If you’re like most Americans, you probably don’t think much about ambulances — until you get hit with a surprise medical bill. These bills can skyrocket to tens of thousands of dollars, and they often come from out-of-network providers.
The problem has become particularly acute during the pandemic, when fear of COVID-19 and reluctance to go to hospitals have led to a sharp drop in non-emergent transports. Many EMS services are now struggling to stay afloat. And despite new laws to protect consumers against surprise medical bills, many people are still getting hit.
A big reason for the high out-of-network charges is that most ambulance companies don’t have contracts with your health insurance provider. Instead, they have a “provider network” that includes only those hospitals with which the company has a partnership agreement. That network can be quite small, and the company may even change its list of participating hospitals from time to time.
In addition, the rates paid by Medicare and Medicaid for ambulance service are often well below what it actually costs to provide those services. Consequently, EMS providers have to turn to balance billing for the income they need to keep going.
Moreover, many of the nation’s 14,000 private ambulance services are owned by for-profit companies, and they don’t have the same relationships with your insurance company that doctors, hospitals, dentists and other health care providers do. And because of these weaknesses, patients are far more likely to receive a surprise bill from an out-of-network ambulance than from any other type of provider.
As a result, Consumer Reports (CR) has collected hundreds of stories from readers who have been hit with expensive ambulance bills. Some of these stories involve trips to the emergency room, but most involve ground ambulance rides. Last year, a study found that about 79 percent of all ground ambulance rides could lead to an out-of-network bill for a patient with private insurance. That’s because a large number of ground ambulance services aren’t protected by the No Surprises Act, which only covers air ambulances.
The federal and state settlement with AMR resolves allegations that between January 2014 and December 2019, the company billed Medicare and Medicaid for Advanced Life Support (ALS) services when they only provided Basic Life Support (BLS). It also resolved claims that AMR billed Medicaid for BLS services that were actually performed by local fire departments in “joint response” situations.
When a bill comes in that you believe to be incorrect or overcharged, the first step is always to call your insurer and explain the situation. If a phone call doesn’t help, you can try to negotiate the charge or even ask for a payment plan. If you can’t get the company to budge, then consider filing an appeal with this helpful guide from the Patient Advocate Foundation. You can also file a complaint with your state insurance regulator or attorney general. And if you’re still stuck with an out-of-network bill, you can use a tool like doxo to make secure online payments. American Medical Response Billing