ER Bills for Uninsured Patients at NYC Hospitals: Self-Pay Visits and Charges at 51 Hospitals

Most ER visits end with the patient going home the same day. New York State records every one of them in SPARCS, its all-payer database, with the hospital, the expected payer and the charge. The Department of Health publishes the totals by hospital and payer each year. We took the 2024 file, kept the emergency departments in the five boroughs and looked at the visits billed to self-pay, the category for patients with no insurance on the claim.

What a self-pay ER visit is billed, hospital by hospital

The top of the list belongs to three systems: Montefiore, NYU Langone and Northwell’s Long Island Jewish campuses. At 11 hospitals the median self-pay visit was billed at $5,000 or more. At the bottom are safety-net hospitals in Brooklyn, the Bronx and Queens, where 16 hospitals had a median under $2,000.

Self-pay patients are not charged a separate, higher price. At the typical hospital the self-pay median was 89% of the median charged for commercially insured visits. The difference is what happens next: an insurer pays a negotiated rate, while the self-pay patient receives the charge itself unless they ask for help.

Where the uninsured go

The public hospitals carry the load. The 11 NYC Health + Hospitals emergency departments handled 145,062 self-pay visits, 42.6% of the city total, and 14.8% of their own visits were self-pay. They also bill the least: the typical H+H median was $1,956, against $3,544 at the 40 other ranked hospitals. Among non-public hospitals, SBH Health System in the Bronx (18.2%) and Jamaica Hospital Medical Center (16.1%) had the highest self-pay shares.

By borough, Queens (11.6%) and Manhattan (11.5%) had the highest self-pay shares, Brooklyn 10.0%, the Bronx 9.8%, and Staten Island the lowest, 5.1%.

The trend since 2018

Self-pay visits fell from 457,115 in 2018 to 197,927 in 2021 and rose to 340,780 in 2024. The low point came while Medicaid kept enrollees covered without renewals during the pandemic; the rise follows the return of renewals in 2023. Over the same years the average self-pay charge climbed from $2,144 to $3,857.

All 51 hospitals

Treat-and-release visits in 2024 at hospitals with at least 200 self-pay visits, sorted by the median self-pay charge. Charges in dollars.

Five more emergency sites had fewer than 200 self-pay visits and are in the CSV, flagged as not ranked. The two BronxCare rows are its two state-licensed sites.

What this means for you

A self-pay ER bill is not final. New York’s hospital financial assistance law covers emergency care at every hospital in the state. If your household income is at or below 200% of the federal poverty level, you owe nothing out of pocket. Up to 300%, the hospital may charge no more than 10% of the Medicaid rate; up to 400%, 20%. Immigration status is not considered, and the hospital must decide within 30 days in writing. The full rules.

Expect more than one bill. The charges in this study are the hospital’s own. The emergency physician group usually bills separately, and so may radiology. How an ER visit is billed.

Ask before you pay anything. Call the number on the bill and say:

“I was uninsured when I went to the emergency room. Before I pay, please send me the financial assistance application and an itemized bill, and put the account on hold while you decide. State law lets me apply at any stage, even after collections.”

A hospital may not send your account to collections within 180 days of the first bill. If the billing office refuses the application or ignores its policy, call the Attorney General’s Health Care Bureau at 1-800-428-9071. For care that is not an emergency, an urgent care center usually bills far less.

Methodology

Data. New York State Department of Health, Emergency Department Treat and Release Encounters by Facility and Payer (SPARCS De-identified): Beginning 2018, downloaded through the state’s open data API on October 16, 2026. The latest year is 2024.

Selection. All emergency departments whose facility county is New York, Kings, Bronx, Queens or Richmond: 56 sites in 2024. Treat-and-release means the patient left the ER without being admitted; visits that ended in a hospital stay are not included. Self-pay is the SPARCS payer category “6 Self-Pay”, the expected payer recorded on the claim. It is the best available measure of uninsured visits, but it can include some insured patients who chose to pay themselves. Hospitals are ranked only with at least 200 self-pay visits; 51 met the bar.

Measures. Visits, share, median, 25th and 75th percentile and mean charges are as published by the state. The citywide average self-pay charge is total self-pay charges, $1.31 billion, divided by self-pay visits. “Typical” hospital figures are the median across hospitals. Charges are what the hospital billed, before any discount, financial assistance or payment.

Download: nyc-er-uninsured-sparcs.csv, one row per emergency department; the 2018 to 2024 citywide series; and the headline figures. Free to reuse under CC BY 4.0. Credit: NYC Med News, “ER Bills for Uninsured Patients at NYC Hospitals,” October 16, 2026, from NYS DOH SPARCS data.