Worry about the costs of surprise medical bills - a Kaiser Family Foundation survey

This article is published in the newsletter PatientEngagementHIT and the author is Sara Heath

67% of Patients Worry About Surprise Medical Bills, Healthcare Costs

Rising patient concern about surprise medical bills and healthcare costs are calling into question healthcare price transparency practices.

September 10, 2018 - Unexpected medical bills are the biggest healthcare and financial concern on patients’ minds, according to a recent poll from the Kaiser Family Foundation.

The survey, which included responses from nearly 1,200 adult patients, found that 58 percent of healthcare consumers are concerned about general out-of-pocket patient cost increases across the healthcare spectrum.

Chief of those concerns was the concept of unexpected medical bills, or healthcare charges that patients believed would be covered by their healthcare payer.

Thirty-eight percent of respondents reported that they are very concerned and 29 percent saying they are somewhat concerned about surprise medical bills. Only 16 percent of patients said they are not at all worried about surprise medical bills.

Unexpected bills proved an even larger concern than high premiums (18 percent), high deductibles (24 percent), and rising drug costs (22 percent).

Worry about surprise medical bills also override financial worry about paying for other lifestyle needs such as rent or mortgage and grocery bills, the survey revealed.

Surprise medical bills are an increasingly prevalent issue in the healthcare industry, the survey noted. Forty percent of insured adults ages 18 to 65 said they have received a surprise medical bill in the past 12 months. Of those respondents, 10 percent said their bill stemmed from out-of-network care.

Out-of-network care can include visiting a hospital or clinic that is not within a patient’s insurance coverage network, or seeing a clinician who is not a part of the patient’s insurance plan but who practices in an in-network facility.

Most of these surprise bills totaled to less than $500 – 50 percent of all patients who received a surprise medical bill said as much.

But smaller cohorts of patients saw astronomical surprise bills. Sixteen percent of respondents reported unexpected bills reaching up to $999, 12 percent received a bill between $1,000 and $1,999, and 13 percent were billed over $2,000.

58 percent of respondents said they are very concerned about general healthcare costs.

Separate studies have likewise indicated that surprise medical bills are of utmost concern for patients.

A 2018 analysis from NORC at the University of Chicago found that 57 percent of patients have received a surprise medical bill, and 58 percent of patients perceive these unexpected charges to be their insurers’ faults.

Seventy-nine percent of the patients who received a surprise bill said it came from an encounter with a provider that was within the patient’s payer care network. The surprise bill may have come from a provider who was not within network but was practicing in a facility that was in network, or for healthcare services that are not a part of a patient’s coverage plan.

These issues point to a need for better patient education about their payer benefits designs, the NORC* researchers said.

“Most Americans have been surprised by medical bills that they expected would be covered by their insurance,” Caroline Pearson, senior fellow at NORC at the University of Chicago, said in a statement. “This suggests that consumers may have difficulty understanding their insurance benefits or knowing which providers are included in their plan’s network.”

Payers may consider being more transparent about healthcare services that are and are not covered under a specific plan, or the providers whose services would not be covered. Additionally, clinics and hospitals may consider being more transparent about the total cost the patient will incur prior to the care encounter. Price transparency should take into consideration the patient’s insurance benefits.

But the Kaiser Family Foundation poll suggested that the solution to surprise medical bills goes beyond more patient-centered billing practices. As noted above, 58 percent of patients believe there is a fundamental issue with rising healthcare costs.

Determining ways to cap out-of-pocket patient spending or make costs more transparent could reduce the “sticker shock” that comes with a surprise medical bill.

*NORC at the University of Chicago is one of the largest independent social research organizations in the United States