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Survey Sheds Light on Frequency of Surprise Medical Bills in America


NORC at the University of Chicago set out to understand more Americans’ experiences with surprise billing. You won’t believe what they found.



Americans are afraid they will not be able to afford unexpected medical bills, with four in 10 people saying they had received a surprisingly large invoice within the past year, according to a Kaiser Family Foundation poll. The poll found that 67% of people worry about unexpected medical bills more than they dread insurance deductibles, prescription drug costs, or basic living expenses such as rent, food, and gas.

NORC at the University of Chicago, an independent, non-partisan research institution, wanted to understand more about Americans’ experiences with surprise billing. It conducted a survey which included 1,002 interviews with a nationally representative sample of Americans using the AmeriSpeakPanel. AmeriSpeak is NORC’s probability-based panel designed to be representative of the U.S. household population. Interviews for this survey were conducted between August 16 and August 20, 2018, with adults age 18 and older representing the 50 states and the District of Columbia.

The survey found that 57% of American adults have been surprised by a medical bill that they thought would have been covered by insurance. Respondents indicated that 20% of their surprise bills were a result of a doctor not being part of the network.

Related: Two Things to Know About the Patient as the New Healthcare Payer

Who’s to blame?

Among survey respondents who indicated that they had been surprised by medical bills in the past, the charges were most often for physician services (53%) followed closely by laboratory tests (51%). Other common sources of surprise bills were hospitals or other healthcare facility charges (43%), imaging (35%), and prescription drugs (29%).

When asked which groups are most responsible for surprise medical bills, 86% of respondents said insurance companies are “very” or “somewhat” responsible, while 82% said hospitals were “very” or “somewhat” responsible. Respondents were less likely to hold their doctors responsible, with 71% saying doctors are “very” or “somewhat” responsible for surprise bills.

“That means there is reputational risk for both insurers and healthcare providers when consumers receive surprise bills,” says Caroline Pearson, senior fellow at NORC at the University of Chicago. “Both parties have a role to play in finding a solution to reduce the frequency of these surprises for patients. It is interesting that while consumers report that physician services are the most common source of their surprise bills, they are most likely to blame insurers for those bills.”

Related: Most Confusing Aspect of Health Insurance to Consumers

Top takeaways

Based on the survey, Pearson offers three takeaways for healthcare executives:

  • Most Americans have received a medical bill that they thought would be covered by insurance.
  • Surprise medical bills happen for many reasons, including providers being out of network, services not being covered by insurance, or consumers not understanding their deductible and cost-sharing requirements.
  • Consumers have difficulty understanding their insurance and hold both insurers and healthcare providers accountable for surprise bills.
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