One-fifth of adults have received a surprise medical bill, survey shows

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One in five adults in the U.S. has received an unexpected medical bill this year, even after a federal ban on surprise medical billing, according to a new survey from Morning Consult. 

Implemented under the No Surprises Act, the new federal protections against surprise medical bills went into effect at the dawn of the new year and ban surprise billing in private insurance for most emergency care and many instances of non-emergency care. They also require that uninsured and self-pay patients receive key information, including overviews of anticipated costs and details about their rights.

The protections bar payers from charging privately insured patients the balance when they seek emergency services or receive care that isn't covered at an in-network facility without realizing it.

The Biden Administration has touted these measures, saying they will help promote competition in healthcare and other sectors of the American economy.

Yet many Americans are still in the dark, the new data shows. Adults who received unexpected bills this year were most likely to get them for in-network lab work that was sent to an out-of-network lab for assessment, which is covered under the law, or for testing or procedures not covered by insurance, which isn't. Another one in five were billed after being treated by an out-of-network doctor at an in-network hospital.

Sometimes those charges were hefty: 22% of adults who got unexpected bills were on the hook for over $1,000.

WHAT'S THE IMPACT?

Many patients are skipping medical care due to fear of surprise bills. About 25% of adults say they've hesitated to seek medical care or have skipped it altogether due to these fears.

Americans aren't equally suspicious of all provider types, though: 45% of adults said they are confident they would know their emergency room bill up-front, for example, compared with 71% who said as much about primary care treatment.

Meanwhile, 63% of adults – including 61% of those who have gotten unexpected bills in the past – said they would be confident that they could address a surprise bill that they believed to be illegal with a provider or insurer.

In an open-ended question, adults who were less sure about their abilities to resolve a surprise bill cited distrust of healthcare companies and confusion around the surprise billing law.

Providers and payers "hold the cards, we do not," said one respondent, while another said they "feel even if I were to contact them about the issue they would use stall tactics until I give up and just pay the bill."

"I would have no clue where to go to seek advice or help with my bill," another wrote.

THE LARGER TREND

A survey by AHIP and the Blue Cross Blue Shield Association shows that the No Surprises Act, which was passed with the intent of preventing surprise medical bills, has lived up to that goal by preventing more than 2 million surprise medical bills across all commercially insured patients.

The analysis also found that, if the trend continues, more than 12 million surprise bills will be avoided in 2022.

Voters have also expressed support for protections against surprise medical bills. A separate poll conducted by Morning Consult on behalf of the Coalition Against Surprise Medical Billing found 79% of voters are concerned that lawsuits from physician and hospital organizations could delay or overturn the patient protections included in the NSA.

When the patient protections in the NSA were still being crafted in the fall of 2021, they received a mixed reaction among players in the industry, with the American Hospital Association calling the interim final rule a "windfall for insurers."

"The rule unfairly favors insurers to the detriment of hospitals and physicians who actually care for patients," the AHA said at the time. "These consumer protections need to be implemented in the right way, and this misses the mark."

While the No Surprises Act has protections that are strongly supported by hospitals and health systems, the interim final rule "has moved away from congressional intent" and floats proposals that Congress had rejected, the AHA said.

Meanwhile, AHIP, which represents insurers, struck a different tone, saying the independent dispute resolution process in the interim final rule should encourage more providers to join health plan networks.

The Blue Cross Blue Shield Association called it a "win for patients" and a step toward a more affordable and equitable health system.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com