WASHINGTON (October 22, 2020) - Surprise medical billing is a concern for more than 60% of respondents to a National Association of Insurance Commissioners (NAIC) Center for Insurance Policy Research (CIPR) survey. According to the survey, a majority of consumers are afraid that they or a family member will receive a bill for health care services that they did not expect. State insurance regulators stand ready to assist consumers who receive such bills.
Surprise billing can occur when people use health care services outside of their health plan’s network. This can happen without the consumer realizing it. Out-of-network care can sometimes result in expensive charges consumers don’t anticipate. Overall, 39% of consumers say they’ve been surprised by a bill after getting care in an emergency room, hospital or clinic, and 46% say those bills were greater than $1,000.
There are several things consumers can do in advance of non-emergency care, including talking with hospitals or clinics to learn about their in-network provider options and contacting their insurance carriers to understand what will be covered. Unfortunately, surprise billing can also happen when consumers make emergency room visits. An in-network hospital’s emergency department may be staffed by doctors who aren’t in-network, and transport services can also be a big factor in surprise bills. The NAIC offers more information on this subject in a Consumer Insight on balance billing.
Taking Action After a Surprise Bill
Proactive communication with providers and insurance carriers is one of the tools consumers can use when they receive a surprise bill. According to the NAIC survey, respondents said they’d take specific actions if they received a surprise bill in the next six months. Overall, 49% of survey respondents said they would negotiate with their health care providers, 47% would work with their insurance companies to pay the bill, and 21% would ask an advocate for help.
Some states have passed legislation to help protect consumers from surprise medical bills, and all states have staff who can answer consumer questions. It is important to contact your state’s department of insurance (DOI) to see what assistance it can provide. Consumers can also contact their insurance and health care providers to see if they can negotiate a lower rate.
More than 2,007 consumers were surveyed online from July 8–10, 2020.