this is "nightline." >> tonight, medical pains. staggering bills adding insult to injury. >> i was like, wait a minute. did you just say that i owe $71,000? >> facing financial ruin from one accident, and he's a doctor. millions of americans at risk. now overdue help for out-of-control bills. plus putting the wow in bow wow. inside the world of creative competitive dog grooming. turning heads and tails. pooches pampered and puffed while groomers fight rumors. >> some people think we tranquilize her to lay on the table so calmly like she does.

>> doggy style gone wild. but first the "nightline 5." >> number one in just 60

good evening. thank you for joining us. it's a punchline to a classic doctor joke. if you think you're hurting now, wait till you get my bill. but it's no laughing matter.

surprising, outrageous medical bills are skyrocketing, putting millions of americans at risk of financial ruin. abc's mary bruce tonight on possible solutions that are long overdue. >> i owe $71,000? >> reporter: $70,000 for emergency surgery after a bike accident. >> we double-checked our insurance, made sure that we would be okay. >> reporter: $50,000 for a 24-hour stay in the nicu. >> how are we going to pay this bill? >> reporter: these ar small example of surprise medical bills patients never saw coming. >> growing problem with medical debt impacting thousands. >> sticker shock after a trip to the emergency room -- >> reporter: while the debate over health care in america has focused on the uninsured, those who have insurance also face a broken system. 1 in 6 insured americans have been hit with a surprise medical bill. in fact, more than two-thirds of all bankruptcies were tied to medical issues and bills. >> these are people who are doing everything right.

>> reporter: elizabeth rosenthal is editor-in-chief for kaiser health news which investigates medical bills. >> they're insured yet stuck paying bills in the thousands if not tens of thousands and sometimes hundreds of thousands of dollars. >> reporter: not even doctors are immune to surprise medical bills. >> you do have two chipped teeth. >> reporter: dr. brad buckingham. the 35-year-old has his own dental practice in austin, texas. outside the office, he's an avid cyclist. >> i was riding around 100 to 200 miles aweek for awhile there. >> reporter: $years ago he set out for a bike ride with friends but did not go as planned. >> i came across train tracks. since it was misty out, the rails were wet. as i went across my wheels came out from independent me. i knew it was bad. i didn't know what it was. i couldn't make words, just screamed. >> reporter: his friends called an ambulance. when paramedics arrived, they discovered he wasn't paralyzed, but the pain was overwhelming. he remembers handing over his

insurance information in the ambulance. again, once he got to the e.r. >> i had insurance, i figured that would sort itself out. i'm not thinking about anything but what happened to me and how is it going to get fixed, how bad is this? >> reporter: after surgery to put a metal rod in his thigh and two days in the hospital, buckingham received a second painful blow. >> then it was like in passing at the end, by the way, you've been out of network this entire time. >> reporter: as a medical professional, buckingham considers himself knowledgeable about insurance. since he was fairly young and healthy, he had a high deductible. that meant if he stayed in network, his out-of-pocket expenses would be $5,000. out of network, $10,000. but buckingham says when the hospital bill finally arrived, he was shocked. >> the first bill came through for $70,000. and i remember i just blew it off like, oh, they didn't get my insurance information. >> reporter: $70,000, seven times his plan's out of network maximum. when buckingham called his

insurance company, they said the bill was correct. he says he kept pressing but never got a real explanation. >> i was like, wait a minute, did you just say in the same breath that i had a $10,000 out-of-pocket maximum? and that i owe $71,000? >> we will never take corporate pac money -- >> reporter: it can even happen to the people making our coun y country's laws. democratic congresswoman katie porter's appendix burst. >> i didn't call an ambulance because i knew it can cost a lot -- >> hold on a second, you feel terrible, you don't call an ambulance because you know it may cost you money? >> ambulances are one of the things that get surprise billed. i specifically had my manager drive me not to the closest hospital, but to the in-network hospital. >> reporter: even though the hospital was in-network, the surgeon who helped save her life was not, she got a bill for nearly $3,000. >> as a patient they expected

