The Rise of Unexpected Medical Costs and the Impact on American Families

It’s unfortunately not uncommon for Americans to incur unexpected medical expenses and receive subsequent unplanned medical bills. Especially in emergency situations, consumers often receive treatment without knowing the true out-of-pocket cost to them.

Getting clarity on healthcare costs through requesting itemized billing is something the Wall Street Journal recommends [1]. But even then, consumers can be left confused and frustrated with hefty, unanticipated medical bills. In 2015, Consumer Reports found that 30% of privately-insured Americans received a medical bill that covered less than they were expecting. Currently more than 25 states are considering legislation that would protect patients from surprise medical bills [2].

Medical costs whether they are unexpected or not have the ability to wreak havoc on a family’s finances. The Agency for Healthcare Research and Quality reported that, as of 2012, the mean cost for a hospital stay due to surgery was $21,200. That was nearly 2.5 times the mean costs for medical stays, which was around $8,500 in 2012 [3]. It’s been estimated by the Consumer Financial Protection Bureau that nearly 50% of collection accounts are due to medical debt [4]. Credit scores can drop anywhere from 50 to 100 points when an account is sent to a collection agency.

Those with insurance coverage and those without share in the struggle of paying for medical expenses. Kaiser Family Foundation and The New York Times released a report earlier this year that cited 26% of people surveyed said that they or someone in their household had difficulty paying medical bills over the past year. This rate increased among un-insured people surveyed (53%). The same report indicated that 66% of respondents asserted that their medical bill problems stemmed from bills for a one-time or short-term medical expense, such as a single hospital stay [5].

Out-of-network rates frequently push unexpected medical costs upward. insurers often pay large portions, if not the full amount, for out-of-network physicians that perform procedures in a hospital setting. The New York Times reports that this activity on the part of insurers may sometimes provide an incentive for doctors to include out-of-network colleagues in a patient’s treatment [6]. In the end, patients can be left with hefty balances due.

According to the National Center for Policy Analysis (NCPA), insurance coverage changes and continues to evolve and more costs are shifting to patients. It’s important for consumers to take an active role in their health care and ask a lot of questions to help ensure costs are transparent and kept under control [7]

BridgeHealth offers pre-negotiated, bundled case rates for a wide scope of procedures. With little to no out-of-pocket expense for Plan Members, the unique solution provides clarity during important healthcare decisions. By negotiating bundled case rates with the top 25% of hospital providers in the country [8], With BridgeHealth, Plan Members benefit from knowing all costs upfront with no surprise bills after surgery.

1) - How to Avoid Surprise Medical Bills (Wall Street Journal)
2) - Unexpected Medical Bills Can Cost American Consumers Thousands (PBS News)
3) - Costs for Hospital Stays in the United States, 2012 (Agency for Healthcare Research and Quality)
4) - How Unexpected Bills Can Ruin Your Finances (CBS News)
5) - The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey (Kaiser Family Foundation)
6) - After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know (New York Times)
7) - Protect Yourself From Unexpected Medical Fees: Expert Advice on Keeping Surgery Costs in Check (National Center for Policy Analysis)
8) – Hospital Quality Scoring and Rating Methods, Comparion Carechex

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