Surprise Medical Bills Even for Patients with Insurance
Health Care

Surprise Medical Bills Even for Patients with Insurance


Patients with comprehensive health insurance are still getting hit with unforeseen and often substantial out-of-network bills, according to a new study by the Kaiser Family Foundation.

KKF analyzed medical bills from large-employer health insurance plans and found that about 18 percent – or nearly one in five – of inpatient admissions result in out-of-network charges. And patients who were careful to use only in-network facilities were not always protected, with 15 percent of admissions at covered facilities racking up out-of-network charges.

The charges typically arise when a patient goes to an in-network hospital but at some point sees an out-of-network medical professional. Patients who needed anesthesia or pathology service were more likely to receive out-of-network bills, which may not be covered by their insurance. Patients needing mental health and substance abuse treatments were also more likely to be billed by out-of-network providers.

The study underscores the vulnerability even the best-insured patients may feel in the U.S. medical system. “Patients in emergency situations have limited ability to control the care they receive and from whom they receive it,” the study said. “Even when the facility is in-network, the professional services may not be and the patient often is not in a position to direct their care.”