you to be able to ask, before you save my life, are you in my network? >> exactly. he wouldn't have known had i asked him, because there are hundreds and hundreds if not thousands of insurance plans out there. he's not going to know that, he's there to make sure i don't die of infection. >> how does that make you feel? >> angry. >> reporter: nearly 80% of americans want legislation to protect patients from these surprise bills. it's one issue with broad agreement from doctors' offices to hospitals, from halls of congress to the white house. >> they should be given a clear and honest bill, up front. >> reporter: republican senator bill cassidy is a doctor, and his family has also been hit. >> what we're trying to do here is pull the patient out of the middle. if the doctors and the hospitals and the insurance companies want to go at each other, they can. >> reporter: cassidy authored one of several bipartisan bills now making their way through congress. but over the summer, ads began running that criticized some of the legislation. >> imagine if the care we needed wasn't there when we needed it

most. >> how challenging to come up with a solution that satisfies the insurers, doctors, providers? >> they're not going to be satisfied because somebody's going to make less money. >> reporter: republican senator lamar alexander is pushing a bill to lower out-of-pocket costs. he had hoped it would pass by the end of 2019, but it's still waiting to be debated. >> i think we will get it done. i think there's a surge of cooperation because people, senatorses know people want their out-of-pocket health care costs down. we have should ways to do it. >> we need congress to be the parent in the room here and say to the insurance companies, to the hospitals, to the she was p service providers, stop. >> reporter: but she's skeptical, with a surprise bill that ruined her family's finances. 2003, she faced a $50,000 bill after her newborn spent 24 hours in nicu. >> ultimately the bill got resolved, but just by

happenstance. there was a third-party lawsuit that we were absorbed into. and the bill was finally absolved. >> my husband and i felt we should not be held responsible. >> reporter: ever since, she's been pushing for reform. even testifying before congress. meanwhile, accidents and diseases wait for no one. rosenthal has some advice. >> the first thing i tell people is, don't write the check. you do have some options here. everyone should know if their state has a law about surprise billing. if it does, youshould invoke it. when people are surprised and it's uncomfortable in health care, you can negotiate. a lot of these providers know that the fees are crazy high. and if you come in and say, hey, i know the bill was $30,000, i'll give you $5,000, no questions asked, they'll often say okay. >> reporter: for cyclist brad buckingham, facing that $70,000 bill, he had to hire a lawyer to get his bill drastically reduced to just a couple thousand. >> if i knew a cyclist that broke his hip today, called me and said, who do i talk to in

the same situation? i'd have to say, a lawyer. i hopefy tell my story and tell it loud enough, that there's going to be change where this isn't an issue anymore. >> our thanks to mary. up next, put your best paws up. because these contenders ain't fluffing around. ♪ oh, oh, oh, ozempic®! ♪ (announcer) once-weekly ozempic® is helping many people with type 2 diabetes like james lower their blood sugar. a majority of adults who took ozempic® reached an a1c under 7 and maintained it. here's your a1c. oh! my a1c is under 7! (announcer) and you may lose weight. adults who took ozempic® lost on average up to 12 pounds. i lost almost 12 pounds! oh! (announcer) ozempic® does not increase the risk of major cardiovascular events like heart attack, stroke, or death. there's no increased risk. oh! and i only have to take it once a week. oh!

