On top of a healthcare system with ever-growing medical debt, a new report indicates that most Americans are unaware they can challenge some of their unexpected medical bills.

According to a new survey from the Commonwealth Fund of a nationally representative sample of 7,873 US adults, 45% of respondents between the ages of 19 and 64 reported challenging a bill for a service that they thought should have been free or covered by their health insurance.

Among the 55% who did not challenge their bills, 54% were unaware they had the right actually to do so. Other reasons cited include being unsure of who to contact, lacking the time to reach out, and viewing the amount as too small to be worth the challenge.

“Getting a bill and not being certain whether it’s an error or if your plan should have covered it, and then the complexity of following up about a bill, not knowing who to contact, not even knowing if you have a right to challenge a bill — it points to considerable complexity in our health insurance system and people’s lack of clarity, both about their own benefit plans and what to do when they have questions about care that they get through those plans,” Sara Collins, senior scholar of healthcare coverage and access at the Commonwealth Fund, told Yahoo Finance.

'Helping people be aware of their rights'

Under the Affordable Care Act, all insurers — both private and public — are required to cover preventive services free of charge. The law also grants people the right to appeal insurance decisions, regardless of what type of insurance they have. However, that information isn’t easily accessible for many consumers.

For individuals who have challenged their bills, 38% saw those bills either reduced or eliminated.

According to Collins, there are a few steps that the healthcare system could take to ease the burden on consumers.

“One is greater consumer awareness and support,” she said. “There are some states that have consumer assistance plans that help provide phone numbers that people can call when they have coverage denial. So just helping people be aware of their rights and the processes to appeal insurance decisions.”

Another move, Collins said, is to increase the federal monitoring of claims denials.

Departments could “more closely monitor rates of claim denials, looking at insurers that have high rates of denials,” Collins said. “On the billing dispute part, I think that a reduction in plan complexity would help a great deal.”

Younger adults between the ages of 19 and 34 and Hispanic/Latino adults were the most likely to not challenge their bills, with a majority stating they didn’t know they had the right to do so.

“For younger people, I think it’s just a lack of experience probably with health plans,” Collins said. “The older you get, the more likely you probably are to use your plans and have a little bit more confidence in what you’re able to do and not do. Among younger adults, they may just be beginning to use their plans. They don’t use that much healthcare, so there’s just a lot of uncertainty about what they have agency over when they get a bill that doesn’t make sense to them.”

For Hispanic/Latino adults, she speculated a language barrier may play a role.

“Among Hispanic adults in our survey, the large share who didn’t know they had the right to challenge a bill may come from a similar place to the extent that a large share of that group of adults are Spanish-speaking,” Collins said. “It could also potentially be a language issue and lack of familiarity with the use of health insurance coverage.”

Deleterious effects

The lack of consumer awareness when it comes to their rights can have serious consequences.

For example, among those who experience some kind of insurance coverage denial, 59% had to delay getting recommended medical care. And 47% of those who delayed their care saw their health problems worsen.

Healthcare costs having deleterious effects on Americans, regardless of insurance type, is not a new phenomenon. A 2023 survey found that 57% of adults between the ages of 19 and 64 reported worsening health problems because of skipped or delayed care.

A fear of incurring more medical debt is a very real problem in the US: An estimated 20 million Americans have racked up roughly $220 billion in medical debt, according to February 2024 findings from the Peterson-KFF Health System Tracker. It’s unclear, however, how much of that debt is due to bills or coverage denials received in error.

“We’ve made really substantial gains in coverage since the Affordable Care Act, and it’s really important that we now look hard at the quality of that coverage and ensure that all sources of health insurance — whether it’s employer, marketplace coverage, Medicaid, Medicare — fulfill their role in enabling affordable access to needed healthcare without having people fearful of incurring medical debt or experiencing the types of things that people are experiencing in the survey,” Collins said.

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Adriana Belmonte is a reporter and editor covering politics and healthcare policy for Yahoo Finance. You can follow her on X @adrianambells and reach her at adriana@yahoofinance.com.

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