Sarah Kliff brings transparency to ER prices, one hospital bill at a time


A medical bill emailed to Vox senior policy correspondent Sarah Kliff got her interested in emergency room facility fees—a widely applied, highly variable, and little understood cost in the healthcare system. The fees, set between hospitals and insurers, are the charge from the hospital for coming in for treatment.

Last October, Kliff set out to learn more about these fees through one of the only ways she could think of to get the information: by collecting hospital bills.

By putting out calls on social media and on the site, Vox amassed a collection of emergency room bills. Kliff worked with Senior Engagement Manager Lauren Katz, News App Developer Kavya Sukumar, Visuals Editor Kainaz Amaria and Special Projects Editor Susannah Locke to get the project off the ground. Today, the database comprises more than 1,600 bills from every state and Washington, DC. So far, Kliff has written half a dozen articles from the database, and she’ll continue the to report from the trove through the end of the year. Since Kliff started the project, lawmakers have introduced multiple bills to address surprise medical fees, including legislation sponsored by New Hampshire democratic Senator Maggie Hassan that aides told CJR is inspired by Kliff’s reporting.

CJR spoke with Kliff about how she came up with this approach to researching murky healthcare pricing, what her reporting has accomplished, and what other journalists can learn from her experience. This conversation has been edited for length and clarity.

Why did you decide to start focusing on emergency department fees?

This whole project actually started with a bill that a reader sent to me. This guy in Connecticut had taken his daughter to the emergency room. It was a 1-year-old girl and he’d been clipping her fingernails and had cut her finger, and it was gushing blood. He was really worried, and it was a weekend, so the urgent care was closed. So he took her to the emergency room. And they said it was nothing to worry about, they put a Band-Aid on her finger and sent them home. And then he received a bill for $629.

I get a handful of medical bills every year, but this one just kind of jumped out at me. That was the start of going down the rabbit hole with emergency rooms. I found out in that bill that the majority of the bill was the facility fee, which is the price of going into the emergency room and seeking service, and that those fees are typically private. You don’t know what they are until you get billed, and they vary hugely from emergency room to emergency room. That story happened in May 2016, and I kept it in the back of my head. Wouldn’t it be cool, I thought, if we could better understand this interaction that happens millions of times a year where people are constantly getting surprise bills?

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