The problem is, the starting point for a provider’s bill is always some outrageous fictitious number that is hugely inflated, in the range of double to five times the rates they agree with their contracted insurers. An E.O.B. for (say) an in-network ambulance might look like:
In other words, the fair price (the price that the provider finds acceptable in its contracts with insurers) is clearly $2000.
But for out-of-network service, even if your insurer agrees to pay a fair amount ($2000), absent State-level statutory protection there is nothing to stop the provider balance-billing you the $4000 difference between their outrageously inflated initial bill and the fair price.
I agree. It sounds to me like this may be the inflated initial bill from the provider, not the contracted rate that an insurer would pay.
Can OP clarify what is happening here? OP said:
If that’s the case, the bill should still go through the insurer at the insurer’s contracted rate, and the insurer (not the provider) would tell the patient how much to pay in the E.O.B.
Unless this was out-of-network emergency service, which (as we have discussed) is a whole different story.
You are describing a non-emergency transfer by ambulance. The OP was describing an emergency response to a reported stroke. Vastly different level of care and capabilities. It’s not the “ride” that he’s being billed for, it’s the staff and equipment that is on the ambulance.
As Joey P. said "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. "
One of the reasons that charges tend to be higher in some areas is because people don’t have access to mass transit (or Uber/Lyft) and call the ambulance for a stubbed toe! And those bills eventually go unpaid and cause our bills to increase.
I had an emergency transfer last year, 75 miles, two ambulances involved. The billed amount was $2,900 and the allowed amount (insurance + copay) was $1600.
With that as a reference, $2000 sounds high for an in-network contracted rate. It may be the provider’s inflated “billed amount” that is what they try to charge if it’s not billed at a contracted rate through an insurer.
Sorry for being radio Silent . I was out of town the past few days. When I’m on my computer again I will reproduce the form letter that was sent to my email after I asked if ambulances were ever covered under my plan.
Also, I should clarify that at the time it was happening, I did not know it was a stroke. Cerebellar Strokes don’t present the same way that some other Strokes do. What I had was extremely severe vertigo, I could not keep my balance or coordinate anything, vomiting like crazy almost Non-Stop, and I couldn’t even think of getting into anybody’s car. I don’t think an Uber or Lyft driver would have appreciated all the barfing. My cousin would have withstood but I wasn’t about to stumbleil in and out of her car.
The insurance company agreed that it was an emergency transfer. I was on a continuous drip of heparin for a 3.5" blood clot inside my heart. The clot had already broken off and gone to my leg which had no pulse in it when I first got there. They were able to fix the leg but deferred to my original heart surgeon. the ambulance ride consisted of an RN and I was hooked up to the same monitoring equipment from the hospital.
Possibly; it’s quite possibly not the same ambulance company in the area of anyone else who would respond to this thread. Because Company A does/not do something, that doesn’t mean Company B will/not do that same thing.
Probably not. Many ambulance companies don’t contract w/ insurance. You need 'em, you use 'em. Why should they contract to take a lower rate? It’s not like you have the time to shop around when you need one, & quite possibly can’t get another one at that time. (You’re not going to get a different 911 ambulance & if you can wait for a transport squad/taxi/Uber/Lyft, then you probably don’t need a 911 bus.
$2000 is very reasonable. A single ambulance can be $150,000 between the truck & all of the equipment. Plus cost of EMT/Medic(s) 24x7x365, even when they’re not doing anything. Plus the cost of building, supplies, admin, etc.
In many places the ambulance sent by the municipality is a private ambulance.
“Basic rate” to me implies EMTs only. ie. BLS / Basic Life Support
ALS / Advanced Life Support includes paramedic, who can do much more than an EMT can. The OP’s call was an ALS call. ALS call could include add’l charges for IV administration, blood draw, cardiac monitor hookup/reading, medicines given, etc.
OP states they were close to the ER, possibly not everything listed above was done due to lack of time.
You’re wrong; it’s quite in line.
Interfacility transport is different than an emergency/911 call.
I was transported with an IV, cardiac monitor, and constant BP checks.
I posted the cost for my ride with full gear and an RN. Short of having a heart surgeon accompany me I’m not sure what else they could have thrown in to run up the cost. Same $150,000 vehicle and personnel operating 24/7. What’s missing from my $1,300 bill for a ride that was over an hour.
More important, why wouldn’t the op verify what the insurance company covers and where this fits within covered costs. I was going to have to pay $1,300 for a paperwork error.
The same could be said of emergency room visits. If you’re involved in a car accident or having a heart attack, you’re going to the closest place. Why should they work with insurance and have discounted rates?
As for not being able to get a different ambulance company. Yes, if you call 911, you’re more than likely going to get city owned ambulance. However, you can call a private ambulance company. Many of them are more than equipped to handle emergency situations. I know that my city will sometimes call them for ‘overflow’, but there’s nothing stopping you from calling them on your own, short of not knowing their phone number.
