Close to half of adults said they received a medical bill or a copayment for a service that they expected to be free or covered by insurance.
However, relatively few challenge these bills, a new survey from the Commonwealth Fund shows.
Researchers polled more than 7,800 American adults and found that 45% of insured, working adults were hit with an unexpected bill or copayment, and 17% said that their insurer denied a claim for a service ordered by their doctor. Fewer than half of these people, though, challenged these costs, according to the survey.
In more than half of cases (54%), the bill or copay was not challenged because the patient didn't realize they had the ability to push back, according to the survey.
“When substantial numbers of people with health insurance are facing unexpected bills and having doctor-recommended care denied, our health care system is failing patients," Sara Collins, co-author of the study and the Commonwealth Fund's vice president for healthcare coverage and access, said in the press release. "And much of this failure can be attributed to the complex insurer billing practices and loopholes that fuel a lack of accountability for these billing errors and unfair coverage denials."
"Patients deserve better—they shouldn’t have to navigate a labyrinth to use the health insurance they and their employers are paying for, and the care their doctors are prescribing," she said.
Uncertainty around challenging unexpected costs was highest for people with low or moderate incomes, people under the age of 50 and Hispanic adults, according to the study. Sixty percent of younger people, especially those aged 19 to 34, were unaware of their rights around challenging insurer decisions.
The study also found that when patients do push back on claims denials or unexpected costs, they often win. Half of those who challenged a denial were able to get some or all of the denied services approved.
In addition, 38% of those who disputed a bill were able to reduce or eliminate their charges, according to the study.
Success rates were highest in Medicare at 61% and next-highest in Medicaid, with 46% of enrollees seeing bills reduced or eliminated after a challenge.
Sixty percent of those who faced a coverage denial saw their care delayed, and 47% said their health conditions worsened because of it. This should spur policymakers to look at ways to strengthen consumer protections, the researchers said.
The Department of Health and Human Services could do more to monitor claims denials, the researchers argued, and regulators could put in place greater penalties for insurers that repeatedly deny coverage unfairly. State and federal programs can also do more to educate consumers about their rights in challenging denials and unexpected bills, they said.
Editor's note: A previous version of this story incorrectly named Sara Collins.