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♪ and now to a tail that's wagging the dog. we are talking about creative,

competitive dog grooming where the hair, the dyes, the design are center stage with some crazy results. here's "nightline's" ashen singh. >> reporter: we're in vegas at one of the biggest dog grooming competitions in the country. but these poodles aren't just here to get primped and pampered. they're works of art with vibrant colors, creative cuts, and elaborate themes. designs so flamboyant, so extravagant, that these pups have heads turning pretty much everywhere they go. >> creative grooming is pretty synonymous with extremely intricate motifs that are scissored and cut into the dogs. >> reporter: this is the world of competitive, creative dog grooming. a quirky, colorful, and controversial industry that has groomers and their pups taking the stage and competing like never before. >> it's an artistic expression. there's minimal creative

grooming like just coloring ears and tails. goes all the way up in range where you almost can't tell it's a dog anymore. >> reporter: cat is a legend in the industry with over 20 years of experience. >> i've been on jimmy kimmel, the cover of "groomer to groomer" magazine, taught creative classes. >> reporter: today at super zoo she's going up against the top creative groomers in the world, for the top spot and cash prize of $2,500. alisa and her poodle ditto are the new kids on the block. >> i haven't been able to be in a division with cat. i love to push myself and go up against those really amazing women because i know that they're the best. >> reporter: only three years into her creative career, she's been waiting eagerly for a shot to try her shears against a grooming heavyweight like cat. >> i've done really well this year. i'm very grateful. we have gotten a lot of good critiques and we just go to the next show and better ourselves.

>> reporter: for these two it's a passion. for the rest of the world a spectacle. >> it's the super bowl of creative grooming. >> reporter: even the center of a full dog "well groomed" streaming on hbo. the public's reactions to these creations are visceral, and it's not without controversy. >> we do get some backlash, especially online, that people think that i'm using my dog for followers or content. >> reporter: at home in elgin, illinois, alisa is a full-time groomer. >> first client today is a shanoodle named helga. i became a groomer about 10 years ago. had art in my life, so it was just another art form to jump into. >> reporter: working out of a mobile grooming van, she says more and more people around town are taking notice of her craft. >> little by little i've been kind of converting some people to be like, oh, yeah, let's see.

it started out with a tail, now we're on to ears. >> reporter: today she's adding a splash of purple to this pup. >> see? you're good. >> reporter: her standard fare is still a traditional groom, but alisa's hoping to do more. >> i do have a lot of clients who know about ditto, who knows what we do because it sparks curiosity. i do get a little of it bought i wish it was more. >> reporter: her real passion is getting ditto's coat contest ready. she works on perfecting a single design throughout the year. ditto's current theme? beetlejuice. >> this one has been probably racking around the 20 some hour line. we do increments. >> you do a different design for each competition? >> luckily you can go through the whole year and do the same design and better yourself and find ways to make it what you want in the end. but you can't go to the same grooming competition the following year with the same design. >> reporter: with the process dependant on her dog's hair

growth, alisa has to plan out her designs far in advance. what is the creative process like? >> i usually either take a picture of my dog and draw on the side on my tablet, oh, i really like this movie, it's got really cool-looking characters, i wonder what it would look like on a dog. i like to carve and color a little bit so my eye can still see the shape. you do it in two-hour increments, whatever the dog will allow. she sleeps through all the coloring. some people think we tranquilize her to lay on the table so calmly like she does. i mean, she's just trained and used to this, so she's just a calm dog. >> for someone who's never seen a dog like ditto before, is creative grooming humane? >> oh, yeah, yeah. everything is nontoxic that i use. they're all vegetable based. they're all safe. ♪ you need to calm down >> reporter: she's even taken to tik tok to prove the point. >> people didn't like the fact that ditto looked different. so people took it the wrong way. they reported it. >> how do you respond to that

criticism when you do hear it? >> i try to not let it get the best of me. i would rather educate someone in a nicer fashion, because why fight fire with fire? >> through all the backlash, is it worth it? >> oh, yeah. in the end it kind of just matters between me and her than what someone thinks on the internet. >> if you have one message for people who are critical of the creative grooming industry, what would you say to them? >> it boosts is confidence of a dog. even to the point where some of them will ask for it. i want people to open their eyes to it. because, you know -- it has such a positive, amazing thing to it that i wish the world could see. >> reporter: alisa and her fellow groomers are no stranger to controversy. >> if you can laugh at yourself, then you'll be a little bit less offended when other people laugh. >> everybody has a right to express theirself. like if you want to go to a nudist beach, i'm not going to

