Surprise Medical Billing in New Mexico - OSI · OSI/RWJF: NM Surprise Medical Billing Study 6 3.2 New Mexicans’ Experiences with Surprise Billing The primary goal of this study

Surprise Medical Billing in New Mexico

Results from the 2017 New Mexico Office of Superintendent of Insurance &

UNM RWJF Center for Health Policy Surprise Medical Billing Study

December 20, 2017

Barbara Gomez-Aguinaga

Gabriel R. Sanchez

Eric Griego

Sam Howarth

Robert Wood Johnson Foundation Center for Health Policy

University of New Mexico

A Publication of the RWJF Center for Health Policy

Preparation of this Research Brief was supported, in part, by a grant to the University of New Mexico from the Robert Wood Johnson Foundation. The views expressed in this report are those of the authors and do not necessarily represent those of the RWJF Center for Health Policy, the University of New Mexico, collaborating organizations, or funders. Editor-in-Chief, Gabriel R. Sanchez, Ph.D. Phone: 505-277-0130 Email [email protected] Location 1909 Las Lomas Road, Albuquerque 87131 Copyright @ University of New Mexico – December 2017.

OSI/RWJF: NM Surprise Medical Billing Study

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1. Introduction In August through September 2017, the UNM RWJF Center for Health Policy surveyed a

total of 554 privately insured adults in New Mexico on behalf of the New Mexico Office

of Superintendent of Insurance (OSI). Participation in the online survey focused on

consumer experiences and was restricted to New Mexico residents who have privately

purchased health insurance through the marketplace or an employer. More specifically, the

survey assessed how frequently consumers received medical bills that they were not

expecting to have to pay.

This phenomenon, known as surprise billing, has been an area of increased concern across

the nation. In fact, recent articles published in both Health Affairs and the New England

Journal of Medicine have documented the growing national trend driven mainly by patients

not being able to avoid seeing a provider outside of their health plan’s contracted network.1

This research has suggested that surprise or unexpected billing tends to be higher among

consumers who have experienced a medical emergency or had major surgery.

Consequently, we explore the prevalence of surprise billing among these sub-groups of

New Mexico’s privately insured population. We also examine whether surprise billing

varies due to other demographic factors through both descriptive statistics and logistic

regression analyses.

The survey also includes information on whether or not privately insured New Mexicans

took any action when they experienced a surprise medical bill, and if so, whether they were

satisfied with the response they received. The survey queried respondents about their

satisfaction with their health insurance plan through a self-reported grade and their overall

experiences with their health care plan. The survey was designed to allow for comparisons

between New Mexico healthcare consumers and a national estimate from a 2015 study

conducted by the Consumer Report National Research Center.2 The results of the New

Mexico survey are timely and provide stakeholders with valuable information that can be

utilized to improve the experiences New Mexicans have with their privately purchased

health plan.

1 http://healthaffairs.org/blog/2017/02/01/stopping-surprise-medical-bills-federal-action-is-

needed/ 2 http://consumersunion.org/research/surprise-bills-survey/

http://healthaffairs.org/blog/2017/02/01/stopping-surprise-medical-bills-federal-action-is-needed/

http://healthaffairs.org/blog/2017/02/01/stopping-surprise-medical-bills-federal-action-is-needed/

http://consumersunion.org/research/surprise-bills-survey/


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2. Summary of Major Findings Six out of 10 privately insured New Mexicans give their plan a grade of ‘B’ or higher.

We found that 35% gave their plan a “B” and 25% gave their plan a grade of “A.”

However, among respondents who received a surprise medical bill, few (12%)

would give their health plan an ‘A’ for its response; most (47%) gave their plan a

grade of ‘C’ or lower.

Twenty percent of privately insured New Mexicans received a surprise medical bill.

In the past two years, 20% of privately insured New Mexicans received a surprise

medical bill (a medical bill they were not expecting to pay / health plan paid less

than expected).

o This is higher for those who have had surgery (36%) or had to visit the

emergency room (55%).

Among those who received a surprise medical bill, 46% received a bill from a

doctor they did not expect to get a bill from; 26% indicated that they received

separate bills from multiple providers; 28% indicated that they were charged an

out-of-network rate when they thought that the provider was in-network.

While many (67%) took action to resolve their billing issue, nearly a third (31%)

did not.

Over three-quarters of privately insured New Mexicans had at least one problem with

their insurer.

In the past two years, over 3 in 4 (77%) privately insured New Mexicans had at

least one problem (e.g., billing issue, coverage denial, difficulty getting an

appointment with a doctor, delays in receiving care or treatment, etc.) with their

health insurer, with many having more than one problem.

The most commonly cited problem in the sample were issues related to billing or

payment for medical services at 36%, and another 25% noting they had a problem

with health services their plan does not cover.


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3. Full Report

3.1 New Mexicans’ Healthcare Plan Satisfaction As reflected in Figure 1 below, the majority (60%) of New Mexicans give their health care

plan a strong grade of “A” or “B.” While 25% of respondents give their plan an “A” or

excellent grade, another 35% gave their plan a “B” or good grade. We find that 27% of

respondents gave their plan a “C,” and only 10% rated their plan with a failing grade of a

“D” or “F.”

Figure 1

New Mexican Satisfaction with Health Care Plan

A – Excellent 25%

B – Good 35%

C – Average 27%

D – Poor 7%

F – Failing 3%

New Mexicans appear to have similar overall satisfaction levels with their plan than

residents from other states, particularly for “A” or excellent grades. As reflected in Figure

2 below, New Mexicans were more likely to give their plans a “C” or average grade than

national respondents. Finally, while 5% of respondents to a 2015 national survey gave their

plan a failing grade, 10% of New Mexicans scored their plan with a “D” or “F.”

Figure 2

New Mexican Satisfaction with Health Care Plan Compared Nationally

Grade New Mexico US

A – Excellent 25% 27%

B – Good 35% 43%

C – Average 27% 22%

D – Poor 7% 4%

F – Failing 3% 1%


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We looked at satisfaction levels across a number of other consumer profiles and found

several important sources of variation. For example, as depicted in Figure 3 below, the

survey finds that New Mexicans who have had a surprise bill in the past two years were

more likely to grade their plan poorly: 18% of respondents gave their plan a “D” or “F”

compared to only 8% among New Mexicans who did not receive a surprise bill.

