Taking the hair? Ambulances hit patients with surprise bills – tech2.org

Taking the hair? Ambulances hit patients with surprise bills


One patient received a $ 3,660 bill for a 4-mile trip. Another was charged $ 8,460 for a trip from a hospital that could not handle his case to another that could. Another one was found abandoned in a hospital outside the network, where she had been taken by ambulance without her consent.

All these patients took ambulances in cases of emergency and were hit with unexpected bills. Public outrage has arisen due to the surprises of medical bills, in general, out-of-network charges that a patient did not expect or could not control, which led to 21 states pbading laws that protect consumers in some situations. But these laws largely ignore ground ambulances, which can leave patients with hundreds or even thousands of dollars in bills, with few redress options, finds a Kaiser Health News review of 350 consumer complaints in 32 states.

Patients usually choose to go to the doctor, but are vulnerable when they call 911 or enter an ambulance. The dispatcher chooses the crew of the ambulance, which, in turn, often chooses the hospital. In addition, many ambulances are not called by patients. Instead, the crew arrives on the scene after learning of an accident on a scanner, or because the police or a bystander called 911.

Betsy Imholz, director of special projects for Consumers Union, who has compiled more than 700 stories of patients on medical surprise bills, said that at least a quarter refers to ambulances.


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"It's a big problem," he said. 19659008] Forty years ago, most ambulances were free to patients, provided by volunteers or fire departments with taxpayers' money, said Jay Fitch, president of Fitch & Associates, an emergency services consulting firm. Nowadays, ambulances are increasingly handled by private companies and venture capital firms. Ambulance providers often charge per mile and, sometimes, for each "service," such as providing oxygen.

Unable to reach an agreement on fair price

The core of the problem is that ambulance and private insurance companies often can not agree on a fair price, so the Ambulance service does not join the insurance network. That leaves patients trapped in the middle with charges outside the network that are not negotiated, said Imholz.

This happens to patients frequently, according to a recent study of more than half a million ambulance trips made by patients with private insurance in 2014. The study found that 26 percent of these trips were billed outside of the net.

KHN's review of complaints revealed two common scenarios that leave patients in debt: First, patients enter an ambulance after a 911 call. Second, an ambulance transfers them between hospitals. In both cases, patients later discover that the rate is much higher because the ambulance was out of the network, and after their insurer pays what they consider fair, they receive a surprise account for the balance, also known as "outstanding balance. "

The Better Business Bureau has received nearly 1,200 consumer complaints about ambulances in the past three years; Half were related to billing, said spokeswoman Katherine Hutt.

While the federal government sets reimbursement rates for Medicare and Medicaid patients, it does not regulate ambulance rates for patients with private insurance. In the absence of federal rules, these patients are left with a fragmented system in which the cost of a similar ambulance trip can vary widely from city to city. There are approximately 14,000 ambulance services throughout the country, administered by governments, volunteers, hospitals and private companies, according to the American Ambulance Association.

Very few states have laws limiting ambulance expenses, and most state laws that protect patients do not apply to ground ambulance rides, according to attorney Brian Werfel, consultant to the American Ambulance Association. And none of the state surprise surcharge protections apply to people with employer-sponsored health insurance plans funded by the employer itself, which are regulated only by federal law. That's a big exception: 61 percent of employees with private insurance are covered by self-funded employer-sponsored plans.

Out-of-Network Expenses

Most of the complaints reviewed by Kaiser Health News did not appear to involve fraudulent charges. Instead, patients were trapped in a system in which ambulance services can charge thousands of dollars for a single trip, even when the trip starts at a hospital within the network.

That's what happened to Devin Hall, a 67-year-old retired postal inspector in northern California. While facing stage 3 prostate cancer, Hall is also fighting with an out-of-network ambulance bill of $ 7,109.70 from American Medical Response, the nation's largest ambulance provider.

On December 27, 2016, Hall went to a local hospital with rectal bleeding. Because the hospital did not have the right specialist to treat his symptoms, he arranged an ambulance transfer to another hospital about 20 miles away. Even though the hospital was inside the network, the ambulance was not.

Hall was surprised to see that AMR billed $ 8,460 for the trip. His federal health plan, the Association of Mutual Benefits of Special Agents, paid $ 1,350.30 and held Hall responsible for $ 727.08, according to the records. The health plan paid that amount because the AMR charges exceeded its Medicare-based schedule of fees based on your explanation of benefits. But AMR turned over its case to a debt collector, Credence Resource Management, who sent a notice on August 25 seeking the total balance of $ 7,109.70.

"These charges are exorbitant, I just do not think what AMR is doing is right," Hall said, noting that he had intentionally sought treatment at an in-network hospital.

He spent months talking on the phone with the hospital, his insurer and AMR trying to solve the problem. Given his prognosis, he worries about leaving his wife with a legal fight and a lien at his home in Brentwood, California, for a debt they should not owe.

After being contacted by Kaiser Health News, AMR said it has removed Hall's case from collections while reviewing billing. After a new review, company spokesman Jason Sorrick said the charges were justified because it was an "intensive care transport, which requires a specialized nurse and equipment on board."

Sorrick blamed Hall's health plan for paying little and said Hall could receive a discount if he qualifies for AMR's "compbadionate care program" based on his financial and medical situation.

"In this case, it seems that the patient's insurance company simply invented the price they wanted to pay," Sorrick said.

In July, a California law came into effect that protects consumers from unexpected medical bills from out-of-network providers, including ambulance transportation between hospitals. But Hall's case happened before that, and state law does not apply to your federal insurance plan.

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