go to the nudist beach with you, but i'm not going to judge you for it. >> it's one more way owners can express their own personality through their pet. >> reporter: when it comes to super zoo, it's all about making sure their creative partners are ready for the competition stage. >> if that dog moves one step, that groomer's control of those tools is the only ing that stands between disaster and a masterpiece. it's showtime. >> reporter: their owners give presentations on their designs. >> this is zealand. she as 5-year-old standard poodle. >> we have beetlejuice and lydia during the wedding scene. >> reporter: it's time for the judges to critique. >> on this side we have the wife, barbara. >> looks really nice. >> hello, darling, hi. >> we are judging color definition, the scissoring technique, how smooth the work is, if the work is very recognizable. >> thank you so much. >> thank you. >> reporter: after much discussion -- >> the first place winner,

sandra whiteness from yucca valley, california, and nevada. >> so we didn't place but i think it was very popular with the crowd. >> reporter: while cat didn't place this time -- >> third place, alisa kasiba. >> reporter: it was alisa who got to go home with some hardware. >> i thought her beetlejuice looked great. >> we placed third at super zoo. >> were you happy with the result? >> it was such an honor to be in the top three. >> you want to come say hi? >> reporter: wide eyed and thrilled after a third place finish? it's still business as usual back in illinois. >> so adorable. >> reporter: when the pups are not on stage, they're just like any other dog. >> what do these guys like to do? >> ditto's favorite thing is to play ball. she loves catch. >> what do you guys think? have you ever seen dogs that look like this before? >> no. >> first time. >> reporter: for "nightline," i'm ashan singh in elgin, illinois.

and next, celebrating one of our own. the incomparable robin roberts. ...she was worried we wouldn't be able to keep up. course we can. what couldn't keep up was our bargain detergent. turns out it's mostly water, and water doesn't get out all the stains. so, we switched back to tide. one wash, stains are gone. kind of like our quiet time. [slurping] what are you doing? don't pay for water. tide gives you three times the active cleaning ingredients. if it's got to be clean, it's got to be tide. (whistling)

♪ ♪girls on the floor gotta thirty point lead and a minute left♪ ♪queens on the team in real life not just on the internet♪ ♪all strength, we ain't stoppin' believe me♪ ♪go straight till the morning look like we♪ ♪won't wait, we're taking everything we wanted we can do it♪ ♪all strength, no sweat ♪all strength, no sweat

about finding good food ind have school.y so, when my wife kat and i learned california public school children couldn't get fresh produce in the cafeteria, we took action. we partnered with local farmers, school kitchens, a non-profit. that program now serves over 300 million

healthy meals every year. the difference between words and actions matters. that's a lesson washington dc could use, right now. i'm tom steyer and i approve this message. and finally tonight, our

north star here at abc news. our robin roberts celebrating 30 years today with the walt disney company. kicking off hare career here as a sports reporter for espn, celebrating today's milestone with former "gma" coanchors diane sawyer, charles gibson, a few special friends. >> robin, congratulations on 30 extraordinary years. let's have 30 more. >> you have always been a light and you've always been an inspiration. >> 30 years? you don't even look like you're 30. >> and trust me, she is a big star with a bigger soul. a disney legend. congratulations, robin. that's "nightline." you can catch our full episodes on hulu. thanks for the company, america. good night.

conditions are protected. vo: a broken promise. trump repeatedly tried to undermine coverage for 134 million americans with pre-existing conditions. mike: "he just doesn't care if you have a pre-existing condition he wants to deny you access to coverage. if he is re-elected, he'll keep trying to do that and i think we can't let that happen." vo: as president, mike will lower costs, and protect americans with pre-existing conditions. mike: i'm mike bloomberg and i approve this message.