A surprise medical bill is any bill for which a health insurer paid less than a consumer expected. Many surprise bills are the result of enrollees not understanding their in-network coverage but far too many are the result of patients inadvertently using an out-of-network provider.
Consumer Reports National Research Center found that 1/3 of Americans had faced a surprise medical bill – and that most don’t know where to turn to correct errors or get help.
Both at the federal and state level, efforts are underway to protect consumers from unfair surprise medical bills. Consumers Union has an assortment of tools to help advocates, policymakers and consumers. Join this important conversation on Twitter using #surprisemedbills.
Resources For Advocates and Policymakers
- Getting Started on Surprise Medical Bills: An Advocate’s Guide
- Surprise Out-of Network Medical Bills: A Grid of State Legislative Solutions
- National survey showing 1 in 3 consumers have experienced at least one surprise medical bill
- Link to our Surprise Bills Complaint Tool – find out where and how to complain about surprise medical bills in your state
- Addressing Surprise Medical Bills: New Research and State Approaches
- New York Case Study: Protecting Consumers from Surprise Out-of-Network Bills
- Surprise Medical Bills Take Advantage of Texans: Little-known practice creates a “second emergency” for ER patients
- Making Provider Directories Meaningful to Consumers
- Network Adequacy Standards and Transparency Needed to Protect Consumers
- Consumer Reports YouTube Video: What If Your Pizza Place Billed Like a Hospital?
- Consumer Reports National Research Center: Washington State Surprise Medical Bills Survey (2016)
- H.R. 3770, End Surprise Billing Act of 2015 (Doggett — Texas)
- Link to interactive map showing legislative activity in the states
- Full text of Connecticut Bill (effective in 2016)
- Full text of NY bill (effective 4/1/15)
- California provider directory bill: SB 137
- “Consumer Statement on Out-of-Network Billing Health Insurance Legislation” [Testimony before the NY State Legislature]
- Health Affairs Blog, “A Tale of Two Deliveries, or an Out-of-Network Problem”
- Ashlee Kieler, Lawmakers introduce legislation to curtail surprise medical bills, Consumerist, October 21, 2015
- Editorial Board, Help may be on the way for healthcare shoppers in California, The Los Angeles Times, September 10, 2015
- Arielle Levin Becker, Cheat sheet: What’s in the big healthcare bill, The Connecticut Mirror, June, 1, 2015
- Audrey Brown, Support bill to end unfair balance billing, Context Florida, October 26, 2015
- Andy Miller, Legislators examine shocker of medical ‘balance billing’, Atlanta Journal-Constitution, October 8, 2015
- Lindy Washburn, Support for NJ bill to rein in health costs, North Jersey, September 10, 2015
- David Robinson, N.Y. law protects against surprise medical bills, USA Today, April 22, 2015
- Steve Twedt, Pa. bill proposed by Democrats aiming to reduce ‘surprise’ medical bills, Pittsburgh Post-Gazette, October 15, 2015
- Stacey Pogue, New law allows more Texans to challenge surprise medical bills, Austin American-Statesman, September 1, 2015