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2019 Gather Award in Engaged Journalism, Project finalist

Hospitals Kept ER Fees Secret. We Worked with Patients to Uncover Them.

About the Project

Americans make 141 million trips to the emergency room each year. Patients only learn how much their care costs after they leave and receive a bill — which can often be surprisingly high.

Vox’s engagement, interactive, and editorial teams worked together to collect and analyze 2,100 bills from all 50 states and the District of Columbia. We built a custom database that let us collect bills securely, and design search queries specific to our reporting.

This database also formed the foundation of our community of patients. We piped the email addresses collected from this form into a newsletter list that let us engage with our community, ask for guidance, and mobilize into a grass-roots sharing network throughout the duration of the project. An advisory network of more than 200 medical professionals, collected via Google Forms, provided us with expert guidance and perspective.

We published dozens of stories that led to changes in hospital billing practices, the cancellation of more than $100,000 in patient medical debt, and inspired state and national legislative proposals. We’ve seen the most change in California. Zuckerberg San Francisco General Hospital, a facility that made the rare decision to be out-of-network with all private health insurance plans, overhauled its billing practices; legislation that would bar California hospitals from pursuing charges beyond a patient’s regular copayment or deductible is making its way through committee.

Collectively, the stories were viewed more than 15 million times across our website and Apple News, validating the enormous public interest in this topic. Near the end of the investigation, we opened our database to local reporters and academic researchers and involved the community at every step.