Figure 3

The study analyzed whether the grades New Mexicans with privately purchased health

insurance awarded their plans varied based on their carrier. Although we have blinded the

health plan carrier names in this report, OSI will share the results of the report with each

major carrier to help inform their strategies to improve satisfaction levels among their

consumers.

As reflected in Figure 4, there is high variation across carriers with large enough sample

sizes in the data to allow for analysis, with a range of 17% to 37% across the “A” category.

The same is true for failing grades, with company “B” only having 7% in the “D” or “F”

categories. Company E has the highest number of failing grades at 32%. Company “B” has

the highest percentage (64%) in the “A,” and “B” grade ranges followed by company “C”

at 63%. Figure 4

New Mexican Satisfaction with Healthcare Plan of Major Insurance Carriers

Grade Company

A Company

B Company

C Company

D Company

E Company

F

A - Excellent 17% 29% 37% 21% 18% 27%

B - Good 43% 35% 26% 35% 21% 27%

C - Average 30% 27% 22% 37% 25% 33%

D - Poor 5% 6% 10% 2% 18% 13%

F - Failing 4% 1% 3% 5% 14% 0%

12%

41%

29%

12%

6%

28%

33%

27%

6%3%

0

5

10

15

20

25

30

35

40

45

A - Excellent B - Good C - Average D - Poor F - Failing

The Impact of Suprise Billing Experiences on Satisfaction With Health Care Plan

Surprise Bill

No SurpriseBill


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3.2 New Mexicans’ Experiences with Surprise Billing The primary goal of this study was to identify the prevalence of surprise billing in New

Mexico among privately insured adults. There are two approaches commonly utilized to

define surprise billing. The approach taken in the national study we reference is to base

this measure on the following survey question: “In the past two years have you received a

medical bill where the health plan paid much less than you thought it would (or perhaps

not at all)?”

Another measure of surprise billing that we reference in our report is based on the following

response categories provided to respondents who indicated on the more general question

referenced above that they experienced surprise billing:

I got a bill from a doctor I did not expect to get a bill from.

I got separate bills from multiple providers.

I was charged at an out-of-network rate when I thought the provider was in

network.

As reflected in Figure 5 and the infographic below, 20% of New Mexicans who are

privately insured received a surprise medical bill in the past two years based on this

narrower measurement approach.

This is lower than the national estimates, as 30% of a 2015 study conducted by the

Consumer Report National Research Center reported experiencing a surprise bill.

However, if we apply the more general indicator employed in that report, it is important to

note that New Mexico would have a much higher rate of 46%.3 We present both sets of

results across the report.

3 The main difference between the two measurement approaches is that the narrower measure

excludes responses for the total amount being higher than they expected, or who were charged for

services they did not receive. We believe that these are issue more associated with billing mistakes

or fraud and not surprise billing so we exclude from our measurement approach.

More than 1 in 5 New Mexicans had an in-

or out-of-network surprise


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Figure 5

Among privately insured New Mexicans who received a generally-defined surprise

medical bill, 46% received a bill from a doctor they did not expect to get a bill

from. Another 26% of privately insured New Mexicans reported that they had separate bills

from multiple providers, and 28% indicated that they were charged an out of network rate

when they thought that the provider was in-network (Figure 6).

Figure 6

20%

30%

0%

5%

10%

15%

20%

25%

30%

35%

New Mexico National

Surprise Billing Percentage - New Mexico (2017) vs. National (2015)

Bill from a doctor I didn’t expect to get a

bill from46%

Separate bills from multiple

providers26%

Charged an out-of-network

rate28%

Type of Surprise Bill


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Experiences with surprise billing are driven by many factors identified in the data (Figure

7). For example, surprise billing is higher for those who have had to visit the emergency

room or have been hospitalized in the past two years (27%), as well among those who have

had surgeries (26%).

Figure 7

No Emergency

Room

Emergency

Room

No

Surgery Surgery

Surprise

Bill 16% 27% 18% 26%

We also explored whether experiences with surprise billing varied by region across the

state of New Mexico. As reflected in Figure 8 below, there is a minor difference between

rural and urban respondents, with 20% of respondents who live in urban areas reporting

that they have experienced surprise billing compared to 21% in rural areas. When we

look more closely at the urban residents in New Mexico across the major urban counties,

we see that the Albuquerque metro area had the lowest levels of surprise billing (18%),

compared to 24% in Santa Fe County and 23% in Doña Ana County.

Figure 8

Albuquerque Metro Area

Santa Fe County

Doña Ana County

Rural Urban

Received a Surprise

Bill 18% 24% 23% 21% 20%

In addition to the percentages we have referenced in the report, we also conducted

regression analysis to identify factors that are statistically correlated with receiving a

surprise medical bill in New Mexico while holding other relevant factors constant.

Consistent with the descriptive statistics, the logistic regression model reveals that

privately insured New Mexicans who were hospitalized or had an emergency room visit in

the past two years are more likely to have had a surprise bill. This relationship is

statistically significant. However, none of the other variables in our regression model were

statistically significant, strongly suggesting that hospitalization and trips to the emergency

room are major drivers to surprise billing in New Mexico. See the appendix for these results

and the percentages for all core content in the survey.


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The survey also asked respondents who had negative experiences with billing if they took

any steps to resolve this billing issue. The vast majority of these respondents (67%)

indicated that they did take action. Respondents who reported that they did take action were

asked to provide the specific action they chose to take to attempt to resolve the issue. These

results are provided below in Figure 9. Among those who took action, 75% indicated that

they contacted someone at their health care plan, and 58% noting that they contacted their

physician’s office. Another 27% referred to their health insurance plan to try and resolve

the issue. Only 15% took the more aggressive step of filing a complaint or requesting an

appeal.

