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Nearly 40% of Patients Find Medical Bills Confusing

Analysis  |  By Jay Asser  
   December 21, 2022

A survey reveals what frustrates Americans about the financial experience after receiving care.

Medical bills are more likely to come across as confusing than straightforward to patients, according to a YouGov survey commissioned by revenue cycle firm AKASA.

Responses were fielded from 2,206 Americans between March 9 and March 14, 2022, to gauge patient burden with the billing experience. The results show that patients are confused by bills in general and have frustrations with specific parts of the billing process.

Nearly one in five respondents (19%) said bills were extremely confusing, while another 19% found bills somewhat confusing. On the other end of the spectrum, 11% answered that bills were not confusing at all and 14% leaned towards bills not being confusing. The most chosen answer, by 37% of respondents, was neutrality on the confusion of bills.

Amy Raymond, VP of revenue cycle operations at AKASA, said of the findings: "The rise of high-deductible health plans, the uncertainty of what's being billed, the complexities of in- and out-of-network charges, and how much patients are on the hook for makes understanding and managing medical bills challenging for many families."

Additionally, the survey asked respondents what parts of the financial experience after seeking medical care frustrates them the most.

Most of the respondents (29%) identified being able to understand what they're being billed for as the biggest source of frustration, while 27% chose uncertainty on if they can pay the bill. Not getting the bill until weeks after they received service (24%) and uncertainty if the final bill will be consistent with the estimate of responsibility (20%) rounded out the selections.

Finally, the survey asked respondents what would be most helpful in allowing them to understand how much they are expected to pay for care or services. More than a quarter (27%) chose a call before the procedure from the provider to walk through what's expected and payment plan options as the most helpful.

That option was followed by an online calculator to help determine cost ranges for care or procedures (12%), an email from the insurance company to walk through the bill after receiving care or services (11%), a call from the insurance company for the same assistance (9%), access to live online customer service through their insurer's website (9%), and a call from the provider to walk through the bill after receiving care or services. Nearly another quarter (24%) of respondents chose none of the above.

"These results show that medical billing is still a black box to patients," Raymond said. "The onus is on healthcare organizations—both providers and insurers—to make medical billing less painful for patients, who may fear going into debt and avoid seeking out care. One critical tool healthcare leaders can leverage to course correct on medical billing and make it more seamless for patients is automation."

Jay Asser is the contributing editor for strategy at HealthLeaders. 


Responses fielded by a YouGov survey, commissioned by revenue cycle firm AKASA, show that patients are confused by bills and have frustrations with specific parts of the billing process.

More respondents either find bills extremely confusing (19%) or somewhat confusing (19%), compared to those that say bills are not confusing (11%) or lean towards bills not being confusing (14%).

The two aspects that cause the most frustration with the billing process are what is included in a bill and if patients can pay it.

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