In March 2015, Consumers Reports National Research Center surveyed 2,200 U.S. consumers and found that in the past two years about one third of privately insured Americans received a surprise medical bill, meaning their health plan paid less than expected. In this group, nearly one out of four got a bill they did not expect. For journalists, these findings may be worthwhile when writing about how the rising cost of health care affects consumers. The Surprise Medical Bills Survey report (pdf) is available online.
In particular, the survey findings suggest that many consumers are confused about their rights when they decide to fight surprise bills. And they showed that insurers often don’t pay when consumers have payment disputes with their insurance companies over bills from out-of-network providers. These providers often do what’s called ‘balance billing’ of consumers, meaning they bill consumers for whatever amount the insurance company does not pay. These balance billing amounts can be quite high.
The survey showed that only 28 percent of privately insured Americans with billing issues were satisfied with how their issues were resolved. More than half (53 percent) of those who received surprise medical bills reported that the issue was either not resolved at all or not resolved as they would have liked. Among these consumers 57 percent paid the bill in full. Here are some of the significant findings from the survey:
Two-thirds (67 percent) of privately insured Americans who responded to the survey did not know which state entity was responsible for resolving health insurance billing issues.
Most (87 percent) of respondents didn’t know the state agency responsible for addressing health insurance complaints.
Many (72 percent) were unsure if they had a right to appeal to the state or an independent medical expert if their health plan refused coverage for medical services.
Among respondents, 1 in 7 were surprised to find a doctor, lab, or other health care facility they thought was in-network, was in fact out-of-network.
Many (63 percent) assumed that doctors working at an in-network hospital are in-network doctors. In fact, not all doctors working at in-network hospitals are in the same network.
Most (85 percent) respondents said hospitals should notify patients if a doctor or technician involved in a procedure performed at that hospital is out-of-network.
Consumers Union supports legislation in such states as California and Texas that would strengthen protections against surprise medical bills.