What gets my goat on ER visits is it wasn't just one combined statement. Instead, it was:
1) one statement on the actual ER charges
2) separate statement from the ER doctors, who are apparently contract MDs
That's based one ER visit for me and one (non-VA ER) for DH in the last 5 years.
On the one that was mine, the outside companies contracted to handle the statements and claims seemed to have very little info given them by the ER/hospital, took a LONG time to send in any claims at all and couldn't seem to figure out how to submit a claim on the secondary policy, even after I gave them all the info that the ER had supposedly not given them. Then they kept sending me statements with balances due, when the secondary claim hadn't been sent in or they hadn't waited for the other insurance to get back to them. I finally got tired of making calls and would just send the statement back to them with a copy of all my coverage info, and a note that I wasn't paying anything until I knew if I owed anything, according to my secondary insurance. It was finally resolved, but an unpleasant experience.
I'm not too surprised about the amount on yours. It's very expensive now! My daughter is a doctor and is often called in on cases in the ER and is in charge of an ICU unit..not to mention all the regular hospital patients she treats (who are not in the ER or ICU's). I can't help but think that asking for an estimate is routine on so many things, but not often done on ERs and hospital visits.