On an ordinary day in September, 24-year-old Nicholas Madison was hanging out with friends. He had just returned to his hometown of Pittsburgh, Penn. after traveling around the United States for the summer.

Things were looking up for Madison, a recent post-graduate who was trying to establish himself. In just 12 days, Madison was about to start a new job as a project coordinator for PNC Bank.

Until then, however, he was without insurance. It was the first time he was in between providers, having recently left his job at a nonprofit mental health organization.

The incident

A seemingly normal day catching up with friends ended up turning into a nightmare. Out of nowhere, Madison felt a sharp, excruciating pain. Within the hour, he was unable to move his neck. Panicked and confused, Madison screamed for his friends to drive him to the ER.

When Madison arrived at the hospital, he allegedly wasn’t admitted right away, being forced to fill out paperwork before a doctor would even see him—later, he would find out that his symptoms were actually life-threatening.

According to Madison, if he had arrived at the hospital just an hour later, he would have been paralyzed. If it was several hours later, he would have died.

“I was in agony and they made me fill out a form. Absolute BS,” Madison tells Upvoted.

Soon after, Madison was diagnosed with Subdural Hematoma (or bleeding around the brain). Doctors told him it was a result of severe hemophilia, a rare genetic disorder that prevents blood from clotting properly.

Luckily, Madison’s procedure was relatively painless for doctors to perform. He didn’t need surgery. He says doctors administered pain and anxiety medication, namely Valium, and injected recombinant Factor VIII, a medication to help his blood clot. He was kept in the hospital for five days to monitor his progress.

The hospital charges

At the end of last month, he finally received a notice in the mail from the hospital. Madison braced himself before opening the letter, which, although technically isn’t his final bill, did state what the current outstanding balance for services rendered is.

Still, Madison suspected the balance would be high—figuring the cost would near $200,000, an astronomical price in itself for a recent graduate to fork out. In actuality, the hospital charge was over $1 million.

Editor’s Note: Madison sent Upvoted the letter in its entirety along with a copy of his ID.

At first, Madison laughed, thinking it was some kind of clerical error. But when he called the hospital, they informed him that this wasn’t a mistake.

And as if things couldn’t get any worse, the hospital also warned him that the outstanding balance could possibly be higher (or even lower)—the actual bill is still pending. The hospital had not yet factored in the cost of the various specialists who attended to Madison with what he describes as 40-second visits.

A photo posted by OneLove3 (@anmlover3) on Nov 17, 2015 at 8:28pm PST

According to Madison, these specialists simply asked him how he was feeling, and he always responded with the same: “I’m fine.”

A representative encouraged Madison to apply to medicaid, a federal financial assistance program for low income individuals. He applied, but at the time of publication, he still has yet to receive a response.

Riled by anger and disbelief, Madison shared a copy of the letter with Reddit’s WTF community.

“Reddit gave me insane support,” he says now. “I had a couple people willing to pay for my attorney fees had it come to that.”

At the very least, the Reddit community provided some laughs:

Why?

Dr. Zubin Damania, a Las Vegas physician and founder of Turntable Health, wasn’t shocked by Madison’s letter when Upvoted asked about Madison’s situation. Damania is a long-time critic of the American healthcare system, creating parody music videos under the moniker ZDoggMD to educate the public about these types of issues.

“[The letter] doesn’t surprise me, although, I think it is especially exorbitant. [Recombinant] Factor VIII costs a ton. But a million bucks? Those are heart transplant prices,” Damania explains.

It turns out, the University of Pittsburgh Medical Center is no stranger to controversy. In 2014, the medical behemoth was sued for allegedly inflating the price of cancer medications. Although technically a nonprofit, UPMC is akin to a profitable business, having made over $10 billion in total revenue in 2014, according to forms filed with the IRS that are available to the public.

At the center of public criticisms is UPMC CEO Jeffrey Romoff for raking in one of the nation’s highest salaries for nonprofit health leaders. Tax forms show he made over $6 million last year. To put that into perspective, the average salary of CEOs at nonprofit hospitals in the United States is around $600,000, according to a 2014 Harvard Study.