(Cite: One of the customers that shops at my store has been both a 911 dispatcher and a private ambulance dispatcher so I hear some of the stories).
paraphrasing the aforementioned letter from the ins. co:
my ambulance insurance benefits under in network providers, are subject to deductible of $6,300.00. Once satisfied, my co-insurance is 100% of the allowable trip per ambulance. For out of network ambulance, the figure is $12,600. Once satisfied, my co insurance is 100% plus difference between billed amt. and allowed amt.
Benefits are one emergency ambulance service when used to transport a member from place of illness or injury to closest medical facility where treatment can be received , or pre authorized non emergency ambulance transport from one medical facility to another.
He was having a stroke. He couldn’t stand; you think he could be arsed to make phone calls & understand answers at that point?
Emergency/911 & transport ambulances are very different things. Yes they are licensed the same but they don’t ‘operate’ the same. There are some places that do both, but there’s many that only do one or the other.
The guys in the ambulance don’t care, or get involved w/ insurance. If we take you further than the nearest appropriate* facility & something happens to you while enroute; you go south, we have an accident, the EMT/Paramedic’s license could be on the line.
bypassing a community hospital to take you to a trauma center or stroke center doesn’t count as the community hospital isn’t considered the best, appropriate facility to treat you. They could stabilize you & then transfer you.
B) If you’re call is on the edge of our territory & we could take you to one of two equidistant hospitals, one in the next town & one in the middle of our territory, we’d go to the one in the middle of our territory because that returns us to service quicker to be able to handle the next potential call sooner. You as the patient don’t necessarily get a say in what hospital you go to. If you doctor is at one hospital, records can be send to the one we’re taking you to, not a big deal.
C) 911/Emergency ambulances are supposed to respond w/in x minutes, at any time of day/night/weather. Private ambulances are not held to the same standard.
Cite: EMT who’s worked 911/Emergency service.
So it sounds like they don’t pay for any ambulance services unless you reach your annual out-of-pocket maximum?
Is this an A.C.A.-compliant plan?
Do you know if the ambulance was in network?
Is the billing being processed through your insurance? Even if you have to pay for it, it should go through your insurance, otherwise you won’t get the contracted rate (if there is one) or credit against your deductible or your out-of-pocket max.
That’s what I took it to me and when I read the claim and the letter. Yes it is part of an ACA Covered California plan.
I have no idea whether the ambulance was in network or not. It’s operated by a company called Care.
Yes, I had already seen the claim show up on my email so I was looking through several claims including this one.
I only brought up this subject because back in 2009 was the first and only other time I ever took an ambulance anywhere. I thought I was having a heart attack at the time. Actually it turned out to be a very diseased gallbladder. The symptoms are nearly identical in some cases. Anyway, the ambulance ride at that time, as I recall, was about 500 or $600. Not $2,000 plus.
Sorry for your difficulties - hope you are feeling better.
No clear info/suggestions other than that you should definitely try to negotiate a settlement/payment plan. Health care providers write of HUGE amounts all the time. But I am unaware of any law that would require them to do so.
Folk need to be sure they are distinguishing between what IS allowed/legal, and what they think an appropriate system OUGHT TO BE. Because what the OP describes is a pretty classic example of what happen all the time in a for-profit heath care system. An inexpert individual in distress is expected to have sufficient resources to make a reasonable consumer decision, comparing providers, negotiating costs, etc. Yeah - RIGHT! :rolleyes:
But you should be able to figure out from what your insurer’s paperwork what’s happening. If the $2000 that you’re being asked to pay is entirely categorized as the “allowed amount” by your insurer, then that represents a contracted amount that your insurer normally pays for this service (either the ambulance is in-network with a contract, or your insurer is agreeing a similar charge to their usual in-network payments for an out-of-network service). Under the dire terms of your insurance, I don’t think there’s really scope for negotiation on a contracted rate, unless the provider/insurer has coded it wrongly and it’s a charge for a service that you didn’t receive.
On the other hand, if the insurer says the “allowed amount” is (say) $1000, but you are being billed a total of $2000 by an (out-of-network) ambulance company, the extra amount is what’s called balance-billing. California has some of the best protections of any state against balance billing, and they were strengthened in 2017, but I can find any clear explanation of whether those protections extend to emergency out-of-network ambulance services. Unfortunately, ambulances seem to be one of the areas with the worst regulation and most predatory billing practices. Supervision of PPOs in California appears to be the Cal Dept of Insurance, helpline (800) 927-4357. They may be able to advise if it’s balance billing.
In any event, most providers do have plans to assist people on low incomes and with no assets, although for a $2000 bill I think you’d have to be in dire poverty to have much leverage. Still, if you can’t get a break any other way, it never hurts to ask. They may offer an interest-free payment plan; or a discount for immediate payment in full, depending what you want to try for.