Health care consumers plagued by inaccurate procedure estimates

U.S. health care consumers continue to struggle paying for medical care, even when they have received a cost estimate for a procedure in advance. Oftentimes, that estimate is either unexpectedly high, or flat-out inaccurate. And generally, the estimates are inaccurate on the low side.

A survey of nearly 2,500 U.S. health care consumers by PYMNTS.com offered more proof that this remains a barrier to consumer trust of the health care system. PYMNTS.com, a provider of data, news and insights on innovation in payments and the payment-related, conducted the survey to learn how many respondents fell into the unexpectedly high and inaccurate estimate category, and what the outcome for them was in the aftermath.

The results were essentially sorted into three categories: those who received unexpectedly high estimates and canceled an appointment; those who got a high estimate but went ahead with the prescribed medical care; those who had their procedure and then got a surprisingly high bill. Here’s what the survey found:

• Three-quarters of Millennials canceled a health care appointment after receiving a high cost estimate.
• 6 in 10 consumers living paycheck to paycheck with issues paying their bills canceled a health care appointment after receiving a high cost estimate.
• Nearly half of consumers who canceled a health care appointment for a reason other than “their condition had improved” cited a high cost estimate as their main reason for canceling an appointment or procedure.

However, just 13% of baby boomers and seniors canceled after receiving an unexpectedly high estimate. Given that most of these likely enjoy the perks of Medicare and affordable gap coverage, the financial hit would be far less painful for this group.

Related: Lack of price transparency still keeping many from seeking health care

The survey revealed that many consumers continue to under budget for their health care –probably because most have little idea about the cost of various procedures and appointments. For instance, nearly 20% of those surveyed said they “experienced financial distress due to health care costs because they spent more than they could afford in the past 12 months.” A quarter of respondents who said their advance notice cost estimates were accurate said they still spent more than they could really afford. Not surprisingly, 43% of those who received inaccurate cost estimates said they spent more than they could afford.

Living paycheck to paycheck can be stressful, and those who do so reported more financial anxiety than other groups.

The survey found that 27% of patients living paycheck to paycheck who reported having issues paying their bills did not have enough money to pay for their last appointment. By comparison, 11% of patients not living paycheck to paycheck were in financial distress due to health care costs during the same period, and only a quarter of those not living paycheck to paycheck canceled a health care appointment after receiving a high cost estimate.

But a backlash could be in store for providers that deliver inaccurate cost estimates ahead of a procedure. The survey found that 60% of patients who paid out-of-pocket health care costs and received either an inaccurate cost estimate or an unexpected bill are “very” or “extremely” interested in switching health care providers for a better payments experience.