January 06, 2016

New Kaiser Family Foundation Survey Finds Many Consumers Hit with Surprise Medical Bills

Jan 6, 2016: From Kaiser Family Foundation -> Private Insurance -> Surprise Medical Bills: http://kff.org/private-insurance/issue-brief/surprise-medical-bills/


"A Kaiser Family Foundation survey finds that among insured, non-elderly adults struggling with medical bill problems, charges from out-of-network providers were a contributing factor about one-third of the time.  Further, nearly 7 in 10 of individuals with unaffordable out-of-network medical bills did not know the health care provider was not in their plan’s network at the time they received care."


Consumers may face surprise medical bills when they provided care from providers outside their network and this often happens without their knowledge.  For example, in an emergency, an individual may not have a choice in selecting the hospital, treating physicians, or ambulance providers. In a non-emergencies, surprise bills may also happen when an individual receives care from an in-network provider and out-of-network providers who are called in to also provide care, such as radiologists, surgical assistants, and others.

As a result, patients may be responsible for both higher out-of-network costs and the difference between the allowed charge and the full charge from out-of-network providers (balance billing).

"Surprise medical bills can contribute significantly to financial burden and medical debt among insured individuals, though data on the incidence and impact of this problem are limited. . . Policy makers have considered and adopted various responses, yet tradeoffs are involved in protecting consumers from surprise bills. There is concern among some as to whether or how new consumer protections might affect insurance premiums.