Back to Stories

Consumers Don’t Understand Insurance Plans Or Bills, Survey Shows


Photo by Heidi de Marco/KHN

A new survey from Bankrate is highlighting just how opaque and confusing insurance coverage and subsequent bills are for many Americans. The survey found that 41 percent of consumers that received medical treatments were surprised by the cost.

The story is all too familiar: someone heads to the doctor, gets treatment, is slapped with a stunning bill a few weeks later, and they don’t understand why.

Jeremy Urbas, a former director at Blue Cross Blue Shield, leads a company that is working to simplify communications between players. He believes that many consumers do not understand their health insurance benefits.

“Even the most well-designed bill can still be confusing because the patient doesn’t understand their insurance,” says Urbas. “Before even seeking care, the patient needs to have an understanding of what their benefit is of their insurance. If they don’t, receiving their bill is going to be even more confusing.”

Urbas advises consumers to ask as many questions as possible before receiving treatment. Understanding what will be covered can help consumers avoid sticker shock and surprise bills.

When consumers do receive a shocking medical bill, it is important to examine the bill’s coding. A staggering 80 percent of medical bills have a coding error, according to Bankrate. While many consumers do not understand the coding associated with their medical bills, they can still check their bills thoroughly. Urbas says that consumers should read their explanation of benefits (EOB) to ensure everything is correct.

"This is where your relationship with your insurer is really important,” says Urbas. “That EOB is the anchor for you to determine if your bills are accurate and if you’re being asked to pay for something you shouldn’t.”

Urbas tells consumers that they should dispute incorrect bills and ensure that medical bills are correct before they start paying them off, as a Consumer Reports survey found that “more than one-third of respondents had paid a bill they were not sure they owed.” Nonetheless, consumers should continue to communicate with the entities contacting them about their medical bills. If bills are ignored, they can be sent to collections and impact consumers’ long-term financial health.


Back to Stories