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Editorial
August 12, 2019

Ending Surprise Medical Bills

Author Affiliations
  • 1Editor at Large, JAMA Internal Medicine
JAMA Intern Med. Published online August 12, 2019. doi:10.1001/jamainternmed.2019.3382

A surprise medical bill refers to unexpected charges incurred when a patient with health insurance receives care from a physician, hospital, or medical transport service that is not part of the insurer’s network. These charges can arise in an emergency, when a patient may not have the ability to choose the emergency department, the physicians, or the ambulance service. Or they can arise as part of otherwise routine in-network care, such as when a patient is treated at an in-network hospital or outpatient facility. A common reason is that certain physicians, such as an anesthesiologist, an emergency department physician, a pathologist, or a radiologist, may not participate in a health insurer’s network and bill the patient directly. Depending on the circumstances, patients may be responsible for the entire bill or the difference between the amount allowed under their health insurance and the amount billed, which is known as balance billing. Surprise medical bills frustrate and enrage insured patients, defeat the purpose of being insured, and they may cause financial hardship. They are also 1 of the few aspects of the fractured, expensive, and sometimes dysfunctional US health care system that Congress may soon address with bipartisan legislation.

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