More on Billing and Collections

More than half of Americans have been surprised by a medical bill, survey shows

When asked, 86 percent said insurance companies are "very" or "somewhat" responsible, while 82 percent said the same of hospitals.

Jeff Lagasse, Associate Editor

Fifty-seven percent of American adults have been surprised by a medical bill that they thought would be covered by insurance, according to a new AmeriSpeak survey from NORC at the University of Chicago. 

Respondents indicated that 20 percent of their surprise bills were a result of a doctor not being part of the network.

Among those surveyed who indicated they had been surprised by medical bills in the past, the charges were most often for physician services (53 percent) followed closely by laboratory tests (51 percent).

HIMSS20 Digital

Learn on-demand, earn credit, find products and solutions. Get Started >>

Other common sources of surprise bills were hospitals or other healthcare facility charges (43 percent), imaging (35 percent), and prescription drugs (29 percent).

Surprise medical bills may occur for several reasons. In some cases, particular services, such as lab tests, or products -- certain prescription drugs -- for instance -- may not be covered by a health plan. Care received before meeting the deductible or high cost-sharing requirements may also surprise consumers. 

In other cases, healthcare providers may be out-of-network for a plan. When that occurs, charges for the services may only be partially covered or not covered at all, depending on the type of insurance and benefit design.

The results suggest that consumers may have difficulty understanding their insurance benefits, and may not be aware of which providers are included in their network's plan.

When asked which groups are most responsible for surprise medical bills, 86 percent of respondents said insurance companies are "very" or "somewhat" responsible, while 82 percent said hospitals were "very" or "somewhat" responsible. Respondents were less likely to hold their doctors responsible, with 71 percent saying doctors are "very" or "somewhat" responsible for surprise bills.

Twitter: @JELagasse
Email the writer: