Surprise Medical Bills

Where We Stand

NAMI believes that all people with mental health conditions deserve accessible, affordable and comprehensive health care. NAMI supports laws and policies to protect people against surprise medical bills received for out-of-network care.

Why We Care

Access to needed health care services is essential for people with mental illness to successfully manage their condition and get on a path of recovery. Yet, surprise medical bills are an increasingly common concern — and barrier — for people seeking mental health services.

Surprise medical bills arise when a person with insurance coverage unknowingly receives treatment from an out-of-network provider and is then charged higher amounts than anticipated. These situations often occur after people receive emergency services but can also happen with planned procedures or when insurers have outdated provider directories.

Surprise medical bills are unfortunately common and happen in one in four hospital admissions from the emergency room. This particularly impacts people with mental health conditions because hospital admissions for mental health or substance use conditions are more likely to include an out-of-network claim, even when the hospital is in-network.

No one should get a surprise medical bill for getting needed health care, particularly after experiencing a mental health crisis. Laws protecting against surprise medical bills must protect people with mental health conditions in all types of health plans and across all health care settings.

How We Talk About It

• Mental health services can be expensive, especially when a health insurance plan doesn’t offer enough quality, culturally competent, in-network mental health professionals.
• Without enough in-network mental health professionals, people with mental health conditions are often forced to use expensive, out-of-network care — including in emergency rooms, racking up medical debt.
• One type of medical debt is an unexpected or “surprise” medical bill. Surprise medical bills occur when a person with health insurance receives treatment from an out-of-network provider and then charged the amount insurance doesn’t cover.
• Unfortunately, surprise medical bills are common and happen in one in four hospital admissions from the emergency room.
• Even if a health care facility is in-network, people sometimes unknowingly receive treatment from an out-of-network provider, which insurance doesn’t usually cover.
• Unfortunately, hospital admissions for mental health or substance use conditions are more likely to include an out-of-network claim, even when the hospital is in-network.
• No one should get a surprise medical bill for getting needed health care, particularly after experiencing a mental health crisis.
• Surprise medical bills impact too many Americans. Unexpected medical bills are the most frequent concern related to health care costs and household expenses.
• Laws protecting against surprise medical bills must protect people with mental health conditions in all types of health plans and across all health care settings.
• Getting needed medical treatment, especially in a crisis, should not put a person into debt.

What We’ve Done

• NAMI is part of a coalition called No Surprises: People Against Unfair Medical Bills and our advocacy work with that coalition can be found here