An excruciating pain jolted Zander Brandt awake at 1 a.m. on Nov. 1. He tossed and turned, unable to sleep, and when his wife touched the painful spot on his midsection, he vomited.

“She was like, ‘OK, that’s not a good sign,’” he recalled. “Let’s go to the emergency room.”

The couple rent an apartment on the edge of the Mission, just blocks from San Francisco General Hospital. Brandt, a 31-year-old project manager at a financial technology company, had heard horror stories of short ambulance rides costing patients thousands of dollars. So instead the couple walked, slowly and gingerly, to the city’s lone trauma center. But what they thought was a frugal course of action turned out to be just the opposite.

Brandt left the hospital two days later with the pain — and his appendix — gone. But despite having health insurance through his employer, he now personally owes the hospital $92,470.

Now that’s excruciating.

Though it’s too late to help Brandt, Mayor London Breed, the Department of Public Health and the hospital have just agreed to halt the practice of “balance billing” — sending patients bills if their private insurance companies don’t pay the full requested amount — immediately but temporarily. Last year, that practice stuck 300 patients — Brandt included — with unexpectedly big bills.

The 90-day respite from balance billing is intended to give the hospital time to come up with a long-term plan to treat privately insured patients more fairly.

“Although balance billing affects a very small number of (S.F. General) patients, the stress and hardship they experience when it happens is very real,” Breed said in a statement. “In an emergency, people’s focus should be on getting help quickly, not on what hospital they should go to.”

As it comes up with a plan, the hospital has begun pursuing contracts with private insurance companies, though CEO Susan Ehrlich wouldn’t say which ones or how many. She said S.F. General will also do a better job informing patients they may qualify for financial assistance, look at expanding the income requirements to qualify for charity care, set an out-of-pocket maximum for patients, and study how other Bay Area hospitals handle their billing.

That’s all great news, but there’s one big caveat. The halt isn’t retroactive — and Brandt still owes $92,470.

And hundreds of other patients stressed out over their shockingly high bills are still on the hook, too, stuck in endless Dilbert-like phone exchanges with hospital billing agents and sent after 90 days to collections at the city treasurer’s office.

“The retroactive part of it is what we need to study,” Ehrlich said in her hospital office. “Anybody who was subject to these policies previously, that’s something we have to work with our city partners and city policy makers on. All that was done under policies that were in place at the time.”

But if it’s agreed now that those policies are broken, they were broken last year, too. All privately insured patients who have outstanding bills at S.F. General should have them forgiven.

Ehrlich said it’s too soon to say whether that will happen, because hospital officials have a duty not only to provide excellent medical care, but to be good financial stewards. She said the hospital’s roughly $1 billion annual budget comes half from Medi-Cal, a quarter from Medicare and the rest from the city, private insurance companies, patient bills and other sources. She said she doesn’t yet know how much forgiving those outstanding bills would cost or where the money would come from.

“We view ourself as a very special resource for the city and all of the people who live here,” Ehrlich said. “We want to make sure we do a better job in the future of taking care of people’s financial health as well as their physical health.”

A Board of Supervisors committee hearing on the billing situation has been set for Feb. 21. Supervisor Aaron Peskin, who called for the hearing, said patients like Brandt should “absolutely” see their bills cleared and that the hearing will include a discussion of whether to make the new prohibition on balance billing retroactive.

“These people should be made whole,” he said.

At issue is the fact that S.F. General has no contracts with private insurance companies, which was first reported by Vox. That means the hospital charges all privately insured patients the full rack rates approved each year by the mayor and Board of Supervisors.

In its forms, the hospital states that it bills patients’ private insurance companies “as a courtesy.” But because there are no contracts with those companies, they can pretty much decide to pay whatever they want. The problem is the hospital sticks the patient with the rest, which can amount to tens of thousands of dollars for everyday ailments like appendicitis, broken bones and migraines.

California law inexplicably bans balance billing for patients insured through health maintenance organizations, but not for those insured through other forms of insurance, including preferred provider organizations. It’s privately insured patients who aren’t on HMO plans who are facing the big bills from S.F. General.

Brandt is insured through Aetna on a exclusive provider organization plan, which offers a local network of doctors and hospitals but pays nothing toward out-of-network care. True emergencies must be covered by exclusive provider plans if treated out of network, but there’s a dispute over Brandt’s bill because he was moved to in-patient care and waited more than 36 hours for surgery, as new patients with gunshot wounds and other traumas kept taking priority.

“They told me about an hour before I was going into surgery that S.F. General is out of network for every provider and because I have an EPO, I wouldn’t be covered for anything,” he said. “I was like, ‘Are you kidding me?’ I said, ‘OK then, I’m going home.’ They said, ‘Well, we wouldn’t recommend that. We just want to let you know that we charge an average of $20,000 to $30,000 a night.’”

He said hospital officials called around, but no other emergency room in the city had space for him. So he proceeded with the appendectomy at S.F. General on the afternoon of Nov. 2 and was discharged Nov. 3. Several weeks later, he received a bill for $97,000. Aetna has paid a few thousand, but Brandt still owes $92,470.

“It was a shock,” Brandt said of the bill. “We’ve been trying to save up to buy a house here in the Bay Area, which obviously is extraordinarily difficult, and this would all but end that.”

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He saved two voice mails from the hospital shortly after being discharged, one reminding him of his follow-up appointment and one recommending he not show up for it because it would cost him so much more money.

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Told there’s now a temporary halt on balance billing — but that he’s still on the hook for $92,470 — Brandt said that’s “pretty outrageous.”

“It’s pretty unfair they’re able to take in the money from me, but not someone who’s getting an appendectomy tomorrow,” he said. “It seems like a no-brainer that this should be applied unilaterally to anyone with pending bills.”

It’s a no-brainer indeed — and here’s hoping City Hall and the hospital will see it that way. Eventually.

San Francisco Chronicle columnist Heather Knight appears Sundays and Tuesdays. Email: hknight@sfchronicle.com Twitter: @hknightsf