The title of last week’s blog asked the question “Have you ever been hit with a surprise medical bill?” The title of this week’s blog sheds light on the nationwide answer. For, at least, 20 percent of Americans, the reply is “yes”. On The Conversation.com, Duke University law professor, Barak Richman explains just how widespread surprise medical bills have become.

“One recent study reported that as many as 20% of elective surgeries at in-network hospitals produce surprise bills,” he reveals, “The average amounts of those bills far exceed what 40% of patients could pay with their available savings. Another study just reported that average surprise bills rose 81% just from 2014 to 2017.”

1 in 5 Americans get unexpected bills after their elective surgeries.

On MarketWatch.com, Elisabeth Buchwald affirms that one in five Americans who undergo elective surgery receive unexpected out-of-network medical bills. These findings are based on a February 2020 study published in the Journal of the American Medical Association. Six medical professionals from the University of Michigan surveyed nearly 350,000 people to complete the study.

As Buchwald reports, the focus of the study was on “patients who received surprise bills after having one of seven common elective operations ‘by an in-network primary surgeon at an in-network facility,’ between 2012 and 2017. An in-network provider means one that accepts the patient’s health insurance.”

The patients who received surprise medical bills owed $2,011 more than what was expected. That doesn’t include the almost $1,800 average cost they are required to pay their insurers for their elective surgeries. According to the authors of the study, the additional two thousand dollars is charged due to a practice known as “balance billing”.

What is balance billing?

Balance billing “occurs when an insurance plan pays a fraction of the cost an out-of-network health-provider charged,” explains Buchwald, “Patients are then responsible for paying the difference, or the balance, between the charges and what the insurance plan agrees to pay.”

Dr. Karan Chhabra is one of the authors of the study. He urges patients to protect themselves from surprise bills by contacting their insurance companies prior to their surgeries. It’s important to find out if the medical professionals who are treating them – anesthesiologists and assistants, for example – are covered by their insurance plans.

What should a patient do if he/she isn’t fully covered?

Consult with your surgeons ahead of time, advises Dr. Chhabra. It’s best to find out if there is an in-network option. If there isn’t, patients should contact their insurance companies to request written breakdowns of what will be charged out-of-pocket.

Richman argues that surprise bills cause a lot more damage to patients than just financial burdens. They capitalize on their vulnerability, he insists. “Patients need to trust their providers, and that makes them uniquely exposed to exploitative financial practices,” contends Richman, “Unlike nearly every other aspect of the economy, health care prices are overwhelmingly hidden from patients.”

Are you an attorney managing a case involving overbilling?

If so, contact Allegiant Experts to learn about how we may be able to assist you. Call us at 407-217-5831 or email us at info@allegiantexperts.com.