing practices of various hospitals as your head is bleeding and you're being taken to the ER, you can end up in a similar situation to an uninsured person.

It turns out that it may in fact be impossible to insure yourself against ruinous bills. Nicely done, there.