- One in five hospital inpatients admitted through the emergency room end up with “surprise “medical bills — ones that were unforeseen by the patient, according to a new study published in Health Affairs.
- Using national medical claims data, the study also found surprise medical bills in 14% of outpatient ER visits and 9% of elective inpatient admissions.
- Patients with more severe diagnoses were more likely to get surprise bills.
A surprise medical bill is an unanticipated bill from an out-of-network provider or one from an out-of-network provider the patient didn’t choose.
There was no one source of surprise medical bills in the study. The researchers note, for example, that out-of-network anesthesiologists wee used in 17% of elective inpatient admissions where surprise medical bills were found, while 12% involved an out-of-network pathologist.
There was also wide variation in the occurrence of surprise medical bills across the U.S., with states that have enacted laws to protect patients against surprise medical bills having among the worst rates, the researchers say. New York, New Jersey, Florida and Texas — states with legal protections against surprise medical bills — all had rates between 40% and 50%, as did Alaska. Just seven states had less than 10% cases with surprise medical bills: Vermont, South Carolina, Wisconsin, Iowa, Minnesota, North Dakota and Washington.
Earlier this year, HHS released a final rule aimed at reducing surprise medical bills. The rule provides for a portion of an out-of-network providers fees to count toward the patient’s annual cost-sharing requirements when the service is provided at an in-network facility.