How many consumers are impacted by surprise medical bills?
According to a representative survey of 407 Georgia residents conducted by Consumer Reports National Research Center, 41% of privately insured Georgia residents received a surprise medical bill where their health plan paid less than expected in the past two years. Of those that received a surprise medical bill, 11% were charged at an out‐of‐network rate when they thought a provider was in‐network.
Out-of-network services are often significantly more expensive.
One state-by-state study conducted by America’s Health Insurance Plans (AHIP) noted that average medical bills submitted by out-of-network providers were 10, 20, and sometimes 100 times higher than Medicare reimbursement for the same service performed in the same geographic area. The report highlighted findings from Georgia, such as out-of-network service charges for radiation therapy that were, on average, 500% higher than the Medicare fee.
We believe that surprise billing legislation should contain the following basic elements:
- Notice to consumers about network status and anticipated healthcare costs in a way that preserves meaningful consumer choice;
- Protections for insured consumers from unavoidable or inadvertent out-of-network charges, particularly in an emergency context;
- A well-defined process for determining payment of surprise out-of-network bills that keeps consumers out of the middle of any dispute between a provider and an insurer over balance billing charges;
- An effective way of informing consumers about their rights in an out-of-network billing context, and
- Network adequacy provisions that ensure consumers have an appropriate choice of providers sufficient to render the services covered under their policy.
Resources and Tools
|Healthcare Access||Short National Consumer Law Center guide for dealing with medical bills and debt.||Dealing with Medical Debt: Consumer Advice from NCLC|
|Medical Bills||A resource from Georgia Watch on managing medical bills and medical debt.||Georgia Consumer Guide for Medical Bills and Debt|
|Medical Bills||A one-page resource from Georgia Watch on handling medical bills and avoiding surprise bills||Medical Bills: Know Your Rights!|