Consumers find success in medical bill disputes

Photo: Jose Luis Pelaez Inc/Getty Images

Most consumers don't negotiate or challenge the medical bills they receive, but if they do challenge a bill, about 78% in a new survey prevailed in getting the disputed charges reduced or removed. AKASA, a developer of AI for healthcare operations, asked more than 2,000 Americans: Have you ever had experience challenging a bill with your physician, hospital, or insurance company?

Sixty-four percent reported never having challenged the validity or accuracy of a medical bill with their physician, hospital or insurance company, and, of all uninsured individuals surveyed, 78% have never challenged a medical bill.

Those with high deductible health plans (HDHPs) (45%) and Medicare Advantage (43%) are more likely to have challenged medical bills than others with different types of health plans.

When comparing responses across different health plans, the findings show those with HDHPs have the highest rates of negotiating their bills. Given the large share that individuals with HDHPs are responsible for paying out of pocket, surveyors were unsurprised by the findings.

WHAT'S THE IMPACT?

Those individuals who said they had challenged a bill with their physician, hospital or insurance company (36%) were also asked: How much time did it take you to resolve that issue?

Twenty-seven percent of respondents said it took one to three months to resolve, 18% said it took three to six months, and 16% said it took more than six months.

"Despite all the negative experiences many patients have with getting surprise bills, we've been conditioned not to question or challenge medical bills we receive," said Amy Raymond, vice president of revenue cycle operations at AKASA. "While providers need to take a close look at their revenue cycle department to prevent those billing mistakes in the first place, we also need to drive awareness among consumers that they can indeed push back on a bill that is simply incorrect."

THE LARGER TREND

A 2022 Morning Consult Survey found that one in five adults in the U.S. had received an unexpected medical bill, even after the federal ban on surprise billing.

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 that 79% of voters are concerned that lawsuits from physician and hospital organizations could delay or overturn the patient protections included in the No Surprises Act.

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."

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

Stesha Selsky and Meg Furukawa will offer more detail during their HIMSS23 session "Building and Validating a Workload Acuity Tool." It is scheduled for Wednesday, April 19, at 11:30 a.m. – 12:30 p.m. CT at the South Building, Level 4, room S404.