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More than half of Americans say they are sometimes or always confused by medical bills, possibly because few patients are offered cost estimates of treatment before they receive it. These findings are outlined in a recent report from TransUnion Healthcare based on a survey of more than 7,000 American household decision-makers with health insurance.

Paying for health care is among the more frustrating bill-paying experiences, because many Americans don’t fully understand health insurance, and it’s common for medical bills to be sent to debt collectors, even before patients have the opportunity to pay them. The TransUnion survey paints a pretty discouraging picture of American consumers and their experiences paying for medical services.

Here are some of the surprising statistics TransUnion collected.

1. Only a quarter of patients are offered pre-treatment cost estimates.

Meanwhile, 63% of patients want to know the full cost of the care they’re going to receive, and 37% want to know what they’ll be expected to pay out of pocket.

2. 62% of patients said they are sometimes or always surprised by the out-of-pocket costs for health care.

Few people see what they expect when they open a medical bill: 54% report being sometimes or always confused by them. That sentiment is most true among Utah residents, 79% of whom report feeling sometimes or always confused by medical bills, which is odd, considering they were most frequently given cost estimates before receiving treatment (39% received estimates without asking, but the national average is 25%). Confusion was least common in Hawaii (48%).

3. 85% of patients who gave their health care providers low quality-of-care rankings also gave low rankings for the billing and payment experience.

A patient’s experience with his or her health care provider is strongly tied to the payment process: 80% of patients who gave their care providers high marks also reported a pleasant payment experience. Eight in 10 Americans said receiving an upfront estimate would have a positive impact on the decision to visit the provider again.

For some consumers, frustration with billing extends beyond the health care industry, because having a collection account on your credit report hurts your credit scores, which impact your access to financial services and affordable loan interest rates. You can see how your medical debt and collections account affect your credit standing by getting two free credit scores on Credit.com.

Recently, there’s been some good news on this topic, with the release of FICO Score 9: The model weighs medical collection accounts differently than other debt collection accounts, and paid accounts don’t have a negative affect on scores. This is similar to the VantageScore 3.0 model already in use, and VantageScore 3.0 is one of the scores you get for free at Credit.com.

As a consumer, you never know which scoring model your potential lender will use to evaluate a loan application — and there are hundreds of models out there — so the best thing you can do is try to practice responsible financial habits and stick to the fundamentals of good credit, like paying bills on time, keeping low debt levels and applying for credit sparingly.

More on Credit Reports and Credit Scores:

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