Backstory:
On June 1, I went by ambulance to the ER. My cousin/housemate had offered to drive me there, but I literally could not get out of bed, let alone stand or walk. Unbeknownst to me at the time, I was having a cerebellar stroke and it compromised my balance and coordination, also making me violently nauseated.
Fast forward to now:
My PPO covered most of my stay in the ER and ICU, so the hospital billing cashier could only offer a discount of $140 if I had paid my $4,000+ bill in full today. I chose a 12-month payment plan instead. I’ve been able to get bigger discounts in the past but they were for smaller amounts.
Question:
Can I work out a payment plan or discount with the ambulance company as well? And would I have any grounds for disputing the charge of over $2000.00? It wasn’t covered by my insurance because my deductible had not yet been met on the morning of June 1.
Two grand seems pretty steep for a ride to a hospital just a few blocks away.
I hope you are feeling better now. That sounds scary.
I’m not sure that feeling that it costs too much is grounds for disputing a bill. But there’s no reason not to contact the ambulance company and see what they are able to do. I’m sure they’ve dealt with this before.
how far was this ambulance ride? I traveled 80 miles to another city and it was something like $1,300. The hospital didn’t code it as an emergency so it went from an in-network cost to out-of-network which had it’s own deductible. I challenged it with the insurance company and they changed it to an emergency and it cost me nothing.
I would challenge all costs before negotiating anything. Let the ambulance company know what’s going on so they don’t think you’re ignoring them.
You could not pay and wait for them to hand it over to a collection agency. Then you you can negotiate with them. Since they buy debt for (usually) pennies on the dollar you can get away with paying less. Your credit rating will take BIG hit, though, so it may or may not be worth it.
I’d suggest calling them and seeing if they would take half, or at least some low ball amount, if you paid today. IME, they’ll decline. I’ve never had that work, but I always hear people talking about it. Assuming they don’t take the offer, I’ve never heard of a medical group that wouldn’t take work out a payment plan with you. One of the groups in my area has a policy of payment plans having a max amount of time (like 6 months), but I’d imagine that if the bill is big enough they could stretch it out. Even if they can’t, I’d imagine you could could make the first few payments then call back and get an ‘extension’.
One thing to be noted though, I don’t know if this applies to all medical groups but it did for mine. They have an in-house collection agency and all payment plans are handled through them. So, when I got the first bill it was from such and such collections. When I called (the hospital) they explained, in not quite these words, that they do that specifically so that if you don’t pay them according to the plan, you’re basically already in collections. They don’t have to mess around with selling the debt, tracking you down etc. It’s already there.
There was another time when I set up a payment plan with a (different) hospital and they screwed something up on their end and sent me to collections. They admitted that I made all my payments on time and that they sent it to collections by accident, but it still took about 3 months to get cleared up. The funny thing was that every time I called them, the first thing they’d ask is ‘did you call the collection agency’ to which I always told them that I had not. I had no interest in making contact (and I assume admitting the debt was mine) to a collection agency and that THEY need to contact them and get it cleared up. Lots of time, lots of phone calls.
Last time I set up a payment plan when I have the money on hand to pay the bill now.
Years ago an ambulance tried to bill be $1500. My insurance company told me balance billing was illegal and fought it on my behalf. I didn’t have to pay it.
OP, can you explain exactly what you mean by this? If you have not met your deductible, the bill should still be processed through your insurance at your insurer’s contracted rate. You will then get an E.O.B. from your insurer, and provided the claim is not denied for some reason, you obligation will be to pay what that E.O.B. says - either the entire amount or any unmet deductible, whichever is less.
If the billing is not going through your insurer, why not? You will not usually be able to renegotiate a contracted rate per se, although you could dispute (with your insurer’s help) whether the billing was coded for the correct type of service. But an insurer’s contracted rate will usually be much less than the obscene amount that a provider will attempt to bill an uninsured person.
