Sue Ducat
Director of Communications
(301) 841-9962

From Health Affairs:

Some Emergency Department Patients Receive Unexpected Bills Afterward

Bethesda, MD—Surprise medical bills—an unexpected bill from an out-of-network provider or a bill from an out-of-network provider not chosen by a patient—have been in the news recently. A new study, released by Health Affairs as a Web First, found that in 2014, 20 percent of US hospital inpatient admissions originating in the emergency department (ED), 14 percent of outpatient visits to the ED, and 9 percent of elective inpatient admissions likely led to a surprise medical bill. This is a decrease from 2007 when those rates were nearly 28 percent, 18 percent, and 14 percent, respectively. The data evaluated were for 2007–14 and came from the Truven Health MarketScan Commercial Claims and Encounters Database. The authors reviewed claims for nonelderly patients with employer-sponsored health insurance.

Other key study findings:

  • The likelihood of receiving a surprise medical bill increased with a patient’s age and the complexity of his or her diagnosis.

  • Surprise medical bill rates for ED patients differed significantly across states, with the some of the highest 2014 rates in Florida (37 percent), New York (35 percent), and Texas (34 percent) (see the exhibit below). 

One In Five Inpatient Emergency Department Cases May Lead To Surprise Bills 

By Christopher Garmon and Benjamin Chartock

Both authors are affiliated with the Federal Trade Commission in Washington, D.C.

This study, part of Health Affairs’ DataWatch series, will also appear in the journal’s January issue.

While previously published research on this topic, including a recent Health Affairs Blog, has covered this subject, this is the first study to analyze surprise medical bills using a data set of multiple health insurers across multiple years. As part of their conclusion, the authors note that the rate of surpise medical bills may be even higher for patients with Marketplace plans, since many of these plans have narrow hospital and physician networks, something Marketplace customers are likely not to realize.

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print and online, with frequent Web First studies and health policy briefs published at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, it then switches to pay-per-view for nonsubscribers. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the iPad app.