5 things to know about surprise medical bills

Surprise medical bills are to blame for one-third of insured Americans facing unaffordable healthcare costs, according to Kaiser Family Foundation and New York Times.

Surprise medical bills may occur in an emergency situation, when the patient has no ability to select emergency rooms, treating physicians or ambulance providers, or during planned care with an in-network provider. In these non-emergency episodes, the in-network facility generally arranges for the supporting treating providers, not the patient. This can lead to out-of-network bills for anesthesiologists, radiologists, pathologists and surgical assistants, unbeknownst to patient at the time of care.

Below are five keynotes from several national surveys on surprise medical bills:

1. Nearly 70 percent of individuals with unaffordable out-of-network medical bills did not know the healthcare provider was not in their plan's network at the time of care, according to the same survey conducted by Kaiser Family Foundation and New York Times

2. In 2011, 8 percent of privately insured individuals used out-of-network care, 40 percent of which involved surprise claims, according to a Health Services Research report.

3. The same Health Services survey found 68 percent of inpatient involuntary contact with out-of-network physicians was related to emergency care.

3. In 2011, the average price of a surprise medical bill was $7,006, of which consumers paid on average $3,778, according to the New York Department of Financial Services.

4. Of surprise medical bill complaints received by New York insurers and HMOs, roughly 90 percent concerned medical bills for non-emergency services, according to the same New York study. Specialty areas most often submitting such bills were anesthesiology, lab services, surgery and radiology.

5. Emergency room physicians often do not participate in the same health plan networks as the hospitals in which they work, according to Texas Department of Insurance. Three of the largest Texas insurers reported between 41 and 68 percent of dollars billed for emergency services at in-network hospitals came from out-of-network physicians. Therefore, many patients taken to in-network hospitals for emergency services unknowingly receive treatment from out-of-network providers.

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