Figure 9

The final set of questions in this battery of items focused on surprise billing is whether

New Mexicans who took action were satisfied with how the issue was resolved. As

reflected in Figure 10, only 22% of the sample was satisfied with how the issue was

resolved. While 33% noted that the issue was ultimately resolved, they did not like how it

was resolved. Just over a third (36%) reported that the issue was either not yet resolved

(23%) or is still currently in the process of being resolved (13%). Of this group, many

either paid the bill in full (64%), through a payment plan (19%), with a much smaller

percentage (10%) negotiating a lower bill.

75%

58%

27%

15%

2%

3%

5%

3%

7%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Contacted someone at the plan

Contacted my physician/physician's office

Referred to the health insurance plan…

Filed a complaint or appeal

Asked a friend or family member for help

Changed health care plan or health care…

Contacted someone outside of the health plan

None of the above

Other

Which of the Following Did You Try to Resolve the Billing Issue?

(Multiple Responses Allowed)


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Figure 10

Respondents were also asked to provide a letter grade for the response they received for

addressing their issue. While only 6% of respondents who reported an issue with their

billing gave their plan an “A,” 20% of respondents gave their plan a “B.” A much larger

percentage (39%) gave their plan a “C,” with 26% assigning a failing grade of “D” (16%)

or “F” (10%).

Figure 11

The survey asked those who did not take action why they chose not to do so. Nearly half

(47%) of those who experienced a problem with their bill but who did not take action

indicated they did not do so because they did not think it would make any difference.

Another 17% indicated they did not have the time or that it was not worth their time and

9% reported that they were confused about what to do or found it too confusing.

33%

22%

23%

13%

5%

0% 5% 10% 15% 20% 25% 30% 35%

The issue was resolved, but not how I liked.

The issue was resolve to my satisfaction.

The issue was not resolved.

The issue is currently still being resolved.

Unsure

Was the Billing Issue Resolved to Your Satisfation?

10%

16%

39%

20%

6%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

F - Failing

D - Poor

C - Average

B - Good

A - Excellent

What letter grade would you give your plan for its response?


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Figure 12

The survey also asked all respondents how likely they would be to complain about an

unexpected medical bill and nearly half of the sample (46%) indicated that they would be

very likely to complain, with another 18% indicating that they would be somewhat likely

to complain about a surprise bill. One in five privately insured New Mexicans reports that

they are not likely to complain about an unexpected medical bill.

Figure 13

47%

17%

9%

5%

2%

2%

17%

I didn't think it would make a difference

I didn't have time/it wasn't worth my time

I was confused about what to do or found it too…

The problem resolved itself

I didn't know how to take action/where to complain

Unsure

Other

Why Didn't You Take Any Action to Resolve Your Billing Issue?

46%

18%

14%

20%

3%

0% 10% 20% 30% 40% 50%

Very likely

Somewhat likely

Likely complain

Not Likely

Unsure

How Likely Are You to Complain About an Unexpected Medical Bill?


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3.3 Problems with Health Provider

The survey asked the full sample of New Mexico adults who have privately purchased

health insurance if they or anyone covered by their plan had any problems with their

insurance plan over the past two years. Over a third (36%) of privately insured New

Mexicans had problems with their billing or payment for medical services. This data-point

along with the surprise billing numbers discussed earlier in the report indicates that health

insurance billing is a challenge for many New Mexicans.

In addition to problems with billing or paying for medical services, the survey reveals that

there are a number of other problems privately insured New Mexicans have with their

health insurer. For example, 25% of respondents indicated that they had problems with

health services that their plan doesn’t cover, and 17% report that they have experienced

coverage denial over the past two years. Among other notable problems identified, nearly

1 in 4 (24%) of privately insured New Mexicans has had difficulty getting an appointment

with a doctor.

36%

25%

24%

17%

16%

12%

12%

10%

8%

7%

7%

7%

32%

0% 10% 20% 30% 40%

Billing or payment for medical services

Problem w/health services my plan does/does n't cover

Difficulty getting an appointment w/doctor

A coverage denial

Not being able to get the specific medication I need

Being forced to change doctors/my doctor dropped…

Delays in receiving care or treatment

Difficulty getting someone from the plan on the phone…

A problem with a listing in the plan's provider directory

Administrators or other plan staff being insensitive or…

Difficulty getting referrals to see a medical specialist

Other

None of the above

Which, if any, problems did you or anyone else covered by your policy have with your main health

insurer related to…?


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3.4 Health Insurance Rights and Knowledge of State Entities

When asked which entities have primary responsibility for resolving issues with health

insurance billing, the majority (60%) of privately insured New Mexicans believe it is

insurance companies who have primary responsibility (see Figure 14 below). Next in

perceived responsibility are doctors and hospitals at 18%, with only 3% indicating that a

state agency is primarily responsible. 12% of respondents reported that they were unsure

or did not know. When asked whether they know which agency or department in New

Mexico government is tasked with handling complaints about health insurance, 46% report

no compared to 53% who self-report that they know the appropriate state agency or

department.

Figure 14

60%

18%

3%

1%

1%

1%

3%

12%

0% 20% 40% 60% 80%

Insurance company

Doctor or hospital

A state agency

The legal system

A consumer assistance program/non-profit agency

A federal agency

Other

Unsure

Which of the Following Entities Have Primary Responsibility for Resolving Issues With Health Insurance Billing?


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As illustrated in Figure 15, 36% of New Mexicans who are privately insured are unsure if

they have the right to appeal to the state or an independent medical expert if their health

plan refuses coverage for medical services they think they need, and another 5% do not

believe they have this right in New Mexico. This compares to the 58% of respondents who

report that they believe that they have the right to appeal to either a state or independent

medical expert.

Figure 15

When we compare the New Mexico results across these indicators of responsibility for

health insurance complaints and the appeal process to national results from a similar

survey, we see that New Mexicans appear to be more knowledgeable than non-New

Mexicans. More specifically, only 21% of the national sample accurately believed they had

the right to appeal compared to 58% of New Mexicans. We believe that this discrepancy

is likely due to differences in the mode of data collection across both studies. The

implications for this difference in data collection approaches are discussed in more detail

in the methods statement for this study at the end of the report.4

4 Social science research has suggested that web based survey samples like that employed in this

study may have more highly educated and sophisticated respondents than telephone based samples.

