Studies Show Increase in Surprise Medical Bills

Findings from 2016 data recently released by the American Medical Association show that 4 in 10 patients with private in-network insurance at hospitals faced surprise medical bills after their visit.

How do surprise medical bills occur? Most often it is from visiting a hospital or ER the patient’s private insurance is in network with, however the doctors that treat them are out of network with the patient’s private insurance. Thus the bill gets forwarded to the patient, at full charges.

In 2016, the report found, 42.8 percent of ER visits resulted in surprise bills for patients, a 10 percent increase since 2010. Additionally 42 percent of inpatient admissions also received surprise medical bills, which is a 16 percent increase from 2010.

The largest source for surprise bills comes from ambulance services. Around 86 percent of patients were hit with surprise medical bills after an ambulance ride to an emergency room, roughly $244 on average. There is legislation under consideration to try to reduce surprise medical bills, but congress has trouble tackling ambulance services since they are usually run by local or municipal governments.

The average bills have dramatically increased in dollar amount since 2010 as well. Emergency room bills typically ran $628 in 2016, up from $220 in 2010. Likewise, inpatient admissions bills have been have increased to a whopping $2,040 in 2016, from $804 in 2010.

Some former debt collection agency executives are forming a non-profit to buy and forgive medical debt, but we are a long way away from that making a huge impact. There needs to be a better focus on hospitals to ensure that doctors treating at their hospitals are in network with as many of the insurances they accept as possible. And if the doctor is unwilling, the patient needs to be made aware ahead of time in the event of inpatient stays that portions of their bill will not be covered by their insurance and provided estimates. Unfortunately for emergency room stays, there is less that can be done to forewarn a patient about potential surprises to their medical bills. After all, if the bill just ends up going to collections, the likelihood of it ever being collected reduces. That’s not a win for the patient or the doctor.