When people call 911, their lives are in the hands of a dispatcher and an ambulance crew. Yet when it comes to medical bills, patients are often on their own.
While Medicare and Medicaid set reimbursement rates for ambulance services, state laws don’t limit charges for private insurance. This leaves patients vulnerable to surprise medical bills.
Patient Account Access
In most cases, DCFEMS first responders send your patient medical record to a third party billing service to manage insurance claim submission and patient account billing. The third party billing service works extensively to identify your insurance coverage and/or patient responsibility for ambulance fees and charges and will send you a statement of account identifying these amounts.
Many patients receive surprise medical bills from EmCare or other ambulance services that take them to hospitals that are not in their insurance network. This occurs when a hospital’s emergency room doctors don’t agree to the pre-negotiated rates and fees set by the insurance companies, according to Betsy Imholz, special projects director at Consumers Union, a nonprofit policy and advocacy group that is part of product testing and ratings publisher Consumer Reports.
In Washington state, the No Surprises Billing Protection Act and a new federal law offer protection against these surprises. In addition, all health care providers are required to provide patients with a good faith estimate for items and services they expect to incur before providing them with those items or services.
Forty years ago, most ambulance rides were free for patients or provided by local volunteer fire departments. But today, ambulance services often charge by the mile or for each service they provide, like oxygen. Many of them don’t belong to an insurance network, which means your private health insurance might not pay for all of their charges.
The New York Times found that when an ambulance company, such as EmCare, takes over a hospital’s emergency room, it often doesn’t honor the rates and fees previously negotiated with insurance companies by the hospital. That can lead to huge surprise bills for patients.
13 HELP Team has heard from several people who say they were shocked by an ambulance bill. A man in Wyoming says he got a bill from AMR after his wife committed suicide. The company wanted to collect money from her estate, even though Medicare paid for the transport. AMR has settled federal and state claims that it billed Medicaid and Medicare for paramedic services at the scene of 911 responses when it only provided Basic Life Support transport.
When you are transported through DCFEMS, your insurance information is automatically sent to the third party billing service. This company verifies your insurance information and personal identifying information, and files a claim with your insurer. If your claim is rejected, you will receive a notice from your insurer.
Unless you are covered by Medicare or Medicaid, the federal government doesn’t set ambulance fees for private-insurance patients. That leaves a gaping loophole for companies like AMR, which has been accused of charging more than it should in many cases.
Some states, such as Washington state, have passed laws to protect patients from surprise bills. But the problem persists. Often, when for-profit firms take over hospital-owned ambulance services, they jack up rates – dramatically. One New York Times investigation found that when EmCare took over a Washington state hospital’s emergency department, it jacked up rates for patients by almost $700 a ride. That’s out of line with what ER doctors charge and can lead to huge, out-of-pocket charges for patients.
Many patients who receive ambulance services don’t know whether the company is in their insurer’s network. That’s a problem because private insurance companies usually pay much less than Medicare for these rides. And although some ambulance providers try to sign up for insurers’ networks, private insurance companies are often reluctant to negotiate rates with them, says the consultant who worked with the American Ambulance Association.
Some states have tried to address this issue by banning balance billing for ambulance rides. But these laws don’t always cover private insurers and only apply to ground ambulance services, not air or helicopter trips.
If you get a surprise medical bill from American Medical Response, the first thing to do is contact your insurer to ask them to cover more of the cost. If that doesn’t work, you can try to negotiate a lower charge or payment plan through the provider. If you have trouble getting your insurer to budge, you can also file a complaint with your state insurance regulator or the Better Business Bureau. American Medical Response Billing