Many people in the United States face unexpected medical expenses despite having private insurance coverage, due to a phenomenon known as “surprise billing.”
Surprise bills occur when people with private insurance get services that fall outside of their plans’ networks. Some of this out-of-network care is very difficult to avoid because it often results from emergency medical services.
People who require emergency transport by an air ambulance, for example, are likely to find their insurers will balk at paying these costs, according to a 2019 report from Congress’ investigative arm, the Government Accountability Office. GAO staff examined data for air ambulance transports of privately-insured patients in 2017. They found 69% of about 20,700 transports in their data set were out-of-network. An air ambulance company, for example, charged $41,400 for transport of a North Dakota consumer, whose insurance plan paid $6,700 of the cost, GAO said. This left the consumer with a potential bill of $34,700, although it’s possible that the air ambulance company later agreed to reduce these costs, GAO said in its report.
Consumers may struggle with the consequences of surprise medical bills, and many of them have stories worth sharing. In many cases, hospitals and other providers of medical care have suddenly lowered costs for consumers after getting calls from journalists.
Kaiser Health News in March 2020 reported, for example, on how Michelle Kuppersmith of New York had made sure the hospital where she had a biopsy of her bone marrow was in her insurance network. But as journalist Liz Szabo reported, Kuppersmith was unaware that a lab company involved in testing this sample was not in the network. She initially faced a $2,400 bill from the lab company. After being contacted by Kaiser Health News, the insurer agreed to pay the lab company the in-network rate, covering $1,200 of the $2,400 charge, and the lab company said it wouldn’t bill Kuppersmith for the other half of the charge, Szabo reported.
Sarah Kliff, now at the New York Times and earlier at Vox, has been a leader in efforts to document consumers’ experiences with surprise medical bills. In her December 2018 story in Vox, titled “I read 1,182 emergency room bills this year. Here’s what I learned,” Kliff recapped her work in looking into high medical costs, including an out-of-network bill of $7,924 presented to Scott Kohan. In May 2018, Kliff reported on how Kohan’s visit to an emergency room in his insurer’s network triggered a surprise medical bill. It turned out that a surgeon who treated him was not in network. In her December story, Kliff reported Kohan’s bill was reversed after Vox reported on it.
But asking journalists to challenge surprise medical bills one by one is not a “scalable solution,” Kliff said in a 2019 briefing on this subject held by the Alliance for Health Policy. Consumers are looking to lawmakers to protect them from surprise…