People who are in the middle of a health crisis often are at an especially high risk for surprise medical bills, according to previously unreleased data from the Kaiser Family Foundation.
The big picture: The new data underscore the importance of a legislative solution to help patients who are powerless to protect themselves.
Details: People having surgery or receiving mental health and substance abuse treatment at an in-network hospital are the most likely to experience a surprise bill from an out-of-network provider.
Among people with employer-based insurance, out-of-network charges were 50% higher among heart-attack victims than for other diagnoses.
21% of women undergoing mastectomies experienced out-of-network provider charges.
My thought bubble: It’s hard to imagine many patients who are so prepared and insurance-savvy that they could protect themselves from an out-of-network bill in the middle of a heart attack.
Why it matters: It doesn’t take a headline-sized bill to wreak havoc on family budgets.
Half of the American people say they would have to borrow money or go into debt to pay a $500 medical bill, or wouldn’t be able to pay it at all.
Unexpected medical bills are the public’s top health cost concern, ahead of deductibles, premiums, drug costs, and even paying the rent or the mortgage.
People with major medical conditions and chronic illnesses are most likely to experience problems paying their medical bills.
The bottom line: Congress is torn between two competing ideas solving this issue and settling payment disputes between insurers and providers. Each plan has its own implications for premiums and industry negotiations, but for patients, just getting a fix is the most important thing.
Spending on prescription drugs in 2018 — both through premiums and out-of-pocket costs — grew a moderate 2.5% from the previous year, which was below the growth rates for hospital and doctor services.
Yes, but: That doesn't give a true accounting of total pharmaceutical spending. Spending on common and expensive drugs that are administered by providers is buried within the hospital and doctor statistics.
Three key lawmakers have reached a deal on the issue of surprise medical bills, according to two sources familiar with the negotiations.
How it works: The proposal — which has been agreed to by Sen. Lamar Alexander (R-Tenn.) and Reps. Greg Walden (R-Ore.) and Frank Pallone (D-N.J.) — would set benchmark rates for the providers who send such bills, and it would use an arbitration process to settle certain high-value payment disputes.