See for example: http://www.pewresearch.org/2015/09/22/coverage-error-in-internet-surveys/

58%

5%

36%

0% 10% 20% 30% 40% 50% 60% 70%

Yes

No

Unsure

Do You Have the Right to Appeal to the State/Independent Medical Expert?

http://www.pewresearch.org/2015/09/22/coverage-error-in-internet-surveys/


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3.5 Consumer Knowledge of In- and Out-of-Network Issues

In the past two years, 22% of privately insured New Mexicans have tried to use a

doctor/facility outside of their plan’s network. However, over this same period, 33% have

been surprised to find out that a doctor or lab/facility they thought was in-network, was

out-of-network. Many (70%) privately insured New Mexicans assume that doctors they

see in an in-network hospital are also in-network. Not surprisingly, nearly all respondents

(96%) believe that hospitals should have to notify patients if a doctor/technician involved

in a procedure performed at that hospital will be out-of-network.

While 44% of respondents believe they must pay the extra cost if an error in their plan’s

provider directory causes them to go to a doctor/hospital that is out-of-network, many

(31%) are uncertain about this, and 24% do not believe they are required to pay.


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3.6 Challenges with Health Plan’s Online Provider Directory

A majority (65%) of privately insured New Mexicans have used their plan’s online

provider directory in the past two years. Among those who have used their plan’s online

directory, 76% used the directory while enrolled in their plan to find in-network

doctors/facilities, another 32% before enrolling in their plan.

Figure 16

The majority (74%) of respondents who have used their plan’s online directory found the

directory somewhat easy (53%) or very easy (21%) to use. The survey also found that 81%

of privately insured New Mexicans were able to find the information they were looking for

in the directory.

Figure 17

65%

35%

0% 20% 40% 60% 80%

Yes

No

Have You Used Your Plan's Online Directory?

32%

76%

17%

0% 20% 40% 60% 80%

Before enrolling inthe plan

While enrolled in theplan

At another time

During Which Time Did You Use the Online Provider Directory

21%

53%

21%

5%

0% 10% 20% 30% 40% 50% 60%

Very easy

Somewhat easy

Somewhat difficult

Very difficult

Was the Online Directory Easy to Use?


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The final question in the set of items asked respondents who have utilized the online

directory to provide their satisfaction with that experience. As depicted in Figure 18, over

a third (36%) of privately insured New Mexicans who utilized the directory were satisfied

(completely or very satisfied) with their plan’s directory. Another third of respondents were

fairly well satisfied, and 23% were somewhat satisfied. Only 11% of respondents were not

satisfied with their plan’s online provider directory.

Figure 18

12%

24%

33%

23%

8%

1%

0% 5% 10% 15% 20% 25% 30% 35%

Completely satisfied

Very satisfied

Fairly well satisfied

Somewhat satisfied

Very dissatisfied

Completely dissatisfied

How Satisfied Are You With Your Health Plan'sOnline Provider Directory?


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3.7 Likelihood to Complain to Government Agencies

The final section of the survey asked respondents to indicate if they have ever complained

to a government agency about other problems they have had outside of health care. This

item provides some context in which to evaluate the findings regarding likelihood to

complain about surprise billing to a government or independent agency. New Mexicans are

not likely to complain to government agencies regardless of the problem they were

prompted with. In fact, most (69%) have never complained to a government agency about

any issue, including an error in their credit report or other bills.

Figure 19

69%

7%

3%

2%

3%

2%

2%

2%

1%

2%

13%

0% 10% 20% 30% 40% 50% 60% 70% 80%

I've never complained to a government…

An error in my credit report

Credit cards

A cable bill

Bank fees

New or used car problems

A gas or electric bill

A telephone bill

A car or homeowners insurance bill

Home improvement issues

Other

Which of the Following Have You Ever Complained to a Government Agency About?


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4. Summary of Results In the past two years, a notable amount of privately insured New Mexicans have received

a surprise medical bill. While many took action to resolve this issue, many more New

Mexicans did not choose to do so. A common reason for inaction was the consumer’s belief

that it wouldn’t make any difference, which is a widely-held perception among the

privately insured public. Many respondents expressed confusion about what to do when

they experience problems with their insurance bills. In fact, when we asked consumers

about health insurance policies and the state entities governing health insurers, we found

most consumers are not very well informed about these issues. These survey results suggest

surprise medical bills are a problem in New Mexico, and unfortunately many New

Mexicans are not clear on what to do to resolve these issues when they occur.


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5. Survey Methodology – Demographics of Sample

The UNM RWJF Center for Health Policy interviewed a total of 554 adults in New Mexico

between June 12 and August 15, 2017, on behalf of the New Mexico Office of

Superintendent of Insurance (OSI). The survey was administrated through the internet with

respondents recruited through email messages sent to the address provided by healthcare

providers in the state, advocacy groups, and OSI distribution lists. To be eligible for

participation in the survey respondents had to be: 18+ of age, residents of the state of New

Mexico, and have privately purchased health insurance through the marketplace or an

employer (specifically excluding those enrolled in Centennial Care, Salud, Medicaid,

Medicaid, UNM Care or Tricare). Screening questions were used to ensure that only

respondents who fit those criteria completed the survey. The survey has a margin of error

of 4.3%.

The majority (59%) of respondents indicated that they received their health insurance from

their employer, another 15% from their spouse or partner’s employer. 15% of the sample

indicated that they purchased health insurance through the state health insurance

marketplace (beWellnm.com or Healthcare.gov). The modal category for how long

respondents have had that insurance is four or more years at 48%, another 14% for three

years, 19% at two years, and 18% for one year. As noted in the report, we have attempted

to mirror the national survey conducted by the Consumer Report National Research Center

to make comparisons between New Mexico and the rest of the nation. It is important to

note that given the difference in fielding year (2015 for national study/2017 for New

Mexico) and mode of data collection (web-based for New Mexico/phone for national) the

results across the two studies are not directly comparable. For example, while web-based

surveys are becoming increasingly common in both industry and academic research, web-

only samples tend to have more highly educated respondents than phone or mail based

surveys. Therefore, while helpful for comparison purposes, we suggest that these

differences in methodology and fielding dates be considered when making these

comparisons.

