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Many Americans billed for care they thought was covered

Written by Diane Archer

A new survey of Americans by Consumer Reports National Research Center reveals that nearly one in three insured Americans (30 percent) are billed for care they thought was covered; they receive bills for services they expected their health plans to pay for. Almost a quarter of them received a doctor’s bill they did not expect. Of those who received these bills, more than a third took no action. And only a small fraction (28 percent) understood their right to appeal these bills and how to do so.

Most of the people who receive these bills are not happy with the way the payment issue is resolved.  Survey results suggest that the majority of Americans pay these bills. Only 28 percent of people surveyed were satisfied with the outcome.

The problem is that even when insured Americans use network hospitals, their health plan does not guarantee that the doctors who provide their care are also in the network.  It’s often hard for a patient to avoid getting care from out-of-network doctors, particularly radiologists, anesthesiologists and pathologists. And, it is especially difficult to avoid receiving out-of-network care in emergency situations. Click here for more information on how to protect yourself.

Consumer Reports is advocating for consumer protections that would prevent patients from receiving these unexpected bills in emergency situations and ensure consumers had notice before out-of-network doctors treated them.  New York recently passed a law to this effect.  And, several other states are now considering similar laws.

If you receive a medical bill that you don’t think you should pay, it’s always smart to appeal. Consumer Reports has launched a web site to help consumers figure out where to go to fight medical bills they believe their health plan should be paying for. People with Medicare have appeal rights that are very simple. And, most people who appeal win.


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