But that’s different. When you look at your insurance EOB or statement from the doctor it’ll say what the office charged the insurance company, subtract any discounts and payments received from the insurance company and the remainder is what you owe. For example, your bill may say:
Office visit $135
Insurance discount ($35)
Your insurance paid ($80)
You owe $20.
That’s all find and dandy.
What’s illegal (or at least what your insurance company doesn’t allow) is:
Office visit $135
Insurance discount ($35)
Your insurance paid ($80)
You owe $55.
Balance billing is a nice way of saying that they’re going to collect the entire amount. It negates the contract the office has with your insurance company. If you go somewhere out of network, it’s probably allowed, but the insurance company typically won’t allow a network provider to do that. If they do, call the billing department and/or your insurance company.
Your insurance documents should spell this out for you.
To expand on the balance billing issue. As Joey P says, if you receive in-network care of any kind, the provider’s contract with your insurer should certainly prohibit balance billing.
In an emergency, you are often not in a position to figure out who is an in-network provider. If you receive out-of-network emergency care, the situation is confusing and complicated. Federal legislation (the A.C.A.) requires your insurer to pay something for your emergency care, but it does not lay out a satisfactory procedure to establish how much constitutes fair payment. When no contract exists between your insurer and the provider, the insurer will often try to pay only a derisory proportion of the billed amount. You may then get billed directly by the provider with a “balance bill” for the difference. And Federal legislation does not prohibit balance billing - this was left to the States to address individually.
States vary in their protections for the patient in these circumstances. Here’s a good article with a table showing the situation in each state:
Some states prohibit balance billing for out-of-network emergency services altogether. Other states permit the provider to balance bill you, but require your insurer to “hold you harmless” against the charges. In other words, if you get balance billed by the provider, your insurer must deal with it, usually by renegotiating with the provider.
When I have a moment I’ll glance at my insurance contract (this is a 200ish page form that lays out just about everything) and see what it says about out of network emergency services. I know it mentions it, I just don’t remember the wording.
Your insurance contract may say nothing at all, and it may even be deliberately misleading. Your protections (if any) are statutory.
I have experience with this from a serious accident out of state last year. I received out-of-network emergency treatment for which I got a surprise balance bill for $150k. Agents at my insurer would only tell me only that “they are legally allowed to balance bill you” - which is a technically correct but highly misleading statement, since I was under no obligation to pay it! What the insurer failed to tell me voluntarily is that my state (NM) has “hold harmless” provisions that require the insurer to take care of the balance bill.
I discovered that very few people know their rights in this situation, and that my insurer is clearly attempting to exploit this ignorance. I called a dozen attorneys, none of whom knew the law; all they care about is liability cases. I eventually did my own research into the law, and got help of the State insurance ombudsman (it’s called the Office of the Superintendant of Insurance in NM). I hired an attorney, explained the law to him (!), and got him to write a stern letter. As soon as the insurer realized that I knew my rights under the NM statutes, they paid up.
I’m a pretty resourceful and tenacious person; I’m retired with time to deal with these things, and English is my first language. But it still took me several stressful months to finally sort out that I was not liable to pay this bill. I think a lot of people get completely fucked. It’s no exaggeration to say that these are sums of money that people might commit suicide over. The healthcare system in the U.S. is very badly broken.
Okay, looking at my Medical Certificate. Any disputes that happen WRT your insurance will fall back on what is spelled out here.
" Participating providers have agreed to accept discounted payment for Covered Health Services with no additional billing to the Covered Person other than copayment, coinsurance and deductible amounts"
“Emergency Health Services provided by a non-Network provider will be reimbursed as set forth under Eligible Expenses as described at the end of this Schedule of Benefits. As a result, you will be responsible for the difference between the amount billed by the non-Network provider and the amount we determine to be an Eligible Expense for reimbursement.”
" For Network Benefits for Covered Health Services provided by a Network provider, you are not responsible for any difference between Eligible Expenses and the amount the provider bills."
