1. BILL AUDIT — The wrist X-ray, two views, is billed twice at $310 each for what reads as a single two-view study performed once. That's the clearest audit finding here: request the radiology report and confirm whether two separate two-view studies were actually performed (for example, before and after splinting) or whether this is a duplicate line for one study. If it's one study, that's roughly $310 that shouldn't be on the bill at all. The facility fee and physician fee are separate, expected charges for an ED visit and not duplicative of each other. 2. LEGAL LEVERAGE CHECK — This likely qualifies for federal balance-billing protection. You received emergency care, and the surprise element here is that the radiologist was out-of-network even though the hospital and your own physician care were in-network. Under the federal No Surprises Act, a patient generally cannot be balance-billed more than the in-network cost-sharing amount for out-of-network emergency-care providers, including many ancillary providers like radiologists reading ED films. Your insurer's payment should be evaluated against your in-network out-of-pocket obligation, not the radiologist's full billed rate. 3. FINANCIAL ASSISTANCE ELIGIBILITY — At roughly $54,000 for a household of 3, you're in a range worth applying for charity care at a nonprofit hospital; many hospital policies offer full or partial free care up to 200-400% of the federal poverty level. Ask the billing office by name for their "Financial Assistance Policy" or "Charity Care Policy" document and the application form. This applies to the hospital-billed facility fee; it likely does not apply to the physician or radiologist fees if those are billed by a separate practice group, so ask each biller separately. 4. NEGOTIATION STRATEGY AND TARGET NUMBER — Run two tracks in parallel. Track one: apply for charity care on the hospital facility fee before negotiating anything, since if approved it could reduce or eliminate that portion outright. Track two: dispute the duplicate X-ray charge and the balance-billing exposure on the radiologist fee directly. Only negotiate a lump-sum discount on whatever remains after both of those resolve. 5. THE SCRIPT AND LETTER Phone script for the hospital billing office: "I'm calling about account {insert account number} for a March 2 emergency visit. First, I'd like to request your Financial Assistance Policy and application. Second, I see the wrist X-ray billed twice at $310 each; can you confirm whether two separate studies were performed, or whether this is a duplicate charge that should be removed?" Letter to the radiology practice: {Insert radiology practice name} Billing Department, Re: Account {insert account number}. I received emergency care at Lakeside Regional Hospital on March 2, 2026, and the radiologist who read my wrist X-ray was out-of-network, though the facility and my treating physician were in-network. Under the federal No Surprises Act, out-of-network providers rendering emergency services at an in-network facility generally may not bill a patient more than the applicable in-network cost-sharing amount. I request a corrected statement and an itemized explanation of how the current balance was calculated. Please respond in writing within 30 days. Sincerely, {insert your name}, {insert your phone number}. Placeholders to fill before sending: account number, radiology practice name, your name, your phone number. 6. NEXT STEPS - This week: request the itemized radiology report to resolve the duplicate-charge question, and request Lakeside's Financial Assistance Policy and application by name. - Send the No Surprises Act letter to the radiology practice about the physician-fee balance. - Tell the hospital billing office in writing that the account is under active review for financial assistance and a billing dispute, so it isn't sent to collections while you wait. - Once the charity-care determination and the duplicate-charge correction both land, negotiate a payment plan or lump-sum settlement only on whatever balance is left.