> Here's the trap: if you don't have insurance, you are not just hit with the high bill that represents what the hospital would pay an HMO, you're hit with he wildly inflated bill they send to an HMO in anticipation of being paid much less.

I spent years working in medical billing. You can negotiate these down to prices as much as 10% of the bill. Typically, you go: "I don't have insurance, but I'm willing to pay 50% now."

The vast majority of the time, they'll accept, because that's more than they expected.

DON'T give them the option to distribute the payments. Explain, you're willing to pay now at X% AND that you don't have insurance. The person on the other end is usually a human and can accept that (somewhere in the billing chain).

If they offer to distribute payments, explain financially, that may put more burden on you. If you actually can't pay or are living pay-check-to-paycheck, explain it may bankrupt you. At that point, they get nothing, so negotiations can ensue.

Another thing to do is debate billing codes, as the error rate is relatively high. For reference, even a 1% error rate means out of 10 visits you're likely to get one, because you'll have multiple billing items every visit.