When asked to comment on Madison’s hospital charges, UPMC spokesperson Susan Manko emailed Upvoted the following statement:

“I want to clarify that what you saw posted on Reddit recently was NOT a bill from UPMC. This was a standard application form for Medical Assistance for a patient seeking help covering the cost of care. The amount shown on that form was NOT billed to the patient or to anyone else. We work very hard to take care of our patients, medically and financially. And we provided $364 million in charity care and Medical Assistance subsidies last year, more than any other healthcare provider in the region. “The number shown represented hospital charges. The complex way in which hospitals are paid nationally was established by federal, state, and private entities over many years. Most importantly, hospital charges are almost never what is actually paid by insurers or patients. Federal and state governments determine payments for their beneficiaries, and most insurance companies individually contract on pricing. The vast majority of people without insurance are covered by some form of financial assistance.”

However, according to the Kaiser Family Foundation, “Those without insurance for an entire year pay for one-fifth of their care out-of-pocket. They are typically billed for any care they receive, often paying higher charges than the insured.”

“Super jacked-up prices”

“This is the US healthcare system, people. Any kind of evil nonsense is possible!” exclaims Damania.

The doctor explains that hospitals use something called a “chargemaster” to set their prices. Because insurance companies only reimburse a portion of the chargemaster price, the original bills are “super jacked up.”

“Our electronic health records are not designed for patient care at all—they are designed to be cash registers so the hospital can effectively bill for every little widget,” Damania says.

Everything down to the tube of vaseline the hospital allegedly gave Madison for chapped lips will be charged, he says. To give you an idea of the markup, Damania has seen a packet of Neosporin (available at any convenience store) priced at $37.

Even as a healthcare worker himself, Damania was a victim of the chargemaster:

“I once bonked my head while rock climbing and hit the local ER in Vegas for three small stitches and a tetanus shot. It cost me nearly $4000. $450 for the tetanus shot alone, which we give in my clinic for free. If I would have known up front what it cost, I would have stitched my own damn head up! Rambo-style.”

A big portion of Madison’s bill will likely be due to recombinant Factor VIII. Madison must continue to take the drug, even after his hospital stay.

Now employed, Madison is currently insured. Madison says the cost of the medication is around $200,000 a year, paid for by his insurance. However, he mentions that his copay and deductible are so high, he can barely afford his medical treatment—even with insurance.

How can you fight the bill?

As Damania explains:

“CoPatient [is a company] whose sole purpose is to review your medical bill for errors or overcharges and then go fight on your behalf to get it reduced. “NEVER pay that original bill until you’ve done some kind of careful review or negotiation. Nine out of 10 times you DON’T have to pay the full price.”

A corrupt healthcare system

It’s no secret that the US healthcare system enriches a lot of people at the expense of our most vulnerable. But it’s hard to pinpoint who is at fault for the way things have become. Is it the insurance companies? The hospitals? The pharmaceutical companies? Whatever the reason, one thing is for sure: A change is necessary.

Big Pharma and Big Risk: How the healthcare industry became a hazard to our health. https://t.co/g8ncxOjI7W pic.twitter.com/LJG8BLiOmN — David Healy (@DrDavidHealy) November 16, 2015

“There is NO price transparency in healthcare in the US. We call it a free market, but it’s the farthest thing from. Medical bills are the #1 reason for personal bankruptcy in the US,” explains Damania. “Eliminating fee-for-service gets rid of itemized lists, and bills one fee for an episode of care. We as patients and doctors need to rise up and say, ‘Enough!'”

As for Madison, since we last spoke with him, he is still awaiting his final bill. He’s contacted an attorney in the meantime to assist him in any possible negotiations.

“[The US healthcare system] is corrupt as fuck,” Madison says. “It’s a basic human right to have healthcare in a civilized society, that is, and the fact that it’s there for the sake of profit makes me sick.”