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North Korea issued a $2 million bill for the hospital care of comatose American Otto Warmbier, insisting that a U.S. official sign a pledge to pay it before being allowed to fly the University of Virginia student from Pyongyang in 2017.

The presentation of the invoice — not previously disclosed by U.S. or North Korean officials — was extraordinarily brazen even for a regime known for its aggressive tactics.

But the main U.S. envoy sent to retrieve Warmbier signed an agreement to pay the medical bill on instructions passed down from President Trump, according to two people familiar with the situation. They spoke on the condition of anonymity because they were not authorized to discuss the matter publicly.

The bill went to the Treasury Department, where it remained — unpaid — throughout 2017, the people said. However, it is unclear whether the Trump administration later paid the bill, or whether it came up during preparations for Trump’s two summits with Kim Jong Un.

The White House declined to comment. “We do not comment on hostage negotiations, which is why they have been so successful during this administration,” White House press secretary Sarah Sanders wrote in an email.

Trump, as recently as Sept. 30, asserted that his administration paid “nothing” to get American “hostages” out of North Korea.

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“I didn’t realize what a negotiation it was going to be to secure his release,” said Flueckiger, who is medical director of Phoenix Air Group, an aviation company based in Cartersville, Ga., that specializes in medical evacuations.

North Korean officials asked the doctor to write a report about his findings. “It was my impression that if I did not give them a document that I could sign off on, that would cause problems,” Flueckiger said in an interview.

But the American said he did not have to lie in his report. Whatever had happened to put Warmbier into that state, it was “evident” that he had received “really good care” in the hospital, he said. The doctors had done “state-of-the-art resuscitation” to revive Warmbier after he suffered a catastrophic cardiovascular collapse, and it was “remarkable” that he had no bedsores, Flueckiger said.

“Would I have lied to get him out of there? Maybe I would have,” he said. “But I didn’t have to answer that question.”

Yun, however, was faced with a more difficult predicament.

The North Korean officials handed him a bill for $2 million, insisting he sign an agreement to pay it before they would allow him to take Warmbier home, according to the two people familiar with the situation.

Yun called then-Secretary of State Rex Tillerson and told him about the bill. Tillerson called Trump. They instructed their envoy to sign the piece of paper agreeing that the $2 million would be paid, the two people said.