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Six Things Employees Should Know about Surprise Medical Bills

Updated: Feb 28, 2022

by Al Lewis

Our Six Things columns usually focus on issues that damage employee health due to employee ignorance. Surprise medical bills fit this topic perfectly. Nothing is more stressful for your employees – hence damaging to health -- than an unexpected bill that in some cases is larger than their paycheck.

Fortunately, we have an elegant solution. Don’t believe us? Gamble 4 minutes to read this through…


1. 57% of Americans have reported receiving a surprise medical bill

Maybe you are one of them? Two of us here at Quizzify have had that experience. In one case, it was a $38,000 bill for…stitches. (In all fairness to the ER that treated him, that included the bandage and the Neosporin too.)

His share amounted to $8000, which the insurance company mostly “waived,” meaning that his employer at the time paid the remainder, likely without looking twice at it. Certainly he never heard from anyone again.


2. This is most common for emergency room visits

For the most recent year available, 2016, 42.6% of all in-network in-hospital emergency department visits generated at least one surprise bill, with over 80% of ambulance trips generating one.


3. Surprise medical bills are not an accident – and get sent even to employees who know enough to stay “in-network”

One of the bigger scams in healthcare is to staff in-network facilities with out-of-network doctors. This often happens at off-hours – which of course is exactly when people tend to need to visit emergency rooms. Emergency room physicians have also figured out that while collusion is illegal between group practices, the same endpoint – charging high prices by refusing to sign in-network contracts – can be accomplished by joining together into a single group. The hospital and carrier thereby lose all leverage.

It isn’t just emergency care physicians. Radiologists, anesthesiologists, and pathologists often send surprise bills in general, and especially for work done in conjunction with emergency visits.


4. There is an entire industry – free-standing emergency rooms – whose business model is to surprise-bill patients.

You must educate your employees to steer clear of these beasts. The freestanding ER industry is so sketchy that these facilities aren’t even legal in about half the states. (In some of the states in which they are legal, they have to be hospital-affiliated…a status which often allows them to tack on a “facility fee.”) They are usually designed to mimic urgent care centers, like these:

The building does say “Emergency” on it but, after all, isn’t that what urgent care centers treat?