Why is the “Trauma Activation Fee” so Outrageous?

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The Trauma Fee Nightmare

When a traumatic event occurs, you want the best health care money can buy. However, you expect the cost of that care to be fair and reasonable.

Former trauma patients are seeing a hefty fee on their medical bills simply for coming through the medical facility doors. This “trauma activation fee” is not so new to the healthcare system but is recently receiving much warranted attention because it is showing up with a higher frequency.

A trauma activation fee is a charge that is billed when a medical third party (ambulance) alerts a medical emergency facility or trauma center that a trauma patient is on the way.


This alert allows the medical staff to prepare supplies and be ready in the trauma area to give their particular concentration of care. A team of health care professionals will meet at a previously designated location within the trauma area prepared with any necessary supplies, such as pre-mixed IV solutions, oxygen and a crash cart, which contains emergency medications and administration supplies.

Medical doctors, registered nurses, respiratory therapists and technicians, lab technicians, operating room personnel, pharmacy staff and radiology technicians should be trained to “drop everything” and respond to a trauma call. Additionally, the OR and ICU units must make sure they are prepared to accommodate trauma victims. Sounds like every department in the hospital, right? It should be. Trauma patients are a big deal and often, the emergency staff does not know exactly what they are dealing with until the trauma patient arrives and is assessed.

Severity of Trauma Not Taken Into Account

surgery2Like any other medical emergency, there are different levels of severity with trauma patients, meaning each case is different and requires different levels of care. For example, a patient with an injury to his arm, leg or foot might not be as severe as someone with an injury to his head or chest. Regardless of the severity of injury of a trauma patient, in many health care facilities, the trauma activation charge is the same.

In addition to the activation fee, the emergency facility is still able to bill for additional emergency room costs and charges from different hospital departments. That means that not only are you paying a fee for representatives to be present from all areas of the facility, you are also paying a fee if you happen to use their service. Read that last sentence again.

You are first being charged to let the facility know you are coming and that you are experiencing some form of trauma. Second, you are being charged by the facility for whatever costs they would normally charge (emergency room fee, medications, IVs, supplies). Third, you are charged by any doctors who see you. And fourth, you are charged by any additional departments from which you required assistance, such as radiology for an x-ray or laboratory for blood drawn (plus any supplies used by those departments).

The $30,000 Trauma Activation Fee

heartmonitorMedical Recovery Services founder Pat Palmer is frequently seeing these charges in her business, which audits excessive medical bills and often reclaims money for consumers, companies, insurance providers and attorneys. Palmer is seeing trauma activation fees from across the country in excess of $20,000 to $30,000.

The formula for creating these fees varies between hospitals and facilities, but there are standards which must be met before a health care facility can charge for a trauma activation. There must have been pre-hospital notification before the patient arrives and the trauma team must have been activated and ready when the patient arrives.

According to the Arizona Department of Health Services, a trauma center or medical emergency facility bases its trauma activation fee either on the actual cost (what the trauma event costs the facility plus mark-up) or on what other facilities are charging their patients.

Palmer has seen a flat rate applied to patients’ bills and she has seen rates based on severity and treatment of trauma event. Interestingly, she has seen vast differences in charges for similar trauma events among facilities in alarmingly close distances of one another.

Vast Differences in Trauma Activation Fees

surgeryWhy are there such vast differences in these trauma activation fees, especially in facilities that are in the same area? A large problem is that many of the high-charging facilities are owned by for-profit health care corporations, such as Hospital Corporation of America, Community Health Systems and LifePoint Hospitals, who pack on hidden fees to help pay hefty administration costs.

A 2012 article from USA Today shows a vast difference in trauma activation fees across Florida. A medical center in Fort Pierce, FL, closer to the southern point of the state, charges approximately $29,000 for a trauma activation fee. An Orange Park, FL facility charges around $20,000 while a Jacksonville hospital charges a more reasonable $7,000. What is very interesting about the charges from Orange Park and Jacksonville is that these two facilities are located approximately 20 miles apart, yet one facility only charges a third what the other charges. None of these facilities are classified as a level I or even a level II ACS-verified trauma center, according to data provided by the American College of Surgeons.

Below, please find a complete, updated list of ACS-verified trauma centers in the U.S., listed by state:

Level 2 Charge More than Level 1 Facilities


The Arkansas Trauma Education and Research Foundation states that their cost-based activation fees pay for overhead and for all staff that respond to the trauma call for their time spent, including extra trauma call pay for some physician staff. Extra charges incur based on the number of patients in the trauma call.

