One in 7 patients get surprise medical bill from in-network hospital: study

One out of every seven patients receive a surprise medical bill from a facility covered by their insurance provider, according to a study released on Thursday, a finding that is likely to bolster congressional attempts to rein in the practice.

Both Republican and Democrat lawmakers – as well as President Trump – are advocating for legislation to address so-called “balance billing,” or the discrepancy between what an insurer covers and a hospital charges that can leave patients on the hook for tens of thousands of dollars.

Those differences are exacerbated when individuals go to an in-network facility but are treated by a clinician who is not covered by their insurance plan. The largest amount of out-of-network claims from in-network admissions came from anesthesiologists, according to the analysis of 620,000 inpatient admissions by the Health Care Cost Institute.

As Congress eyes legislation to curb surprise medical bills, the insurance and hospital industries are at odds on how to determine the fair cost for services. Insurers previously suggested price caps for some provider offerings, a suggestion the hospital industry panned as government overreach.

“Not only is it a dangerous precedent for the government to start setting rates in the private sector, but it could also create unintended consequences for patients by disrupting incentives for health plans to create comprehensive networks,” the American Hospital Association and the Federation of American Hospitals previously said in a statement.


While it’s an issue lawmakers have tried to tackle for years, surprise hospital bills gained renewed attention after Trump earlier this year urged Congress to address it.

“The pricing is hurting patients, and we’ve stopped a lot of it, but we’re going to stop all of it,” he said in January.