Rutgers study: Insured just as likely to get surprise medical bills as uninsured

Medical and health insurance claim form with stethoscope on clipboard

Rutgers University’s Center for State Health Policy released a new study on the impact of surprise medical bills in New Jersey on Thursday, just before Gov. Phil Murphy is slated to sign a bill to prevent the practice in the state-regulated market.

The bottom line: It doesn’t matter if you have insurance coverage or not, surprise bills are a problem.

“The poll shows that the uninsured are about as likely as those with public or private insurance to report having received a surprise bill,” according to the results published by the center.

The study is the second of three Health & Well-Being Polls funded by the Robert Wood Johnson Foundation, and was conducted in the fall of 2017, according to a statement.

The poll did not set parameters for what a “large” unexpected bill was, but the results show that at least 14 percent of the state’s population had a large surprise bill in the past year.

Here are some other key takeaways from the 1,052 respondents.

The prevalence of large, unexpected bills rose to around one in five among such groups as:

  • Lower-income families;
  • Those with less than a high school education;
  • Asian, Hispanic and black non-Hispanic residents;
  • People who reported being in poor health.

Among those with public or private insurance, respondents revealed:

  • 48 percent said they received surprise bills from in-network providers;
  • 43 percent from out-of-network providers;
  • 9 percent said they didn’t know whether the bills were from in or out of their network.

The state already has protections against surprise medical bills, but not the transparency that is part of the new bill.

The out-of-network bill, which passed both houses after nearly 10 years, also only covers a small percent of the market in the state, since more than 70 percent of the state is covered by federally regulated self-insured plans, and the state cannot regulate those insured under Medicare.

But it is a step in the right direction, according to the center’s director, Joel Cantor.

“Our conclusion is that there is something deeper and more systemic than the network problem,” he said in a phone interview with ROI-NJ.

“It’s intrinsic, it’s just part of our health care system. Whenever anyone has a complex health condition, they are going to get lots of bills from different providers.”

One of the key ingredients is the administrative costs in the U.S. health care system compared to other developed countries. They are two to three times higher.

“That’s part of the same problem we are describing here,” Cantor said. “It’s a very fragmented system, so there is lots of billing and lots of transactions and in the case of the poll, we are finding it is shock and awe for consumers and it adds to the overall high cost of health care in this country.”

More can be done to standardize billing and standardize procedures, he said.

That goes for the insurance industry as well. Though the out-of-network bill is set to become law, it will not control or lower premiums — despite popular political rhetoric indicating as much.

“There’s constant upward pressure on premiums; this is one source of many,” Cantor said.

But the bill will help trim some of the expenses that burden patients.

“I think the legislation goes a long way for the entities that are regulated by the state to improving the situation, but clearly more is needed than that,” Cantor said. “I think it’s a very big step in the right direction.”

To see the full results of the poll, click here.