For more information about the poll, please contact Gabriel R. Sanchez, Ph.D. at

[email protected].

mailto:[email protected]


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6. Appendix

Logistic Regression Predicting the Surprise Bills (1) VARIABLES Surprise Bill

(OSI’s definition) Age 0.0857 (0.116) Race/Ethnicity 0.162 (0.154) Education Level -0.0383 (0.129) Employment Status -0.00490 (0.0991) Income -0.0326 (0.0584) Region of Residence 0.0412 (0.0847) Source of Health Plan -0.0802 (0.0770) Emergency Room/Hospitalized 0.609*** (0.230) Surgery 0.215 (0.243) Insurance Company 0.0599 (0.0560) Constant -1.982** (0.854) Observations 530 Log-Likelihood Full Model -264.2 Chi-square test 15.63 Percent Correctly Predicted 79.06

Standard errors in parentheses *** p<0.01, ** p<0.05, * p<0.1


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Q12. Please select the type of health plan that insured you in 2016. If you were

covered by more than one plan, select the ONE plan that you relied on MOST.

US OH FL TX CA NM

A health plan from a

current employer 54 52 53 58 48 59

A health plan from my

spouse's/partner's employer 19 24 17 18 19 15

A health plan through my

parents or parent's employer 9 5 4 6 9 1

A health plan from a

previous employer

(COBRA) 7 8 7 9 8 1

A privately-purchased

health plan that I bought

from the insurance

company or one of its

agents/brokers 6 7 11 4 7 9

A health plan from

healthcare.gov or my state

health insurance

marketplace (beWellnm) 6 5 8 6 8 15

Total (sample size) 2202 588 628 729 787 548


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Q13. How long have you had this insurance?

US OH FL TX CA NM

1 year 17% 17% 21% 19% 16% 18%

2 years 12% 14% 11% 10% 11% 19%

3 years 8% 6% 9% 8% 9% 14%

4 years or

more 59% 62% 57% 61% 62% 48%

Not

applicable 3% 1% 3% 3% 3% 1%

Refused 0% 0% 0% 0% 0% 1%

Total 2202 588 628 729 787 554

Q14. Based on all your experience with YOUR health insurance plan, what letter grade

would you give it?

US OH FL TX CA NM

A - Excellent 27% 24% 22% 23% 31% 25%

B - Good 43% 45% 43% 44% 43% 35%

C - Average 22% 23% 25% 25% 17% 27%

D - Poor 4% 5% 5% 4% 6% 7%

F - Failing 1% 2% 2% 2% 1% 3%

Unsure 3% 1% 3% 2% 2% 2%

Refused 0% 0% 0% 0% 0% 0%

Total 2202 588 628 729 787 556


24

Q15. Over the PAST TWO YEARS, how many times were you or anyone else covered

by your policy in the Emergency Room or hospitalized?

US OH FL TX CA NM

0 55% 47% 59% 56% 58% 57%

1 21% 23% 20% 23% 21% 23%

2 10% 13% 10% 7% 9% 11%

3 5% 6% 3% 3% 4% 3%

4 2% 2% 1% 1% 1% 3%

5 or more 2% 4% 1% 2% 1% 1%

Not applicable 5% 6% 5% 8% 6% 0%

Refused 0% 0% 0% 0% 0% 0%

Total 2202 588 628 729 787 556

Q16. Over the PAST TWO YEARS, how many times did you or anyone else covered

by your policy have surgery?

US OH FL TX CA NM

0 68% 63% 71% 64% 68% 70%

1 17% 21% 18% 19% 18% 20%

2 6% 6% 4% 7% 6% 8%

3 2% 2% 2% 2% 1% 1%

4 1% 1% 0% 0% 0% 0%

5 or more 0% 1% 0% 0% 0% 1%

Not applicable 5% 6% 5% 7% 6% 0%

Refused 0% 0% 0% 0% 1% 0%

Total 2202 588 628 729 787 553


25

Q17. How likely are you to complain about an unexpected medical bill?

US OH FL TX CA NM

Very likely 31% 29% 38% 37% 37% 46%

Somewhat likely 31% 32% 28% 30% 25% 18%

Likely complain 62% 62% 66% 67% 62% 14%

Not Likely 30% 33% 26% 28% 29% 20%

Unsure 7% 6% 8% 5% 8% 3%

Refused 0% 0% 0% 0% 0% 0%

Total 2202 588 628 729 787 553

Q18. In the PAST TWO YEARS, which, if any, problems did you or anyone else

covered by your policy have with your main health insurer related to…?

US OH FL TX CA NM

Had any problem 37% 38% 35% 40% 37% *

Billing or payment for medical

services 17% 21% 15% 19% 14% 36%

A problem with health services my

plan does or does not cover 9% 10% 12% 12% 10% 25%

A coverage denial 9% 9% 8% 9% 6% 17%

Not being able to get the specific

medication I need 7% 6% 9% 8% 5% 16%

Difficulty getting an appointment

with a doctor 6% 4% 6% 5% 10% 24%

Difficulty getting someone from the

plan on the phone to answer my

questions

5% 6% 5% 4% 6% 10%

Being forced to change doctors or

my doctor being dropped from the

plan

4% 4% 8% 4% 5% 12%

Administrators or other plan staff

being insensitive or not helpful 3% 5% 3% 3% 4% 7%

A problem with a listing in the plan's

provider directory 3% 3% 4% 3% 5% 8%

Delays in receiving care or treatment 3% 1% 2% 2% 6% 12%

Difficulty getting referrals to see a

medical specialist 2% 1% 2% 2% 6% 7%

Other 2% 1% 3% 3% 2% 7%


26

None of the above 63% 62% 65% 58% 61% 32%

Refused 1% 1% 0% 2% 2% 0%

Total 2202 588 628 729 787 1172

*Multiple responses allowed

Q19. When you or anyone else covered by your policy had a problem with your plan’s

provider directory, which, if any, of the following DID you do FIRST?

