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As a small employer, you care about whether your employees are able to engage with their work. It can be difficult for employees to keep their eye on the ball, however, when they find themselves staring at unexpected medical bills. As their employer, you sponsor a group health plan to help cover them, but they can receive out-of-network healthcare bills that adversely affect their mental health, and productivity at work. What can you do to help your workers avoid these bills?

Why do unexpected medical bills come from?

Many people are unfamiliar with the fact that they can get out-of-network care even while they go to an in-network hospital. Hospitals don’t usually inform their patients in advance when certain procedures or services do not count as in-network. According to Kaiser (, nearly 20 percent of emergency room visits and 15 percent of inpatient admissions end in unexpected bills for patients.

Emergency medical situations often result in surprise bills because patients are unable, given the urgency of their situation, to find ambulances, doctors, or technicians within their insurance company’s network. In other instances, a hospital may employ specific technicians or surgical assistants who aren’t a part of their regular in-network system. If one of these professionals happens to assist with an in-network patient, they would send out a separate bill. A study ( finds that most unexpected medical bills involve the use of out-of-network emergency room doctors, radiologists, and surgeons.

How can your employees stay clear of unexpected medical bills?

Fortunately, help is on the way that will resolve much of this problem.  In December 2020, then President Trump signed into law “The No Surprises Act” that will end surprise medical bills for patients – so they’re responsible only for their usual in-network cost-sharing amounts and deductibles. This applies to out of network doctors, hospitals, air (not ground) ambulances, emergency care as well as planned treatment. 

Some of these patient protections were already in effect in California, but they did not cover employees in federally (as opposed to state) mandated employer groups like self-funded plans.  Now, self-funded plan participants have much more protection when they receive medical services from and out-of-network provider.

In the meantime, education can help your employees avoid unpleasant surprises.

Encourage research: It’s important to put out educational materials for employees to read, that stress on the importance of research prior to seeking healthcare. Before seeking medical care, your employees should first enquire with different in-network hospitals for estimates, and specifically tell their doctors that they only want them to use in-network laboratories. The health insurance company should be able to give them information on in-network labs.

Encourage your workers to learn about preventive care: Preventive care appointments are usually covered. Hospitals, however, may mistakenly assign a six-digit medical billing code to preventive care visits, and your employees showing up for preventive care visits may receive co-payment bills. It’s important for employees to call the insurance company, learn what kinds of services are covered, what the billing codes for them are, and ensure that the hospital bills them with the right codes.

Look up information on applicable surprise medical bill laws: Every state has its own set of laws on unexpected medical bills ( These laws offer consumers protections against such bills. It can help to collect all relevant legal information that your employees could use and provide it to them in a format that they may easily understand.

Inform your employees that bills are negotiable: If an employee receives an unexpected bill for out-of-network medical care, they should know that such a bill isn’t necessarily set in stone. Negotiating with the billing manager may be a possibility. If it was an emergency, your employee may request the hospital to certify that they were not in a position to choose the right ambulance, and that they received critical treatment. They may also be able to ask the hospital to help them out with an extended payment plan.

Learn as much as you can about facility fees: Some hospitals add a separate facility fee to their bills to cover patients’ use of their space, personnel, and medical equipment. Facility fees are not typically covered by health insurance. Your employees can ask any hospital they go to about their facility fee policy, and whether they can go to another location where such fees are not charged.

The bottom line is that it’s important to encourage your employees to seek information and make deliberate choices when it comes to obtaining medical care. The more time they devote to seeking the right kind of facilities and providers, the less likely it is that they will face unexpected bills.  If you do not have the resources to provide medical bill protection tactics for your employees, your employee benefits advisor can provide your employees with these tools.

Robert Lehrer

[email protected]

CA License #0549514