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Paul Zimmerman
pzimmerman@mrllp.com
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Survey Says: Nearly 1 In 3 Americans Receive Surprise Medical Bills

In the past two years, nearly one-third of all privately insured Americans received a “surprise medical bill” in which their health plan paid less than expected, according to the just released results of a survey conducted by the Consumer Reports National Research Center in March 2015. 

Whether a medical procedure is routine, pre-authorized, or an emergency, health plans often set an unreasonable amount as the “allowed amount” for out-of- network providers, even though the health plan has agreed to cover a portion of the out-of-network costs. By doing so, the health plan simply passes those expenses onto the unwitting patient.  In addition, the survey results show that most patients don’t know to what state agency or governmental department they can challenge the health plans’ “allowed amount,” and end up unnecessarily shouldering the costs.  In other cases, patients simply can’t or won’t pay, ultimately short-changing the providers.  The only one not adversely surprised is the health plan. We will continue to monitor developments regarding fair reimbursement, which protects the patient and the provider.

This article is not offered as, and should not be relied on as, legal advice. You should consult an attorney for advice in specific situations.