The U.S. National Library of Medicine and National Institutes of Health released the results and details of a study performed on 57 U.S. trauma centers evaluating charges for severely injured patients. The report found a vast difference in the cost of trauma activation charges across the country. The fee for a full trauma activation ranged from $837 to $24,963. The report also revealed that level II trauma centers tended to charge more than level I trauma centers.

A level I trauma center has more to offer a trauma patient than a level II trauma facility, such as a wide range of various in-house specialists. Not only would this type of facility offer general surgeons, orthopedic surgeons and neurosurgeons, but might also offer plastic surgeons and oral and maxillofacial specialists. Their trauma team participates in ongoing continuing education opportunities and provides prevention education to the public. They are able to see a trauma patient through from the moment they enter the facility with an injury all the way through rehabilitation.

This type of facility is trained and updated on every aspect of trauma care for every type of injury possible and because the volume and variation of injuries which come through their doors is so great, they would have the most experience in trauma care, meaning they would likely have the best surgeons, doctors, nurses and staff in the region. So, how can a level II trauma center justify higher charges for trauma activation, since they supposedly base this charge on the cost of facility operations, which includes physician pay? Are these highly-skilled surgeons really making less money than their colleagues who work for lesser ranked facilities? This report just further validates that there is no rhyme or reason to these fees charged to trauma patients.

Surcharge for Pre-Arrival Announcement

There is no doubt trauma centers are costly to operate. The cost of surgical coverage and equipment and expenses of medical staff can be extremely high. Specialty staff must be available 24/7. Keeping the OR and ICU available for new traumas costs money (not just the staff, but equipment as well). However, what can justify charging a patient tens of thousands of dollars in addition to regular fees and charges just to walk through the door because their arrival was announced ahead of time, regardless of type or severity of injury?

Unfortunately, there doesn’t seem to be an end in sight to fees created in hospitals and other healthcare facilities to offset the costs of running that facility, according to data from the long-term budget from the U.S. Congressional Budget provided by the Arkansas Trauma Education and Research Foundation. A 2010 report projects the federal cost of health care will double by 2035.

  • “Trauma Finance 101.” Arizona Department of Health Services, n.d. Web. 25 Feb. 2014. <http://www.azdhs.gov/bems/documents/trauma/workshop/131115-trauma-finance-101.pdf>.
  • Arkansas. Arkansas Trauma Education and Research Foundation. By Deb Brown, RN, BSN, MHA. N.p., Aug. 2013. Web. 25 Feb. 2014. <www.aterf.org/wp-content/uploads/2013/08/The-Nuts-and-Bolts-of-Trauma-Activation-Fees-by-Deb-Brown.pdf>.
  • Crain, W., SM Fakhry, R. Maier, and C. Potter. “Survey of National Usage of Trauma Response Charge Codes: An Opportunity for Enhanced Trauma Center Revenue”. National Center for Biotechnology Information. U.S. National Library of Medicine, Dec. 2009. Web. 27 Feb. 2014. <http://www.ncbi.nlm.nih.gov/pubmed/20009689>.

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2 responses to “Why is the “Trauma Activation Fee” so Outrageous?”

  1. Eric Cooper says:

    Ms. Palmer:

    I am a personal injury attorney and frequently must attempt to have the trauma activation fee deleted from my client’s medical bills when negotiating payment here in Texas. I currently have a client who arrived at the hospital via ambulance and was treated and discharged in one hour and one minute. The hospital charged approximately $7,000 for the services and then tag her for another $5,500 in trauma activation charges. This seems outrageous, as one would ask how bad could the trauma have been if she was treated in such a short time. Any thoughts on challenging these fees or successful strategies is welcomed and appreciated


    • Pat Palmer Pat Palmer says:

      Hi, Eric. Thanks so much for your inquiry!

      We have been fighting an escalating number of cases of unwarranted trauma activation fees and have successfully reduced most of these charges. We recently reduced a similar bill in which a patient was charged a $35-thousand trauma activation fee but was only at the facility for 45 minutes before being transferred to another facility — and was never even treated at the original facility.

      In order for a facility to charge a trauma activation fee, they must have numerous detailed documents to support it. Get these documents and any relevant medical records to review the details. If you need assistance, we would be happy to have our staff review these documents for you and provide you with a detailed report of our findings. If you would like a release form for our services, please give us a call and our legal staff will be happy to forward this to you. Our number is 855-203-7058.

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