How Health Execs Can Prevent Surprise Billing

August 27, 2019

Why price transparency is a top consumer demand.

Healthcare executives need to better understand what drives surprise billing and how to prevent it, since it leads to consumer frustration and dissatisfaction, according to a new survey. 

eHealth’s survey of more than 800 consumers provides insights into how few consumers get an estimate of costs for medical care up front, and how even those who do get estimates often end up with a higher bill than originally estimated. The survey sought to dig deeper into the consumer experience to illustrate some of the factors that contribute to surprise billing.

“It’s hard for consumers to make informed medical care decisions for themselves and their families when they don’t know what they’re going to have to pay for care,” says Lisa Zamosky, senior director, consumer affairs at eHealth, a private online health insurance exchange. “Our survey findings suggest that medical care providers may want to proactively offer consumers an up-front estimate of their final, post-insurance costs, and to make sure these estimates are as accurate as possible.”

Related: Survey Sheds Light On Frequency Of Surprise Medical Bills In America

Key highlights from the report:

  • Most consumers do not get an up-front estimate of costs. A majority (58%) said they are “rarely” or “never” given an up-front estimate of costs before receiving medical care. 

  • Most have to ask for cost estimates. Of those who received estimates, 70% had to ask their medical care provider for the estimate; 30% were offered an estimate without asking.

  • Final costs often exceed estimates that are given. 44% of those given an up-front cost estimate said their final costs exceeded that estimate.
     

  • Medical providers and insurers may help to reduce final costs. Among those not required to pay the full bill, 47% said the medical provider agreed to accept a lower payment; 35% said their insurer helped to negotiate a lower charge. 

When required to contribute toward their annual deductible for medical care, few consumers have the savings to do so. Specifically, the survey found:

  • 36% of respondents say they have paid out a full annual deductible at least once.

  • Unfortunately, 56% say they have $2,000 or less in savings, while the average individual deductible for ACA coverage is $4,320.