HCMG Study Guide Exams Questions/Answer 2025/2026
Graded A+
If hospital is in network, and primary doctor is out of network or there is an ambulance
claim
Percentage of hospital cases with potential surprise medical bills 2007 - 2014 - In 2007,
30% of patients who were in the ED as an inpatient encountered a surprise medical bill
It has decreased as years go on but percentage is still high
There are a lot of mergers, there are less people and less groups for insurance
company to negotiate with, so less time to spend to negotiate with all these small
providers, so able to contract more doctors, more doctors in network, less chances of
encountering a bill from a physician that is out of network.
Surprise Medical Bills by Type of Category (diagnostic category) - There are higher
rates of surprise medical bills for trauma care
Surprise Medical Bills Vary By geography - There are different states with higher levels
of medical bills (New York, Texas, etc.) where 40-50% of people are encountering a
surprise medical bill
Hypothesis for this: The way that these states have laws talking about how insurers
contract with physicians - BUT THIS HAS NOT BEEN PROVEN STATISTICALLY
SIGNIFICANT
Summary of Positive Results - Surprise medical bills are prevalent (20% ED cases led
to likely surprise bills)
Vary significantly by geographic area - Few states have way higher rates of surprise
medical bills (New York, Texas)
More severe diagnoses → higher rates of surprise medical bills (So more doctors you
have working on a severe case, more chance they could be out of network)
Vary moderately in prevalence by type of care.
What are some normative considerations regarding surprise medical bills? - Why is this
phenomenon happening and what can we do about it?
Why is Surprise Out of Network Billing Happening? - Some theories: Changing
contractual relationship between hospitals and physicians such as Mergers, etc. New
types of facilities that lend themselves to create higher rates of surprise medical bills
Ex: EmCare
New types of emergency rooms have higher rates of out of network physicians -
patients will have a higher rate of encountering a surprise medical bill
Different new technologies - higher rates of surprise medical bills
What can be done about surprise out of network billing? - Government Regulation
Different legislation is being passed to see whether or not they can address problem of
medical bills
New York
Graded A+
If hospital is in network, and primary doctor is out of network or there is an ambulance
claim
Percentage of hospital cases with potential surprise medical bills 2007 - 2014 - In 2007,
30% of patients who were in the ED as an inpatient encountered a surprise medical bill
It has decreased as years go on but percentage is still high
There are a lot of mergers, there are less people and less groups for insurance
company to negotiate with, so less time to spend to negotiate with all these small
providers, so able to contract more doctors, more doctors in network, less chances of
encountering a bill from a physician that is out of network.
Surprise Medical Bills by Type of Category (diagnostic category) - There are higher
rates of surprise medical bills for trauma care
Surprise Medical Bills Vary By geography - There are different states with higher levels
of medical bills (New York, Texas, etc.) where 40-50% of people are encountering a
surprise medical bill
Hypothesis for this: The way that these states have laws talking about how insurers
contract with physicians - BUT THIS HAS NOT BEEN PROVEN STATISTICALLY
SIGNIFICANT
Summary of Positive Results - Surprise medical bills are prevalent (20% ED cases led
to likely surprise bills)
Vary significantly by geographic area - Few states have way higher rates of surprise
medical bills (New York, Texas)
More severe diagnoses → higher rates of surprise medical bills (So more doctors you
have working on a severe case, more chance they could be out of network)
Vary moderately in prevalence by type of care.
What are some normative considerations regarding surprise medical bills? - Why is this
phenomenon happening and what can we do about it?
Why is Surprise Out of Network Billing Happening? - Some theories: Changing
contractual relationship between hospitals and physicians such as Mergers, etc. New
types of facilities that lend themselves to create higher rates of surprise medical bills
Ex: EmCare
New types of emergency rooms have higher rates of out of network physicians -
patients will have a higher rate of encountering a surprise medical bill
Different new technologies - higher rates of surprise medical bills
What can be done about surprise out of network billing? - Government Regulation
Different legislation is being passed to see whether or not they can address problem of
medical bills
New York
