Common medical billing errors keep many Americans from getting care: report

By Dennis Thompson HealthDay Reporter

THURSDAY, Aug. 1, 2024 (HealthDay News)

A new study from the Commonwealth Fund finds that insured working-age adults regularly face medical bills for services that should have been covered.

The research shows that almost half (45%) of insured employees received a bill or personal contribution in the past year for a service that they believed should have been reimbursed by the health insurer.

Less than half of respondents objected to the bills, largely because they did not know they had the right to do so, researchers found.

But when they did file an objection, patients often discovered that the bill had indeed been incorrectly drawn up.

The research found that more than a third (38%) of people who contested medical bills saw their bills reduced or even eliminated.

“Our findings highlight a troubling reality: Even with health insurance, many Americans struggle to navigate a complex and often opaque health care system,” said Dr. Joseph Betancourt, president of the Commonwealth Fund.

The results show that the same is true for convincing insurers to reimburse medical services. Many applications are wrongly rejected.

Nearly 17% of patients did not receive reimbursement from their insurer for a doctor-recommended treatment.

But half of adults who appealed a coverage denial reported that they were successful in getting some or all of the denied services approved, the researchers found.

Research has shown that these denials of coverage have a direct impact on patients’ health.

Nearly 60% said a refusal led to a delay in their care, and nearly half (47%) saw their symptoms worsen as a result.

“When significant numbers of people with health insurance are faced with unexpected bills and are denied care recommended by doctors, our health care system is failing patients,” said researcher Sara Collins, senior researcher at the Commonwealth Fund and vice president for health coverage and access.

“And much of this failure can be attributed to insurers’ complex billing practices and loopholes in the law that contribute to a lack of accountability for these billing errors and wrongful denials of coverage,” Collins added in a Commonwealth Fund news release.

Of those who did not object to an error in an invoice, more than half (54%) said they did so because they were unsure whether they had the right to do so.

This uncertainty was most common among low- to middle-income people, people under age 50, and adult Latinos.

Research has shown that young adults (19-34 years old) are most often unaware of their rights. 60% do not know that they can challenge a bill.

The research found that people under the age of 50 are most likely to not know where to turn when medical billing errors are reported.

“Patients deserve better. They shouldn’t have to navigate a maze to get the health insurance they and their employers pay for and the care their doctors prescribe,” Collins said.

The federal government should tighten oversight of denied claims, as required under the Affordable Care Act, and implement policies that penalize insurers that frequently wrongly deny coverage or make errors in claims, researchers say.

“Being wrongly denied care and fighting to get what is needed for patients’ health and well-being is exhausting and demoralizing for both patients and physicians,” Betancourt said. “Especially as some commercial insurers report record profits, we must ensure that health insurance lives up to its promise to protect people’s health and financial well-being.”

The report, published on August 1, is entitled Unexpected health care bills and insurance denials in the US

It is based on a survey of 5,602 US adults, who were interviewed by telephone and online between April 18 and July 31, 2023.

More information

Consumer Reports has more information about correcting medical billing errors.

SOURCE: Commonwealth Fund, press release, August 1, 2024

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