Dive Brief:

• One in five American adults reported receiving a surprise or unexpected medical bill this year even though the federal ban on surprise bills went into effect Jan. 1.        
• Morning Consult found 21% of surveyed adults said they received a surprise or unexpected bill from an out-of-network provider at an in-network facility, and 32% said the unexpected bill originated from lab work collected at an in-network facility and sent out-of-network. 
• The survey, conducted in June of more than 2,200 people, found 22% of adults paid more $1,000 on unexpected medical bills this year.     

Dive Insight:

A majority of adults surveyed by Morning Consult said they know nothing about the law that went into effect this year, which protects consumers from getting saddled with surprise medical bills in most cases.  

And 38% adults feel somewhat confident they would be able to resolve a surprise bill with either their provider or insurer, according to the survey, while 25% felt very confident. 

The No Surprises Act shields patients from surprise medical bills in most instances. The legislation tackled a nagging problem in the nation's healthcare system: patients stuck between payers and providers over payment disputes. 

It protects patients from owing the balance of a medical bill, like when a patient goes into an in-network facility for care but is unknowingly treated by an out-of-network physician. That physician sends the bill to the insurer, which only pays for a portion and leaves the patient with the remainder of the surprise out-of-network  bill. 

The survey results point to the complexity and weaknesses in the existing law.

Patients are not protected from surprise bills related to lab work in all instances. A patient is not protected from a balance bill if a physician in a doctor’s office orders blood work as part of a routine annual exam but that blood work is sent to an out-of-network lab. 

However, the law protects patients when the patient is at a hospital, hospital outpatient department or ambulatory surgical center, and services like blood work are sent out of network, according to the law.

A doctor’s office seems to fall outside of that scope, and underscores how these subtleties in facility definitions may prove confusing to patients.  

The prompt asked whether patients received a surprise bill for "lab work at an in-network hospital or health care facility that was sent to an out-of-network lab for assessment.”

While the law protects patients in this instance, respondents may have answered in the affirmative if they received blood work at the doctor’s office given they may consider that a healthcare facility.  

Of the respondents who said they did receive a surprise bill, the second most cited reason was in-network care that resulted in lab work sent out-of-network.