Friday 1st March 2024
Durbar Marg, Kathmandu

The public outcry over surprise medical bills has spurred 21 states to pass laws protecting consumers from charges they didn’t expect or could control. But the law’s protections don’t extend to ground ambulance rides, which often leave patients with hundreds or thousands of dollars in unexpected bills and little recourse. That’s because most ground ambulance providers are out-of-network with most private insurance plans.

The issue stems in part from the fact that ambulance companies and private insurers often can’t agree on a fair price, so the ambulance company doesn’t join the insurance network, Imholz says. That leaves patients in the middle, with out-of-network charges that aren’t negotiated.

It also stems from the fact that most private insurance plans don’t cover ground ambulance services at all, or only partially cover them. For those few insurance plans that do, the coverage tends to be very limited. That means patients must pay a substantial amount out-of-pocket for the service, even if it’s covered by their insurance plan.

Another factor contributing to surprise ambulance billing is the fact that most ambulance services make only a small profit on Medicare transports. On average, Medicare pays an ambulance service just over $224 per trip plus $7.29 a mile. That’s far below the cost of operating an ambulance, according to government studies. The result is that many ambulance services must seek out other revenue sources to cover their costs.

A few local ambulance services try to limit this problem by contracting with some private health insurance companies, but that’s not the case everywhere, and the contracts don’t always work out, Chhabra says. And patients aren’t always aware of whether their local ambulance service is in or out of their insurance network, so they may not ask.

For non-emergency transports, a patient can usually find out whether their local ambulance service is in or out-of-network by calling their insurance provider before calling the dispatch number, Chhabra says. If the transport is for a hospital visit, it’s probably safe to assume that the ambulance will be in-network.

In addition to asking about insurance networks, patients can ask if the ambulance service offers discounts through an ambulance membership program. These programs typically require patients to pay an annual fee in exchange for lower ambulance rates. But that may not be a good option for everyone, since CR’s data shows that these programs generally only save consumers about $15 on an emergency transport.

The Hagas received a bill from American Medical Response after their daughter, Ella, had a breath-holding spell (a condition that can be triggered by stress and affects about five percent of children between the ages of six months and six years). They called AMR but were told they couldn’t talk to the person who would help them because the dispatcher was out of the office.

Mike Haga is frustrated with the lack of help he has gotten from AMR’s customer service. He’s been on hold for an hour and a half. “I’m thinking about hiring a lawyer,” he says. “This feels like a scam.” American Medical Response Billing

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