What Patients Really Do NOT Want: Surprising Medical Bills

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The Bill From the Ambulance Ride

Like many newlywed couples, my husband and I were broke and inexperienced when we first got married.

We were a recipe for disaster in Dave Ramsey’s book. For you see, both of us are “free spirits,” and lacked the necessary balance a “nerd” would have provided.

If I lost you on that last sentence, feel free to click here for an explanation.

Responsibilities quickly grew (namely in the form of four children within three and a half years), and the financial pressures stacked up. Suddenly the skill of creating and managing a budget became extremely necessary.

Although we have more money now than we did then, my husband’s currently a full-time pastor and I’m a full-time mom – not exactly financially lucrative careers. Yet, for the most part, we live comfortably and without financial anxiety because we have learned how to budget what we do have and live within those means. You will not find us at the Tesla dealership or vacationing in Paris because that would most likely wreak havoc on our budget. I like to think we live simple, grateful lives. We prefer to buy what we can afford because life is already stressful enough without the added pressure of debt. (Can I get an amen?)

Likewise, when I had an asthma attack a couple of months ago, I avoided calling an ambulance because I knew from previous experience that would result in a bill outside of our budget. However, I quickly realized when it comes to life and death situations, sometimes you just need to foot the bill. We made it about ten minutes down the road when we decided to call an ambulance. Guess what now hangs on our refrigerator next to our children’s artwork – the bill from that ambulance ride.

Although it was absolutely the right decision to call an ambulance in that specific scenario, it turns out I’m not the only person who hesitates to reach out for medical care due to finances.

According to PatientCo’s 2020 survey report, one in four patients have delayed medical treatment because of cost concerns and as a result, had their condition worsen. (1)

What’s even more shocking is that one in four Americans said they would rather have their entire wallet stolen than receive a five-hundred-dollar surprise medical bill. (1) That illustrates a very strong disdain for surprise medical bills!

Bottom line: patients do not like to be surprised by medical bills and it’s a frequent misfortune in healthcare right now with one out of three patients having never received a price estimate before treatment. (1)

COVID-19 Affecting Budgets

According to PatientCo’s 2020 survey, “The Coronavirus pandemic has amplified the frustrations that patients face when paying for their healthcare expenses. As patients see their income and health insurance status shift because of the economic implications of the pandemic, they are being forced to make difficult budgeting decisions on how and when to pay their healthcare expenses. Paying a healthcare expense is being weighed amongst other necessities such as groceries, mortgage and rent and other debts.” (1)

Seventeen percent of all American households lost half or more of their income due to the pandemic according to Business Insider’s article, “10 Charts that Show how the Coronavirus has Changed Americans’ Spending, Saving, and Future Plans.” (1)

More specifically, the younger generations were negatively impacted the most. Twenty-one percent of millennial households lost half or more of their income. (2)

That’s a huge number given Erin Duffin’s report stating that millennials have passed Baby Boomers as the largest generation group in the U.S. in 2019, with an estimated population of 72.1 million. (3)

Millennial Patients

If we know millennials make up the largest population in America, and that they took the hardest financial hit due to COVID-19, I think it would behoove us to zoom in on their financial healthcare experience.

In her article titled, “What Different Generations Want in Healthcare,” Maria Clark writes regarding millennials, “This generation also focuses on the cost of healthcare when making choices. They desire price transparency, a variety of price options, and want plans with high deductibles with lower premiums.” (4)

Furthermore, Clark notes it only takes one bad experience to cause them to switch providers. In this consumer-driven world we live in today it would benefit every healthcare organization to educate themselves on the millennial generation and their desires regarding their healthcare experience.

Backwards Spending

Just before Election Day this year, Monica Wehby writes in her opinion piece, “As most Americans are painfully aware, patients currently don’t know how much they will pay for healthcare until after their bills show up weeks and months later in the mail.” (5)

Seems a bit backwards, right? The previously given example of my choice to call an ambulance was a matter of life or death, but a lot of healthcare decisions are not always as black and white.

Patients sometimes have options of treatment that range in price. Just like most people don’t purchase a car or a house without first knowing the price, patients shouldn’t have to be blindsided by their medical bills after they’ve been treated – consequently putting them in a stressful (if not devastating) financial position.

Patients desire to have conversations with their providers ahead of time regarding potential costs and options of treatment.

Inform and Empower

Recently Cleveland’s University Hospitals unveiled its new UH Hospitals Price Estimator tool to help improve financial transparency for their patients. Local CBS News 5 quotes UH Chief Revenue Cycle Officer, Kathy LeBrew in their news report: “Part of this is just doing the right thing for the patient, right? Empowering them with information so they can make informed decisions about their care.” (6)

Upfront transparency regarding potential medical costs does exactly that – it informs patients and empowers them to make decisions in their best interest.

Financial Reputation

Optum’s article, “Meeting Patient’s Financial Expectations: Is Your Billing Process Helping or Hurting Your Reputation” grabbed my attention.
The article highlights how billing transparency is also in the best interest for providers and healthcare facilities.

Authors Morgan Haines and Samantha Wyld write, “When patients reported a poor experience with the business office, only 25 percent paid their bills in full. But when patients reported being very satisfied with the business office experience, the paid-in-full percentage reached nearly 75 percent.” (7)

In addition to patients paying their bills, a positive financial healthcare experience also attracts consumers, drives patient loyalty, and improves patient retention.


Research shows patients are highly aware of how they are spending their resources and desire a compassionate and honest financial healthcare experience now more than ever.

The patient’s last impressions of your organization is with your billing department and one that will most likely determine if they schedule a return visit.

What kind of impression is your healthcare organization leaving?

Please let us know if you have comments or questions, and subscribe to our Email Updates, so that you can be assured to receive Thinking Thursdays TIPs.

Thank you!

Jerry L. Stone
MedicalGPS, LLC.


  1. https://www.patientcolife.com/
  2. https://www.businessinsider.com/personal-finance/charts-show-how-coronavirus-changed-americans-finances-2020-10
  3. https://www.statista.com/statistics/797321/us-population-by-generation/
  4. https://etactics.com/blog/generations-in-healthcare#gen-y=
  5. https://www.insidesources.com/trumps-final-health-insurance-rule-completes-his-price-transparency-trifecta/
  6. https://www.news5cleveland.com/news/local-news/investigations/what-am-i-paying-medical-bill-transparency-and-a-tool-that-will-help-you
  7. https://www.optum.com/business/resources/advisory-insights/patient-financial-experience.html

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