US OH FL TX CA NM

Contacted my health insurance plan 53% * * * * 48%

Contacted the doctor, hospital, or

health care provider 24% * * * * 31%

Contacted a consumer assistance

program or non-profit organization 0% * * * * 2%

Other 2% * * * * 10%

I didn't do anything 21% * * * * 10%

Refused 0% * * * * *

Total 64 * * * * 42%

Q20. If you had a problem with billing/payment of services, which, if any, of the

following WOULD you do FIRST?

US OH FL TX CA NM

Contact my health insurance plan 53% 57% 55% 52% 57% 69%

Contact the doctor, hospital, or

health care provider 23% 29% 26% 26% 23% 21%

Pay the bill out of my own pocket 4% 1% 2% 4% 3% 2%

Contact a consumer assistance

program or non-profit organization 1% 0% 0% 2% 1% *

Contact someone in a state

government agency 1% 0% 1% 0% 0% 1%

Contact my state legislator or

member of Congress 1% 0% 0% 0% 0% *

Other 1% 0% 1% 1% 1% 6%

None of the above 15% 12% 13% 15% 14% *

Refused 1% 0% 1% 0% 0% *

Total 1836 465 533 587 681 173


27

Q21. When you (or anyone else covered by your policy) had a problem with

billing/payment of services, which, if any, of the following DID you do FIRST?

US OH FL TX CA NM

Contacted my health insurance

plan 46% 45% 43% 43% 52% 49%

Contacted the doctor, hospital, or


Paid the bill out of my own pocket 14% 12% 8% 15% 10% 11%

Contacted a consumer assistance

program or non-profit

organization 1% 3% 0% 1% 3% 0%

Contacted someone in a state


Other 1% 0% 1% 2% 2% 2%

None of the above 7% 5% 8% 5% 6% 11%

Refused 0% 0% 0% 0% 0% 1%

Total 366 123 95 142 106 374

Q22. How often do you review your medical bills from visits to doctors, hospitals, or

other health care providers?

US OH FL TX CA NM

Review bills sometimes or more 87% 90% 91% 90% 81% 97%

Always 59% 66% 60% 61% 54% 74%

Often 15% 15% 17% 18% 14% 16%

Sometimes 12% 9% 14% 11% 13% 7%

Rarely 9% 7% 8% 7% 15% 3%

Unsure 4% 3% 1% 2% 3% 1%

Refused 0% 0% 0% 0% 1% 0%

Total 2202 588 628 729 787 555


28

Q23. In the PAST TWO YEARS, have you received a medical bill where the health

plan paid much less than you thought it would (or perhaps not at all)?

US OH FL TX CA NM

Yes 30% 33% 34% 35% 23% 48%

No 56% 54% 56% 53% 65% 44%

Unsure 14% 12% 10% 12% 12% 72%

Refused 0% 0% 0% 1% 1% 1%

Total 2202 588 628 729 787 555

Q24. How much was the medical bill you received?

US OH FL TX CA NM

$1-100 * * * * * 6%

$101-500 * * * * * 44%

$501-1,000 * * * * * 25%

$1,001-5,000 * * * * * 17%

$5,001 and

above * * * * * 7%

Total * * * * * 263

Q25. When did you receive the bill?

US OH FL TX CA NM

Less than 6 months ago 36% 28% 28% 43% 38% 33%

6 - 12 months ago 34% 40% 31% 29% 35% 34%

1 - 2 years ago 21% 18% 26% 22% 19% 27%

2 - 5 years ago 5% 7% 8% 4% 6% 5%

Over 5 years ago 0% 0% 1% 0% 0% 0%

Unsure 4% 7% 6% 1% 1% 2%

Refused 0% 0% 1% 1% 2% 0%

Total 657 195 216 255 177 264


29

Q26. Which, if any, of the following surprised you about the bill?

US OH FL TX CA NM

The total amount charged was

higher than I expected 63% 59% 62% 62% 67% 44%

I got a bill from a doctor I did

not expect to get a bill from 23% 26% 23% 35% 22% 20%

I got separate bills from

multiple providers 20% 28% 19% 29% 20% 11%

I was charged at an out-of-

network rate when I thought

the provider was in network 14% 14% 12% 20% 18% 12%

I was charged for services I did

not receive 4% 4% 5% 6% 6% 1%

Refused 10% 11% 13% 7% 6% 1%

Other 1% 0% 0% 1% 0% 11%

Total 657 195 216 255 177 264

Q27. Did you take any action to resolve this billing issue?

US OH FL TX CA NM

Yes 64% 63% 66% 71% 60% 67%

No 35% 37% 33% 29% 40% 31%

Refused 1% 0% 0% 0% 0% 2%

Total 657 195 216 255 177 261


30

Q28. Why didn't you take any action to resolve your billing issue?

US OH FL TX CA NM

I didn't think it would make a

difference 42% 55% 48% 42% 51% 47%

I didn't have time/it wasn't worth

my time 18% 8% 13% 14% 19% 17%

I was confused about what to do

or found it complicated 14% 7% 8% 11% 9% 9%

The problem resolved itself 13% 10% 15% 13% 7% 5%

I didn't know how to take

action/where to complain 12% 9% 10% 11% 18% 2%

I was afraid of creating trouble

with the plan or physician 4% 2% 2% 2% 1% 0%

Other 18% 18% 22% 22% 14% 17%

Unsure 5% 10% 5% 2% 5% 2%

Refused 0% 0% 0% 4% 0% 0%

Total 229 72 72 75 71 81

Q29. Which, if any, of the following did you TRY to resolve the billing issue?

