Dec 9, 2019

Surprise bills often hit in emergencies

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Reproduced from Kaiser Family Foundation; Chart: Axios Visuals

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.

Go deeper

Surprise medical bills inflate everyone's health insurance premiums

Data: Health Affairs; Chart: Axios Visuals

Four specialties that are often out-of-network — anesthesiologists, pathologists, radiologists and assistant surgeons — raise employer insurance spending by 3.4%, according to a new study in Health Affairs.

Why it matters: Surprise medical bills are not only unaffordable for the patients who receive them, but also inflate everyone else's premiums.

Go deeperArrowDec 17, 2019

Health care industry opposes Congress' new surprise medical bill legislation

Sen. Lamar Alexander (R-Tenn.). Photo: Astrid Riecken/Getty Images

The health care industry is not very happy with Congress' latest proposal on surprise medical bills, which also includes other provisions designed to lower health costs.

Driving the news: The bill, championed by Sen. Lamar Alexander and Reps. Frank Pallone and Greg Walden, cracks down on industry behavior that is often profitable at patients' expense.

Go deeperArrowDec 10, 2019

Podcast: Settling surprise medical bills

More than 50% of Americans have reported receiving surprise medical bills, when a provider charges more than an insurer will pay — but Congress is proposing a fix, over the health care industry's objections.

Go deeper: Hospitals' dog in the surprise billing fight

Keep ReadingArrowDec 11, 2019