When Emily Christian-Michaels went to UPMC Magee-Womens Hospital in Pittsburgh for a regular scan at 20 weeks pregnant, she didn’t expect to get hit with a $1,900 bill.
The now-31-year-old Bellevue resident said hospital staff performed an extended scan without letting her know — a procedure that was not covered by her health insurance.
After appealing the bill twice and getting denied both times, Christian-Michaels met with hospital officials who she said admitted they made a mistake.
One in three Pennsylvanians who were privately insured received a surprise medical bill in the past year, according to the Pennsylvania Health Access Network, a nonprofit organization based in Philadelphia. The organization gathered their data through a survey sent to Pennsylvanians 18 and older.
“These data confirm what we already knew anecdotally,” Patrick Keenan, director of policy at PHAN, said in a news release. “Pennsylvanians are receiving surprise medical bills at an alarming rate, and most don’t know where to turn to correct errors or get help. We need lawmakers in Harrisburg to step in and take action to protect Pennsylvanians from unfair surprise medical bills.”
While 78% of those who received a surprise bill took initial steps toward resolving it — by contacting the health plan or consulting an insurance policy (40%) or contacting the doctor or hospital (21%) — about 22% paid the bill without disputing it, the Pennsylvania Health Access Network said. And 13% took further action such as filing an insurance appeal, contacting government officials or lawyers, or filing a formal complaint.
According to Keenan, the issues can consist of higher-than-expected charges, unexpected bills and surprise out-of-network bills. Keenan said some facilities use doctors who are out-of-network, causing patients to be sent bills they were not expecting.
And for some people, such as James Poland, 62, of York, those high, unexpected bills mean bankruptcy.
Poland isn’t alone in that. According to Jessica Brooks, CEO and executive director of Pittsburgh Business Group on Health, 60% of people who file for bankruptcy do so because of medical bills.
Now, organizations across the state are working together to end surprise billing, starting with government officials.
According to the news release, state actions could help alleviate some of the billing issues through protections that could stop the bills from happening. The goal is to take patients out of the equation.
“We want to end surprise billing all together,” Brooks said. “We suggest we don’t just put a Band-Aid on the issue but continue moving forward.”
Increasing awareness and teaching consumers there are options past the initial steps can help put an end to surprise billings, said Lynn Quincy, director of the Healthcare Value Hub at Altarum.
Across the country, states are working to simplify health plan benefit designs and improve the accuracy of provider directories and adequacy of provider networks.
“The long-term implication is that they don’t trust going to the hospital or going to that provider again,” Keenan said. “When cost becomes an issue, consumers delay, forgo or put off health care all together.”