In the meanwhile consumers can be more aggressive by inserting restrictive clauses into the paperwork they sign upon admission (at least when conscious). A few years ago when I had to take my wife to the emergency room I demanded to be given some range of predicted cost. The intake clerk told me I would have to talk to the business office about that, so we sat there as I repeatedly tried to get through to the business office. Finally, I just inserted into the “agree to pay” section of the intake paperwork the phrase “not to exceed $500 aggregate from all providers whether in or out of network for my insurance plan or direct employees of the hospital or 3rd party providers”. Later when the roughly $2500 of bills arrived in connection with a skin rash examination that was effectively treated with a cortisone ointment, I sent each provider a copy of my intake paperwork along with a pro-rated amount ( their bill/total charges*500) and a memo on the check referring to the paperwork and the statement “paid in full”. The only provider that complained or pursued collection was the hospital itself. As soon as the hospital attorney went over the intake paperwork with me the hospital accepted my payment as payment in full.