If a person without health insurance is brought to the emergency room in the U.S. and needs immediate surgery, treatment will take precedence.

This is mandated by the U.S. 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 is 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 or partial reductions, and interest-free installment plans may be available.

   • State and local government assistance funds: Some states reimburse hospitals for the costs of emergency treatment for the uninsured.

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

3. Out-of-pocket expenses and installment payments
   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, may send the debt to collection agencies, affecting credit scores.

4. Handling of the hospital's 'bad debt'
   Amounts that are not collected are treated as uncompensated care by the hospital, and are partially offset through tax deductions, government subsidies, higher charges to other patients, and insurance premiums. Ultimately, the entire society shares the cost.

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

• Remaining gaps: Hospitals, the state, and other insured individuals indirectly bear the burden

In conclusion, the misconception that "if you have no insurance, you don't have to pay hospital bills" is misleading, and there is a high possibility that you will have to bear the costs yourself. In the U.S., it is common for medical bills to exceed $100,000, leading many Americans to declare bankruptcy due to medical expenses, which was one of the reasons for the implementation of Obamacare.

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 for emergency medical coverage.