Michigan Association of Health Plans

Causes of Surprise Medical Bills Examined

Receiving a “surprise” medical bill is a common concern regarding health care and with good reason, a report by the Kaiser Family Foundation says.

The foundation—not affiliated with the Kaiser medical provider—said that in a survey of concerns about medical costs, 67 percent said they are very or somewhat concerned about being hit with an unexpected bill, compared with just 53 percent about out of pocket costs. Thirty-nine percent said they received an unexpected medical bill in the past 12 months, including one in ten who said that bill was from an out-of-network provider. In 13 percent of those cases, the bill was for $2,000 or more.

It said that 18 percent of emergency visits result in at least one-out-of-network charge, noting that “in an emergency setting, patients are often unable to ensure they go to an in-network emergency room . . . As a result, patients can and do receive surprise bills for emergency care from the emergency room facility and from providers who treat the patient in the ER.”

“Surprise medical bills might also arise from the hospital and/or other treating providers if the emergency patient is subsequently admitted for inpatient care,” it added. Where there is a subsequent in-patient admission, 26 percent experience an out-of-network charge compared with 17 percent treated only in the ER and then discharged.

Similarly, on average 16 percent of in-patient stays result in such bills. “Even within an in-network facility, out-of-network charges for professional services can occur. That is because the doctors who work in hospitals often do not work for the hospitals; rather they bill patients separately and may not participate in the same health plan networks that cover the in-network facility,” it said.