Surprise Medical Bills Are On Their Way Out
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Here's your money briefing for Wednesday, July 14th. I'm J.R. Whalen for The Wall Street Journal. What do people dread more than having to go to the hospital? Getting the bill, especially if it contains unexpected charges.
There have been a number of studies that have shown that people are seeing more medical debt because of the surprise bills that they can't pay. So it can have both a big impact on consumers in terms of their bottom line, but also overall health care spending in the United States.
So what's being done about it? Our health care reporter, Stephanie Armour, has been tracking a new set of rules aimed at combating surprise hospital bills that's making its way through Washington. So tell us what to expect after the break.
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What problem do surprise medical bills create for patients and the healthcare system?
If you've ever been hit with a surprise hospital bill that you thought would be covered by insurance, you know how confusing it can be. Well, our health care reporter Stephanie Armour has been following some new rules that are part of the federal No Surprises Act that would protect patients from unexpected medical bills. And she's with us to discuss. Stephanie, thanks for being here.
Thanks so much for having me.
So, you know, Stephanie, nobody likes to open the mailbox and see a surprise bill for anything, let alone a medical bill. What kind of surprise bills are we talking about?
Well, typically these surprise bills happen when, let's say you have a medical emergency and you are treated in the emergency room, but say the doctor who treats you happens to not be in your insurance network, you may get a really high bill that you were never expecting because you didn't realize that the doctor who treated you was not in your network. That's typically how it happens. And it can be a lab service that looks at your blood in an ER. That could potentially be someone who is out of network. Or let's say you have a colonoscopy and the anesthesiologist is not in network. So it can happen in a lot of ways where people just aren't aware that they're being seen by someone who is out of their insurance network.
And so then they get this big bill.
How big an impact do surprise bills have?
It can be significant. There have been a number of studies that have shown that people are seeing more medical debt because of the surprise bills that they can't pay. There have been other studies that show that the out-of-network charges from a group of anesthesiologists, pathologists, assistant surgeons can increase spending overall by $40 billion annually. That was a study that was done out of the Yale School of Public Health. So it can have both a big impact on consumers in terms of their bottom line, but also overall health care spending in the United States.
Now, hasn't the issue of limiting out-of-pocket spending been addressed before?
The Affordable Care Act did put caps on how much you may have to spend out of pocket, but that's for in-network care. So it kind of left this loophole, which has increasingly eaten up out-of-pocket spending for consumers when it comes to health care.
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