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Content warning: this article describes sexual assault. The widely reported allegations in the Cornell case have renewed calls for prevention and accountability — but they also highlight a quieter crisis: after an assault, survivors often shoulder steep, long-lasting costs. Who pays for medical care, lost income and the recovery that follows is increasingly a policy question as much as a moral one.
Immediate medical bills can be surprisingly high
Federal law requires that a rape kit used to collect forensic evidence be available without charge, but many other emergency and follow-up services are billed to patients or their insurers. A KFF analysis of 2016–2018 insurance data found that 83% of women diagnosed with sexual violence still received bills for treatment. A separate study cited by the New England Journal of Medicine put the average emergency-department bill for survivors at about $3,551.
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Online accounts by survivors echo those figures. A TikTok creator known as xo, simone posted that she spent roughly $12,780 on care after an assault. Others report hospital or lab charges in the thousands, even when a forensic kit itself was not billed.
Emergency-room experiences vary widely. In an ideal setting, a survivor would be seen by a SANE (Sexual Assault Nurse Examiner), receive a forensic exam and get immediate medications and follow-up information — all without facing a separate bill. But many hospitals lack SANE coverage and advocates, or they misroute charges through billing departments, leaving survivors with unexpected invoices.
A few real cases, and what they illustrate
Leah, 25, traveled between two hospitals after an assault in rural Oklahoma because the first facility did not have a SANE on staff. Weeks later she received a bill totaling $3,338, mostly for checking into the ER; after her parents’ insurance paid, her responsibility was $451.06. The emotional reaction was visceral: she could not understand why emergency care after being attacked would carry a personal cost.
Shannon, assaulted in Colorado, was seen by a SANE and received emergency contraception and STI prevention medication. Her family later received an itemized bill showing $82.85 for pharmacy charges and $5,821.55 for ER admission; insurance reduced the balance to $3,247.10. Some states reimburse a broader range of post-assault services, but eligibility and the application process differ substantially by jurisdiction.
The hidden, long-term economic fallout
Medical bills are only the start. Survivors frequently face missed work, ongoing mental-health care costs, legal fees and other expenses that ripple outward.
Danielle, now 27, described years of therapy, medication costs and lost academic credit after a college assault and a protracted Title IX process. When repeat incidents later affected her work hosting events, she canceled programming and lost about $6,000 in income.
For others, the economic impact is even less tangible: elite athletic careers interrupted, education delayed, or the inability to hold a job because of post-traumatic symptoms. Researchers at Brandeis’ Institute for Economic and Racial Equity, led by Rebecca Loya, argue that addressing these economic harms directly could speed recovery and mitigate cascading losses.
Barriers to reimbursement and support
Many state victim-compensation programs exist to reimburse survivors for medical and related expenses, but they are often hard to access. Applications typically require documentation, receipts and sometimes a police report — a major barrier because most assaults are never formally reported.
Programs that do exist often operate on a reimbursement model, meaning survivors must front the costs and wait for repayment. That works poorly for people with limited savings. Marnie Shiels, a former attorney adviser at the Department of Justice’s Office on Violence Against Women, has noted that federal rules can be misinterpreted at the state or local level, and if no complaint is filed with the DOJ those violations can go uncorrected.
Funding strains are widening
Support systems for survivors are under pressure. In April 2025 the Department of Justice cut millions in grants that had funded hotlines, crisis advocates and nonprofits that help survivors navigate medical and legal systems. Those reductions have affected programs that supply SANE nurses and local rape-crisis services.
Late the same year, a government shutdown delayed the approval and distribution of grant dollars, marking an unprecedented interruption in the Office on Violence Against Women’s usual funding cycle. Shiels, who retired in 2025 after 24 years working on these issues, says the funding picture has become markedly worse.
The DOJ has also proposed a reorganization that advocates warn could eliminate roles filled by experienced specialists who train and support frontline services. The consequence is not only program cuts but fewer people available to help survivors manage billing disputes, apply for aid and secure the medical care they need.
Community fundraising and nonprofit help fill gaps — imperfectly
Many survivors turn to crowdfunding and local nonprofits to cover immediate needs. Taylor, 41, raised about $10,000 through GoFundMe after an assault; that money paid for moving costs, lease termination fees, replacement furniture, and some medical bills, and it paid for advocacy and legal help to contest wrongful charges.
Still, those donations do not solve everything. Taylor’s campaign did not cover higher childcare costs after relocating, nor did it prevent employers from finding her case in news searches. Nonprofit advocates provided critical services — a hospital advocate, court support and free therapy — but those organizations depend on the grants that are increasingly at risk.
Experts propose two broad fixes: a federal standard that guarantees free, comprehensive medical care for survivors anywhere in the country, and survivor-centered compensation programs that do not require upfront payment, excessive paperwork or a police report. Proponents say such reforms would reduce confusion, expand training for medical staff and make reimbursement systems easier to navigate.
If you or someone you know needs immediate legal support about sexual assault, Take Back the Night’s National Sexual Assault Legal Hotline provides 24/7 access to victim-focused attorneys at 567-SHATTER (567-742-8837).
