er visits

New England Journal of Medicine: 22% of Surprise Medical Bills occur in ER Visits

Have you ever experienced a situation when you have been made to pay a bill twice for the same product? This is exactly what is happening in the healthcare industry. According to a recent study published in the New England Journal of Medicine, surprise medical bills have been presented to 22% of ER visits or Emergency Room visits.

The most common reason for these shocking and surprising bills is the “in-network” factor in your insurance plans. The ER that you have visited might be within the “in-network” coverage; however, the ER doctor might not be within the same network. The reason behind this problem is that there are several insurance companies that have negotiated certain financial arrangements with medical service providers. These service providers are the “in-network” providers. However, if you are being treated by a medical facility or practitioner who is not within the network, the chances of you getting these surprise bills is rather high.

Most people tend to forget this factor when visiting an ER. That’s completely understandable because in an emergency situation, preliminary treatment is the most important. But if you are with some helping hands in such an emergency, it is better to mention this issue to them so that they can quickly check out all “in-network providers” and then select the doctor and medical clinics based on this list.

However, after all these cautious steps, you might still come across some surprising medical bills. Here are some of the possible reasons:

Missed Out Insurance Payments

Have clear idea about the insurance coverage, as it is possible that the covered amount might be missed by accountants. It pays to make sure that the presented bill has been prepared after excluding the entire coverage amount as per your insurance coverage.

General Billing Blunder

Mistakes happen, and could be as basic as a wrong name, wrong insurance company’s name, and wrong insured amount – any of these that have been entered by the hospital staff members. Check your bill to ensure that you are not paying the wrong bill.

Bill Ambiguity

Same name, different surname – there are chances that another person with the same name as yours is also getting treated at the same hospital. That can and does lead to billing errors. Ensure that the details given in the bill pertain to you before making the payment.

Delay by Insurance Company

There are a few insurance companies that are extraordinarily lethargic in making the bill payments but very active while signing the insurance agreement with customers. In such a case, the hospitals would not hesitate to include everything in the amount to be paid by you. Work on sorting the issue with the hospital, doctor’s chamber and also the insurance company. Make documentation for each and every conversation on this. If payment is still kept on hold, contact the state or local insurance department and raise this issue with them.

Change in Insurance Terms and Policies

There are actually a lot of negotiations that take place among the clinics, hospitals, practitioners and insurance companies. As a result, terms get altered time and again, the effect of which is experienced by the insured person in terms of coverage. Make sure to read and record every mail from the insurance company mentioning any changes in its terms and policies.

Missed Negotiation

Remember one thing….hospital bills are not fixed. Speak out and discuss any financial problem that you have with the hospital authorities. Negotiate! Surprisingly, the bills might come down.


  1. Johnson, C. Y. (2016, November 17). The surprisingly common reason your medical bill might be higher than you expect. Retrieved December 01, 2016, from
  2. Rice, S. (2016, November 29). Surprise medical bills occur in about 22 percent of ER visits. Retrieved December 01, 2016, from
  3. VILAS-BOAS, E. (2016, November 18). HERE’S WHY YOUR MEDICAL BILLS ARE SO FREAKING HIGH. Retrieved December 01, 2016, from
  4. Zack Cooper, P. a. (2016, November 17). Out-of-Network Emergency-Physician Bills — An Unwelcome Surprise. Retrieved December 01, 2016, from

About the Author:MedConverge

Leave a Comment