US OH FL TX CA NM

Contacted someone at the plan 56% 59% 56% 44% 58% 75%

Contacted my

physician/physician's office 56% 43% 54% 58% 42% 58%

Referred the health insurance

plan documents for information 25% 34% 22% 27% 27% 27%

Filed a complaint or appeal 13% 17% 16% 11% 19% 15%

Asked a friend or family

member for help 5% 1% 3% 5% 4% 2%

Changed health care plan or


Contacted someone outside of

the health plan 2% 1% 2% 1% 6% 5%

None of the above 5% 8% 2% 4% 4% 7%

Refused 2% 3% 3% 4% 2% 3%

Other 0% 1% 0% 1% 0% 0%

Total 423 122 144 180 106 342



31

How helpful was the following towards resolving your billing issue? (Q30-36)

Q30. Referred to health insurance plan documents for information

US OH FL TX CA NM

Very helpful 18% * * * * 4%

Somewhat helpful 42% * * * * 33%

Not very helpful 26% * * * * 29%

Not helpful at all 12% * * * * 16%

Refused 1% * * * * *

Total 104 * * * * 263


Q31. Asked a friend or family member for help

US OH FL TX CA NM

Very helpful * * * * * 6%

Somewhat helpful * * * * * 8%

Not very helpful * * * * * 8%

Not helpful at all * * * * * 5%

Does not apply * * * * * 72%

Total * * * * * 260


32


Q32. Changed health care plan or health care provider

US OH FL TX CA NM






Total * * * * * 255


Q33. Contacted someone at the plan

US OH FL TX CA NM

Very helpful 27% 21% 23% 21% 0% 12%

Somewhat helpful 39% 52% 43% 56% 0% 32%

Not very helpful 19% 21% 18% 18% 0% 13%

Not helpful at all 15% 6% 16% 5% 0% 11%


Total 237 72 80 79 62 259


Q34. Contacted my physician/physician's office

US OH FL TX CA NM

Very helpful 26% 25% 31% 18% 0% 10%

Somewhat helpful 38% 47% 36% 45% 0% 38%

Not very helpful 22% 16% 21% 23% 0% 14%

Not helpful at all 14% 12% 12% 14% 0% 11%


Refused 0% 0% 0% 0% 0% *

Total 236 53 78 104 44 263


33


Q35. Contacted someone outside of the health plan (like a lawyer or state agency)

US OH FL TX CA NM






Total * * * * * 258


Q36. Filed a complaint or appeal

US OH FL TX CA NM

Very helpful 22% * * * * 3%

Somewhat helpful 30% * * * * 5%

Not very helpful 21% * * * * 5%

Not helpful at all 27% * * * * 4%


Total 55 260


34

Q37. You said you contacted someone outside of the health plan. Which, if any, of the

following did you contact?

US OH FL TX CA NM

Someone at my work whose job

it is to deal with health insurance

issues * * * * * 13%

A lawyer * * * * * 0%

A state agency * * * * * 38%

An elected official, such as my

governor, state legislator, or

member of * * * * * 0%

Congress * * * * * 0%

A navigator, enrollment

counselor, or agent/broker * * * * * 25%

Unsure * * * * * 13%

Other * * * * * 13%

Total * * * * * 8

Q38. Which, if any, of the following are reasons why you didn't contact a state agency

about your billing issue?

US OH FL TX CA NM

I didn't realize that was an option * * * * * 80%

I wasn't sure how to * * * * * 0%

I didn't know which agency to

contact * * * * * 0%

My problem did not fall under the

agency's authority * * * * * 20%

It was too big of a hassle/wasn't

worth my time * * * * * 0%

Other * * * * * 0%

Total * * * * * 5


35

Q39. Was the billing issue resolved to your satisfaction?

US OH FL TX CA NM

The issue was resolved, but not

how I liked 30% 29% 28% 38% 37% 33%

The issue was resolved to my

satisfaction 28% 28% 28% 22% 26% 22%

The issue was not resolved 23% 30% 25% 23% 19% 23%

The issue is currently still being

resolved 10% 8% 10% 13% 11% 13%

Unsure 8% 4% 9% 4% 7% 5%

Refused 1% 1% 1% 0% 0% 3%

Total 657 195 216 255 177 261

Q40. Which, if any, of the following BEST describes what happened with the billing

issue?

US OH FL TX CA NM

I paid for the bill in full 57% 56% 57% 49% 60% 55%

I am paying for the bill through a

payment plan 18% 25% 19% 22% 13% 24%

I negotiated a lower bill 10% 7% 13% 11% 15% 6%

The provider sent the bill to

collections 7% 6% 6% 8% 6% 9%

My billing issue was dismissed or

written off 3% 1% 1% 1% 2% 0%

I filed for bankruptcy 1% 0% 0% 0% 0% 0%

Unsure 4% 5% 4% 9% 4% 4%

Refused 1% 0% 0% 0% 0% 1%

Total 349 115 114 155 99 143


36

Q41. Overall, thinking about how your health insurance plan handled or responded to

your billing issue, what letter grade would you give your plan for its response?

US OH FL TX CA NM

A - Excellent 10% 12% 8% 6% 7% 6%

B - Good 22% 21% 29% 26% 24% 20%

C - Average 35% 37% 35% 39% 38% 39%

D - Poor 14% 14% 15% 10% 22% 16%

F - Failing 9% 6% 5% 13% 3% 10%

Unsure 8% 9% 8% 6% 6% 7%

Refused 1% 0% 0% 0% 0% 3%

Total 657 195 216 255 177 261

Q42. Which, if any, of the following entities have primary responsibility for resolving

issues with health insurance billing?

US OH FL TX CA NM

Insurance company 22% 21% 23% 26% 28% 60%

Doctor or hospital 11% 12% 11% 11% 10% 18%

A state agency 7% 6% 5% 8% 11% 3%

The legal system 3% 3% 4% 4% 4% 1%

A consumer assistance

program/non-profit

agency 2% 2% 2% 1% 3% 1%

A federal agency 1% 1% 1% 1% 3% 1%

Other 0% 0% 1% 1% 0% 3%

Unsure 67% 70% 67% 62% 60% 12%

Refused 1% 1% 0% 1% 1% 1%

Total 2202 588 628 729 787 551


37

Q43. Do you know which agency or department in your STATE government is tasked

with handling complaints about health insurance?

