Consumers still face unexpected, huge medical bills despite insurance

The point of health insurance is to insulate consumers from the often high cost of medical treatment, but it doesn't necessarily always work out that way. Millions of Americans have substantial medical debts to deal with on a regular basis, and this is an issue that can impact them regardless of what kind of coverage they have.

Studies show that as many as 1 in 3 Americans have had to deal with a surprise medical bill in the last two years as a result of a bill that differed from what they would have expected, according to a report from the Arizona Republic. For instance, one man in the greater Phoenix area severely injured his hand and went to a hospital within his insurance network to have it examined. It was determined that he needed surgery and was sedated, then operated upon by a surgeon he did not choose himself because he was heavily sedated, but who was outside his network.

Consumers may face unexpected medical bills for certain treatments.

What happened next?
The man in question didn't learn that a surgeon outside his network had completed the operation until days later, the report said. That's when a bill for some $16,000 came in the mail, and obviously put him in a difficult financial spot. The patient recognized the problem so quickly that he actually had his wife remove the stitches in his hand so he could avoid accruing further out-of-network medical bills that wouldn't be covered by his current insurance provider.

Moreover, consumer advocates say that as insurance networks shrink, this problem is becoming increasing prevalent nationwide, the report said. Organizations like Consumer Reports are now hearing more often about people being hit with surprise bills of this type, meaning the story outlined above is both vexing and becoming more commonplace. And to that end, insurers can actually only do so much for their policyholders, because they cannot force care providers to join their networks, but also cannot be expected to pick up tens of thousands of dollars in medical bills for out-of-network care. This, then, can be seen as an issue created mainly by care providers not doing enough to ensure treatments are being made in-network.

What does this mean?
Unfortunately, this issue does nothing but leave the onus on people stuck with tens of thousands of dollars in unexpected debt, the report said. Until more and better agreements are reached between care providers and insurers, this is going to be the issue at hand.

“It is very complicated for consumers – and, we think, unfair,” Betsy Imholz, special projects director for Consumers Union, told the newspaper. “Everyone is pointing their finger at everyone else. Nobody is taking the responsibility, and the consumer is left holding the bag.”

This trend, however, could incentivize more deals between insurers and care providers. For the latter, these help to ensure full payments on the treatments they provide, while the former would likely benefit from greater customer satisfaction.