" You are responsible for paying any difference between the amount the non-Network provider bills you and the amount we will pay for Eligible Expenses."
In the section “covered health services” it reads “Emergency ambulance transportation by a licensed ambulance service (either ground or air ambulance) to the nearest Hospital where the required Emergency Health Services can be performed” it also mentions covering a non-emergency ride from a non-network facility to one that is in the network.
It goes on to mention other things regarding network and non-network and how much is covered (but they’re in grid format and not easy to cut and paste).
In the end, what it comes down to is that you either need to pick through your copy of the medical certificate (again this is a 200ish page document, not the 10 page SBC) and see what you can figure out. Also, you can call your insurance company and ask them. Even better, ask your employer for their insurance broker’s phone number. IME, that’s the person most likely to A)be on your side and B)willing to call the insurance company or doctor’s office on any ‘mistakes’ they might have made.
(PS, I know it’s just a bunch of random quotes, but I just grabbed what I saw and posted them here, hopefully they’re coherent. Also, this is just from my specific plan, I can’t vouch for anyone else’s.)
You are in Wisconsin, right? That being so, per the article that I linked above, your state unfortunately offers no protection against balance billing for out-of-network emergency services.
This language appears to be consistent with that. Your insurer is stating that they will satisfy their obligation under Federal law (the A.C.A.) to pay something toward out-of-network emergency care. But that if the amount that they pay does not satisfy the provider (and it won’t), you are liable to pay the balance bill from the provider.
This puts you in an unenviable position. If you have a serious accident, unless you insist that you are taken to an in-network ER (and of couse you will probably be in no position to do so) you could be stuck with a huge bill. If you have an accident out of state, where every ER is probably out-of-network, you are shit out of luck.
ETA: here you go, easy to find a Wisonsin example:
That article is from 2014. Many states are introducing new legislation to protect patients in this situation, but per the article I linked earlier Wisconsin still had no protections in 2017; and with a quick google I can’t find any recent legislation.
A couple years ago I was at hospital #1 where diagnostic tests showed I’d had a heart attack. They wanted to transport me a couple miles to hospital #2, where a stent would eventually be placed. I felt like I could drive (it was 2 or 3 miles) but the nurse said :eek:.
They had an ambulance ready to transport me, but I wanted to investigate things first. I called my insurance company’s number on my ID card. They said the ambulance that was there would not be covered. However, an ambulance called from my home area (an hours drive) would be covered in full.
I explained the situation to the nurse, then called for an ambulance transport. I had to wait 90 minutes, but I was just laying there on an IV anyway. I saved $3,000 by waiting and the EMT was someone I knew!
Yes, in fact they basically say they’ll make up some random amount to cover. Sure, they explain how they’ll come up with it, but have fun arguing with them about it.
On the other hand, that’s what your insurance broker and Commissioner of Insurance are for.
Leaving aside the entire issue of insurance = the charge itself is perfectly reasonable. You were having a stroke, you called for help, the ambulance (which is basically an emergency room on wheels) responded with EMT’s who have spent thousands of dollars being trained in life saving techniques. The charge is not excessive.
Good luck in resolving the situation with insurance, but don’t stiff the ambulance provider if insurance doesn’t pay. Work out a payment plan if necessary.
In my city they’re updating the rates. For a resident their basic rates are Base Rate $625, Oxygen $85, Spinal Immobilization $125, On Scene Care $200 and then $15 per mile. Those charges added up are about a grand plus mileage. It’s easy to see how, in a city with higher rates (I’ve never compared it to other cities) you could easily end up with two grand. I also wouldn’t be surprised if there were other charges in there, including some administrative ones.
This is why more and more, people are choosing to take Uber/Lyft to te hospital instead of an ambulance in non life threatening situations. I’d be willing to be the EMTs don’t mind. They’d probably rather have their rigs available for ‘real’ emergencies instead of taxiing people to the ER because they sprained their ankle.