US OH FL TX CA NM

Yes 11% 11% 13% 11% 15% 53%

No 87% 89% 87% 88% 85% 46%

Refused 1% 0% 1% 1% 1% 1%

Total 2202 588 628 729 787 550

Q44. To the best of your knowledge, do you have the right to appeal to the state or to an

independent medical expert if your health plan refuses coverage for medical services

you think you need?

US OH FL TX CA NM

Yes 21% 18% 22% 26% 28% 58%

No 6% 3% 3% 5% 4% 5%

Unsure 72% 79% 75% 68% 67% 36%

Refused 1% 0% 0% 0% 1% 1%

Total 2202 588 628 729 787 554

Q45. In the PAST TWO YEARS, have you tried to use a doctor or facility outside of

your plan's network?

US OH FL TX CA NM

Yes 11% 9% 11% 13% 9% 22%

No 83% 85% 85% 82% 85% 76%

Unsure 6% 6% 3% 5% 5% 2%

Refused 1% 0% 1% 0% 1% 1%

Total 2202 588 628 729 787 555

Q46. In the PAST TWO YEARS, have you been surprised to find out that a doctor, lab

or facility you thought was IN your provider's network, was actually OUT-of-network?

US OH FL TX CA NM

Yes 14% 13% 18% 19% 13% 33%

No 76% 77% 76% 73% 78% 61%

Unsure 9% 10% 7% 8% 8% 5%

Refused 1% 1% 0% 0% 1% 1%

Total 2202 588 628 729 787 553


38

Q47. Do you TYPICALLY assume that DOCTORS at an in-network HOSPITAL are

also in-network?

US OH FL TX CA NM

Yes 63% 67% 58% 61% 63% 70%

No 36% 32% 42% 38% 35% 24%

Refused 1% 1% 0% 0% 1% 5%

Unsure * * * * * 1%

Total 2202 588 628 729 787 552

Q48. In the PAST TWO YEARS, have you used your plan's online provider directory?

US OH FL TX CA NM

Yes 43% 46% 56% 52% 43% 65%

No 56% 54% 43% 47% 56% 35%

Refused 1% 0% 1% 1% 1% 0%

Total 2202 588 628 729 787 554

Q49. During which, if any, of the following times did you use the online provider

directory?

US OH FL TX CA NM

Before enrolling in the plan 24% 26% 27% 29% 27% 32%

While enrolled in the plan 78% 76% 79% 77% 76% 76%

At another time 11% 14% 10% 15% 12% 17%

Refused 1% 0% 2% 0% 0% 0%

Total 947 272 354 380 341 448


Q50. Was the online directory easy to use?

US OH FL TX CA NM

Very easy 31% 33% 32% 34% 29% 21%

Somewhat easy 53% 58% 58% 57% 52% 53%

Somewhat difficult 12% 8% 7% 7% 16% 21%

Very difficult 4% 0% 2% 2% 3% 5%

Refused 0% 0% 0% 0% 0% 0%

Total 947 272 354 380 341 360


39

Q51. Were you able to find the info you were looking for in the online directory?

US OH FL TX CA NM

Yes 89% 96% 94% 94% 86% 81%

No 11% 4% 6% 6% 14% 19%

Refused 0% 0% 0% 0% 0% 0%

Total 947 272 354 380 341 360

Q52. Overall, how satisfied are you with your health plan's online provider directory?

US OH FL TX CA NM

Completely satisfied 15% 16% 14% 13% 13% 12%

Very satisfied 31% 37% 36% 34% 29% 24%

Fairly well satisfied 31% 32% 34% 36% 33% 33%

Somewhat satisfied 14% 12% 11% 13% 16% 23%

Very dissatisfied 5% 2% 4% 2% 6% 8%

Completely dissatisfied 2% 0% 1% 1% 3% 1%

Refused 1% 0% 0% 0% 0% 0%

Total 947 272 354 380 341 360

Q53. In your opinion, should hospitals have to notify patients if a doctor or technician

involved in a procedure performed at that hospital will be out-of-network?

US OH FL TX CA NM

Yes 85% 88% 90% 88% 85% 96%

No 6% 4% 4% 5% 5% 1%

Unsure 9% 8% 6% 6% 9% 2%

Refused 1% 0% 0% 1% 1% 0%

Total 2202 588 628 729 787 554


40

Q54. To the best of your knowledge, if an error in your health plan’s provider directory

causes you to get a doctor or hospital that is actually out-of-network, are you still

required to pay the extra cost of the out-of-network visit?

US OH FL TX CA NM

Yes 27% 25% 31% 35% 21% 44%

No 19% 15% 20% 19% 26% 24%

Unsure 53% 59% 49% 45% 52% 31%

Refused 1% 1% 0% 1% 1% 1%

Total 2202 588 628 729 787 552

Q55. Which, if any, of the following have you ever complained to a government agency

about?

US OH FL TX CA NM

I've never complained to a


Complained 16% 15% 16% 16% 18% *

An error in my credit report 2% 2% 2% 3% 4% 7%

Credit cards 2% 2% 2% 3% 4% 3%

A cable bill 2% 2% 2% 2% 3% 2%

Bank fees 2% 2% 3% 3% 3% 3%

New or used car problems 2% 1% 2% 1% 2% 2%

A gas or electric bill 2% 3% 1% 4% 2% 2%

A telephone bill 2% 1% 2% 4% 4% 2%

A car or homeowners

insurance bill 1% 1% 1% 2% 2% 1%

Home improvement issues 1% 1% 2% 1% 1% 2%

Other 5% 6% 6% 5% 5% 13%

Refused 2% 1% 0% 1% 2% 3%

Total 2202 588 628 729 787 595

Documents

Surprise Medical Billing in New Mexico - OSI · OSI/RWJF: NM Surprise Medical Billing Study 6 3.2 New Mexicans’ Experiences with Surprise Billing The primary goal of this study