Imagine you walk into a hospital for a planned procedure, for example a knee operation to be performed by an orthopedic surgeon. Before you scheduled the surgery, you did your due diligence and confirmed that the surgeon performing the procedure participated in your insurance plan, and that the hospital where you were having the surgery was also in-network.
You know that you will still owe hundreds or perhaps thousands of dollars (depending on the details of your insurance coverage or any deductible you need to meet), but you’re certain the costs are manageable and you’re prepared to pay the final amount.
The surgery goes well, and you begin your recovery. Then, several weeks later, you get a bill for the surgery that’s much, much more than you expected to pay—maybe even ten or twenty times what you expected to pay. How did this happen?
A new paper, Solving Surprise Medical Bills from the Schaeffer Initiative at the Brookings Center on Health Policy, takes a closer look at surprise medical bills in America—and how policymakers can protect patients from them.
You might be shocked to receive the bill, but you wouldn’t be alone. Over the past several years, an increasing number of Americans have been hit with surprise bills for medical care. Surprise medical bills result from providers (physicians, hospitals, out-patient facilities, laboratories, etc.) that patients reasonably assumed would be in-network, but actually are out-of-network, or when patients have no real choice over the network status of their provider.
These bills are sometimes the result of emergency situations. None of us, in an emergency, place a call our insurance company to make sure the ambulance we need or the hospital we’re brought to is in-network. Yet you can still be liable for the astronomical bills that result.
Other times, patients are billed by out-of-network providers, such as an anesthesiologist, even though patients did everything they reasonably could to remain in-network for a planned medical procedure. As a result, patients incur much higher charges, which often exceed what insurance reimburses, sometimes are exorbitant, and can lead to financial distress.
There is bipartisan agreement that this problem exists, is increasing, and needs to be addressed. Important differences exist, however, on how the problem should be solved. Over a dozen states have enacted important protections and federal and state officials have proposed additional remedies, but these efforts are incomplete, and they pursue a variety of different strategies.
Read more: Solving surprise medical bills | Brookings Institution
You know that you will still owe hundreds or perhaps thousands of dollars (depending on the details of your insurance coverage or any deductible you need to meet), but you’re certain the costs are manageable and you’re prepared to pay the final amount.
The surgery goes well, and you begin your recovery. Then, several weeks later, you get a bill for the surgery that’s much, much more than you expected to pay—maybe even ten or twenty times what you expected to pay. How did this happen?
A new paper, Solving Surprise Medical Bills from the Schaeffer Initiative at the Brookings Center on Health Policy, takes a closer look at surprise medical bills in America—and how policymakers can protect patients from them.
You might be shocked to receive the bill, but you wouldn’t be alone. Over the past several years, an increasing number of Americans have been hit with surprise bills for medical care. Surprise medical bills result from providers (physicians, hospitals, out-patient facilities, laboratories, etc.) that patients reasonably assumed would be in-network, but actually are out-of-network, or when patients have no real choice over the network status of their provider.
These bills are sometimes the result of emergency situations. None of us, in an emergency, place a call our insurance company to make sure the ambulance we need or the hospital we’re brought to is in-network. Yet you can still be liable for the astronomical bills that result.
Other times, patients are billed by out-of-network providers, such as an anesthesiologist, even though patients did everything they reasonably could to remain in-network for a planned medical procedure. As a result, patients incur much higher charges, which often exceed what insurance reimburses, sometimes are exorbitant, and can lead to financial distress.
There is bipartisan agreement that this problem exists, is increasing, and needs to be addressed. Important differences exist, however, on how the problem should be solved. Over a dozen states have enacted important protections and federal and state officials have proposed additional remedies, but these efforts are incomplete, and they pursue a variety of different strategies.
Read more: Solving surprise medical bills | Brookings Institution
