(Bloomberg) -- Forty-five percent of US adults say they’ve been billed in the past year for medical care that they thought was covered by their insurance, leaving many footing the bill for insurance-company errors.
Less than half of those who received surprise bills wound up challenging them, according to a report Thursday from the Commonwealth Fund, an independent health research foundation. Many who didn’t challenge say that’s because they weren’t aware it was an option or feared it wasn’t worth their time.
While US workers and their employers together pay about $24,000 a year for family health insurance premiums, the diversity of plans and options leaves many people confused about what exactly is covered and what they have to pay out of pocket.
“It is stressful enough dealing with a complex health care issue,” said Sara Collins, vice president for health care coverage and access at the Commonwealth Fund and one of the study’s authors, in an interview. “And then to have a financial complexity inserted into that really exacerbates what’s already a difficult situation for families.”
Collins noted that among people who challenged their bills, 38% said the money they owed was ultimately reduced or eliminated. When people challenged insurers’ decisions to deny medical care, the successful appeal rate was around 50%.
Those findings suggest that people are being billed erroneously or denied care they should be getting, Collins said.
The report was based on a survey of a nationally representative sample of 7,873 adults. The Commonwealth Fund focused its analysis on 4,803 working-age individuals who were insured for the past year.
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