Legislators in New York and Florida have adopted measures designed to protect consumers from "surprise" medical bills — substantial and unanticipated invoices for medical services that the consumer either thought was covered, or didn't know would be part of the services rendered.
These "surprise" bills may have the legs to become the next opioid crisis or brouhaha over specialty drugs. A recent report on "surprise" bills by NBC News pointed to a Consumer Reports study that estimated that a third of Americans got "surprise" bills following a hospital visit.
The news report cited several representatives of consumer advocacy groups and state agencies who said "surprise" bills are almost expected these days.
Recommended For You
"Surprise" bills are yet another side effect of the changing health care landscape. Doctors don't always advertise which health care networks they participate in, and insurers don't always give adequate notice to customers about services that aren't covered by insurance.
"I think it's just deeply unfair to consumers," Dr. Ashish Jha, a professor of international health at the Harvard School of Public Health, told NBC News. "Hospitals just have to function differently. I think ultimately they should be responsible for making sure everybody's on the same insurance and that customers get one, simple bill."
The New York and Florida laws may not solve the problem, but they do let consumers off the hook. The state laws essentially kick all "surprise" bills back to the insurers and hospital bean counters to negotiate a settlement.
"These state-based solutions are helping provide consumers with needed relief, as well as offering an outlet to amicably settle out-of-network bills," Rick Pollack, president and chief executive of the American Hospital Association, told NBC News.
According to the news report, hospitals and insurers are blaming each other for the "surprise" bill outbreak.
Insurers claims out-of-plan-network doctors and, in particular, specialists, are overcharging and not giving patients a heads-up that their services aren't going to be fully covered. The medical profession says insurers should offer more comprehensive networks and be more upfront with consumers about who's in and who's out of the network.
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
