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The Impact of Surprise Medical Billing

Surprise medical billing is a large issue being discussed across the country regarding the cost of medical care for patients.

In terms of what an insurance company is willing to cover, medical care might not be as straightforward for patients as they would hope. The impact of surprise medical billing or balanced billing is leaving patients across the nation frustrated with their medical care and unprepared in an emergency situation.

What is Surprise Medical Billing?

Surprise medical billing occurs when a patient receives a medical bill larger than what they expected it to be due to their care provider being out-of-network. This is considered a surprise because, in most situations where it takes place, the patient is not aware that they received out-of-network care. This occurs most often in emergency situations when a patient is not able to clarify the cost of care before services are rendered. The most common example of surprise medical billing takes place when a provider who is out-of-network is rendering services at an in-network hospital. Surprise medical billing is leaving patients all over the country with large unexpected medical expenses, sometimes totaling hundreds of thousands of dollars depending on the situation.

How Often Does It Happen?

Some research shows that as much as 20% of emergency room visits result in care delivery from at least one provider who is out-of-network and as much as two-thirds of ambulance rides are out-of-network. Due to the fact that patients rarely choose where they are to receive emergency care, it happens relatively regularly and most commonly in emergency care situations. Patients may have received a surprise medical bill and paid it without realizing it was a bill for out-of-network services.

How Does it Impact Patients?

The impact on the patient is largely the unexpected medical cost that falls in their lap after unplanned emergency care. When a patient is entering an emergency room, they are not considering that a doctor, whom they do not know, would be out-of-network in a hospital they know to be in-network. While some patients might be able to decline an ambulance ride, many are not able to and are left with a surprise medical bill as a result. Surprise medical billing often leads to financial hardship for patients who are not prepared to pay the large sum.

How Does it Impact the Provider?

Providers who operate out-of-network tend to do so because the insurance or health plan compensation for their services is often too low and they do not wish to operate under the restrictive nature of healthcare plans. They wish to focus and make decisions that are best for the patient rather than worry about coverage and payment. Surprise medical billing impacts the provider only if they operate out-of-network and depends on patient payments.

What’s Being Done?

Many patients view surprise medical billing as an unfair and unjust pillar in the medical community. As long as surprise medical billing has existed, efforts at each level of legislation have made efforts to mediate surprise medical billing and find a solution.

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