Rutgers Poll Reveals Widespread Surprise Medical Bill Problem

Over the course of a year, more than 400,000 New Jersey families receive large medical bills they don’t expect, according to the findings of a Rutgers Center for State Health Policy (CSHP) poll released today.

These surprise medical bills almost equally affect families with or without health insurance and are just about evenly split between in- and out-of-network providers among families with insurance, suggesting that the problem will be eased – but not solved – by recently passed state legislation. Unexpected medical bills have been a controversial issue nationally and in New Jersey. After years of debate, the New Jersey Legislature in April passed, and Gov. Murphy is expected to sign, the Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act. This legislation requires more upfront disclosure to make patients aware if they are dealing with an out of network service provider.

The results come from the second of three annual Rutgers CSHP Health & Well-Being Polls funded by the Robert Wood Johnson Foundation. The poll was conducted in the fall of 2017.

“So many people receive surprise bills because the information our health care system provides to patients is often difficult to interpret, especially for those with multiple or complicated health conditions,” said Joel Cantor, distinguished professor of public policy and director of Rutgers Center for State Health Policy. “Those least able to absorb the financial shock of large, unexpected medical bills are most likely to receive them.”

One in seven New Jersey adults polled reported that someone in their family living with them received a large, surprise medical bill in the previous year, which comes to 428,743 New Jersey families. The poll results quantify the extent of the problem that the new legislation addresses.

The prevalence of large, unexpected bills rose to around one in five among such groups as:

  • Lower income families
  • Those with less than a high school education
  • Asian, Hispanic and black non-Hispanic residents
  • People who reported being in poor health.

The poll left it to respondents to define what they consider to be a large bill, so it is not unexpected that patients with lower incomes would consider more bills to be large enough to be a problem. Those experiencing a health crisis may receive separate bills from emergency room doctors whose names they don’t recognize, other providers who render services throughout their hospital stay – for example, an anesthesiologist – and potentially even the ambulance that transported them. Separately, the hospital will send bills for facility charges.

Though the new reforms would restrict the amount that health providers outside of a policyholder’s insurance network may charge, the poll results show that a somewhat greater portion of insured people surveyed said they received large, unexpected bills for services provided within their network than from outside.

Among those with public or private insurance, respondents revealed:

  • 48 percent said they received surprise bills from in-network providers
  • 43 percent from out-of-network providers
  • 9 percent said they didn’t know whether the bills were from in or out of their network.

It is common for private and government-sponsored insurance to cover only the specific providers within their networks. The recently passed legislation requires health care facilities to more thoroughly disclose whether they are in or out of a patient’s insurance network and to clearly post on their website a list of standard charges. Insurance carriers would be required to more frequently update their list of in-network providers, among other reforms.

“While the poll results make it clear that the reforms passed by the legislature would go a long way to address the cost of surprise medical bills, they also show there is a deeper problem rooted in the complexity of our health care system that will require additional steps,” Cantor said.

“Making sure that patients know what bills to expect is clearly a responsibility of health care providers and insurers,’’ Cantor said. “Patients and their families also have the responsibility to ask about what services they will be receiving and what charges to expect.”

The New Jersey Health & Well-Being Poll was funded by the Robert Wood Johnson Foundation ( and designed and analyzed by researchers at the Rutgers Center for State Health Policy ( The poll was conducted in English and Spanish from October 12 through November 19, 2017, with a sample of 1,052 respondents. Interviews were conducted by landline (n=452) and cell phone (n=600). The sample is designed to be representative of New Jersey adults, and is weighted to match population demographic and telephone status distributions. The margin of sampling error for weighted estimates based on the full sample is plus or minus 3.7 percent (subgroup results have higher margins of error). Additional details about the poll are available in a methodology report.

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