If someone without health insurance is brought to the emergency room in the U.S. and needs immediate surgery, treatment will be prioritized first.

This is mandated by the federal law EMTALA (Emergency Medical Treatment and Labor Act), which enforces "treat first, bill later."

Hospitals must complete diagnosis, surgery, and stabilization without considering insurance status or ability to pay.

Then, the hospital bills flow like this

1. Billing the Patient
   A detailed "sticker price" including surgery fees, anesthesia, imaging, tests, and medications will be sent first. There are no regulations that automatically waive the costs billed by the hospital. At this point, medical expenses can be quite high, which is often covered by the media.
   

2. Applying for Cost Reduction or Assistance

   • Hospital Charity Care: If income and assets fall below certain thresholds, full waivers, partial reductions, or interest-free payment plans may be available.

   • State and Local Assistance Funds: Some states partially reimburse hospitals for the costs of emergency treatment for the uninsured.

   • Emergency Medicaid: If you are low-income, Medicaid may retroactively cover hospital costs even after surgery.

3. Out-of-Pocket Expenses and Payment Plans
   If you are not eligible for assistance or only receive partial reductions, the patient must cover the remaining amount directly. The hospital may offer payment plans, or if unpaid, the debt may be sent to collections, affecting your credit score.

4. Handling of Uncollected Costs by the Hospital
   Amounts that are not collected are treated as uncompensated care by the hospital, and they may be offset by tax deductions, government subsidies, higher charges to other patients, or insurance premiums. Ultimately, the costs are shared by society as a whole.

Summary at a Glance

• Emergency Situations: Treatment cannot be refused — surgery will proceed even without insurance

• Primary Responsibility: The patient is billed for hospital costs

• Mitigation Options: Full or partial forgiveness possible through charity care, emergency Medicaid, state funds, etc.

• Remaining Gaps: Costs indirectly borne by hospitals, the state, and other insured individuals

In conclusion, the belief that "if you have no insurance, you don't have to pay hospital bills" is a misconception, and there is a high likelihood that you will be responsible for the costs. In the U.S., it is common for medical bills to exceed $100,000, leading many Americans to file for bankruptcy due to medical expenses, which was one of the reasons for the implementation of the Affordable Care Act.

If you are a traveler in the U.S. or have an unstable immigration status, it is advisable to enroll in short-term health insurance or travel insurance that includes emergency medical coverage.