Millions of insured Americans struggling with unexpected medical bills

Insured, working-age Americans might face more widespread medical billing errors than was previously thought, according to a new survey by Commonwealth Fund. According to the survey, close to half (45%) of insured, working-age adults in the U.S. have received a medical bill or copayment in the past year for a service they expected to be covered by their insurance. 

Nearly 1 in 5 patients were denied coverage by their insurer for a service that had been recommended by their doctor. 

Unfortunately, among those who experienced coverage denials or billing errors, the survey found that fewer than half of patients challenged them, mostly because they weren’t aware they had the right to do so. This lack of knowledge was especially prevalent among people with low and moderate incomes, those under the age of 50 and Hispanic respondents. 

Of those patients who did end up challenging coverage denials, the survey found that half reported success in getting some or all previously denied services approved. Additionally, among those who disputed inaccurate medical bills, more than one-third of patients’ appeals resulted in their balances being reduced or eliminated altogether. 

The study found that the success rates of appealing medical bills were even higher for patients who are enrolled in Medicare and Medicaid. Among Medicare recipients, 61% had bills reduced or eliminated after challenging them, and 46% of Medicaid recipients achieved the same results. 

For many patients, coverage denials led to decreased health. According to the study, denials caused delays in care for nearly 60% of affected patients, with 47% reporting worsened health conditions as a result. 

Study authors noted that enhanced monitoring of claim denials, stronger accountability measures and heightened consumer awareness could significantly improve the consumer experience. 

Related: Despite employer insurance, Americans unprepared for medical bills, delay care

“When substantial numbers of people with health insurance are facing unexpected bills and having doctor-recommended care denied, our healthcare system is failing patients. And much of this failure can be attributed to the complex insurer billing practices and loopholes that fuel a lack of accountability for these billing errors and unfair coverage denials. Patients deserve better – they shouldn’t have to navigate a labyrinth to use the health insurance they and their employers are paying for, and the care their doctors are prescribing,” said Sara R. Collins, study coauthor and Commonwealth Fund Senior Scholar and Vice President for Health Care Coverage and Access.