Every sixth emergency room patient receives a suprise score after treatment

According to a new study, on average, one out of every six clients of emergency departments in the United States receives a medical bill, “surprise,” as a result of treatment.

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Chances to face this vary depending on the region, writes ABC News.

The Kaiser Family Foundation report says that millions of people who have good insurance against large employer companies incur large bills worth thousands of dollars for using “offline” medical services.

The patient's chances of getting a “surprise” score vary considerably depending on the state in which he lives. For example, in Texas, 27% of calls to the emergency room and 38% of inpatient stays at a hospital that is part of the patient’s insurance network lead to a “surprise” score. Minnesota looks safer in this respect and has 2% and 3%, respectively.

Researcher Karen Pollitz says that the reasons for such significant differences are not entirely clear, but they seem to be related to the breadth of hospital networks in each state, as well as how these networks are designed.

Patients in New York, Florida, New Jersey and Kansas are among the top five regions where the likelihood of unexpectedly medical bills is high. South Dakota, Nebraska, Maine and Mississippi are located on the other side of the ranking, in addition to Minnesota.

On the subject: What to do if you got a medical surprise bill

If the results are averaged across the country, then 18% of visits to emergency departments and 16% of inpatient treatment at the hospital network end with “surprises” billed by health insurance patients with good coverage from the employer.

According to Pollitz, these data indicate the need for Congress to intervene, since medical insurance plans that large employers pay for their employees are regulated by federal law, and protection from bills- “surprises” adopted by some states does not apply to them.

“This is a serious problem affecting patients, it cannot be solved by state laws, and it by definition cannot be solved by patients on their own,” Pollitz said.

The 26 May Senate Health Committee will review a bill that will restrict medical billing for patients. The bill would require insurers to pay doctors and hospitals outside the network the average price for the same services provided by providers within the network.

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Score- “surprises” can be the result of different situations. In an emergency, the patient may end up in a hospital that is not in the insurer's network. Even in an online hospital, emergency room doctors or anesthesiologists may not have a contract with the patient’s insurer. Even with a planned surgery in a hospital network, not all doctors can be on the network of a patient’s insurance plan.

Account “surprises” can be tens of thousands of dollars. Often, patients can negotiate a reduction in the cost of services by negotiating with their insurers and the medical institution or doctor. But this process usually takes months and is quite stressful. If the negotiations were unsuccessful, invoices can be sent to collection agencies.

The Kaiser Family Foundation study is based on insurance data from 2017 on almost 19 million people, or more than 20% of those who have medical insurance from large employers. The information was obtained from the IBM Health Analytics database. Researchers have excluded patients aged 65 and older, most of whom receive medical care from Medicare.

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