Insurance Companies and Ambulance bills


Back in May, Mr. Nightingale had a very severe allergic reaction to a medication. He swelled up, turned red, broke out in a rash, vomited, and could barely breathe. The reaction began three minutes after he took the pill, and he was home alone at the time. After calling me at work to ask if there was anything he could do to make it stop, he dialed 911 for an ambulance. They arrived, took very good care of him at the scene, and then rushed him to the nearest hospital – he was so sick that they refused to transport him to the hospital where I work, which is across town. The folks in the ER also took great care of him, and after multiple rounds of medication and several hours in the ER, he went home and spent the next week recovering.

Now for the part that has me upset: Blue Cross paid only a fraction of the ambulance bill, leaving us saddled with the rest. Our portion of the EMS bill is more than our portion of the hospital bill! This was a genuine lifethreatening EMERGENCY, in no way an abuse of either the EMS system or our insurance, and I guess I’d just assumed that the insurance would pay all or most of it. The man was too sick to walk or talk, much less drive himself to the hospital.

Don’t get me wrong, I’m grateful that we have good health insurance and that the largest part of the day’s adventures were covered, but this bill comes at a really bad time for us, financially. Fortunately, the city is kindly letting us work out a payment plan which pretty much amounts to “pay what you can, as long as you send a little each month”.

Yeah, I know it’s not much of a rant. I just needed to vent a little.

Ugh sorry to hear that, I hope Mr. N is feeling better these days.

I’d appeal the bill to Blue Cross. Seriously. Send BC supporting medical records that indicate that this was a life-threatening emergency, and that ambulance care was required.

I’m thinking that either the ambulance company does not participate with BC (which is unusual since everyone participates with BC), or the claim was coded with a non-emergency diagnosis. The ambulance company needs to check the code and make sure it reflects the emergent nature of the services. Again, send supporting documentation.

Definitely appeal it. In all liklihood, it just got coded wrong. Frankly, you should never take no for a first answer from a health insurance co. They’re just people - they make mistakes all the time. Appeal it and see what happens. Good luck.

That’s a good idea, Ms. Robyn. The diagnosis on my bill says “Anaphylactic Shock” but maybe it didn’t get sent to the insurance company that way. BC did pay about 25% of the bill, but the rest was left up to us. It’s not an amount that will bankrupt us, but we just have no extra cash right now. We’re subsisting on ramen noodles and hamburger helper already in an attempt to get our finances under control, and this is just another bill to pay. I will definitely call BC later this week and ask them to check their records.

Thanks, World Eater, for the well wishes. Hubby is indeed feeling better, but he was under the weather for almost a month after the big event. I’ve been an ER nurse for two+ years, and his was the worst case of anaphylaxis I’ve ever seen in person. I really expected him to be intubated when I got to the hospital; he sounded terrible when he called me.

And even though this is the Pit, I want to say a big loud “Thank You!” to EMS personnel everywhere. The frontline responders can make all the difference in a patient’s outcome, and I’m convinced that Mr. Nightingale would not be with me today if they hadn’t responded so quickly and appropriately to his call. It was the treatment he received in the ER that turned the reaction around, but it was the treatment he received in the field that got him to the ER alive.

Where I live the city offers a $60/year program referred to as FireMed:

No out-of-pocket cost for paramedic and emergency ambulance service provided by the Fire Department.

Coverage for your entire household, anywhere in the City, emergency ambulance transportation is allowable to hospitals outside of the City.

Umbrella coverage for visitors who suffer an emergency medical incident at a FireMed household.

The Medical Information Program - a vital information resource used by paramedics in an emergency.

Free American Heart Association CPR Classes.

I do not know if this is common in other city governments but worth checking out.

BTW…good to hear Mr. N came through it okay.

This may not help, but … where I live, ambulance services are not completely covered by most insurances because they are “private contractors,” not public health providers (those may not be the exact words, but hopefully you get the gist). If the ambulance services were provided by the fire department or a local ambulance corps, regardless of the Dx, you may not be able to get BC/BS to pay any more than they already have. Usually, the only way you can get ambulance services to be covered in full is to become a “member,” in a program similar to the one lostronin described. Then, BC/BS pays whatever is covered, and the ambulance company writes off the rest. Otherwise, they accept whatever BC/BS will pay and bill you for the difference.

Before you call BC/BS, I would also check with your insurance plan administrator and ask them if ambulance services are covered under your plan (every BC/BS plan is a little bit different). Your local abulance corps might accept BC/BS for services, but the insurance might only pay a little bit out. Like everyone else said - be prepared to send them everything you have, and be persistent. Good luck!!

Sorry for the bad news about the $$, but glad that Mr. Nightingale is OK.

D’oh!! Obviously, I meant paperwork-wise. Sorry for any confusion.

That’s weird; anaphylactic shock should pay as an emergency code. And if the bill says anaphylactic shock, that should be the diagnosis that was on the claim. This means that either the ambulance company doesn’t participate with Blue Cross, or that there was some kind of authorization required that wasn’t obtained. The second is a longshot. I know that some insurance plans require an authorization for non-emergency ambulance services, but I’ve never heard of this for emergency services, and I especially never heard of this when 911 was called.

Don’t call the insurance company. You’ll deal with some customer service rep who doesn’t have the authority to scratch their own ass without permission. Review the procedures (which should be on their website) and file a formal appeal. Get a copy of all the hospital’s records on that date of service, as well as records of subsequent care. (Flinging mud helps.) Also, get a copy of the ambulance’s trip sheet that shows what kind of care they gave him in the field and en route to the ER. Submit all of this to the insurance company as part of your appeal. Don’t lose hope, you can appeal all the way to the level of your state insurance commissioner.

If you don’t want to deal with the headache yourself, speak to the billing person at the ambulance company and have them appeal. Make sure they send the appropriate documentation, and have your husband sign a release so they can get and send the ER records.

Please keep me posted.


It’s amazing how well you can succeed if you throw enough documentation at insurance companies. A few years ago I helped my boss (ironically, an attorney) appeal when she got screwed over medical bills for her child’s broken leg, and I’m still convinced that the multiple reams of documentation we faxed to them was a big factor in our favor. Plus the lengthy description we wrote up of what happened, what went wrong, and how we thought it should be fixed. Oh, and this was Blue Cross, by the way, in the DC area. They eventually gave us 100% of what we asked for, even the red herring we threw in just so they’d have something to deny!

If you show that you’re serious about the claim, they’re likely to take you a lot more seriously. And as soon as you start heavily documenting everything you’re talking about, they know you mean business and will quite likely be far more amenable to considering your claim. Because if anaphylaxis isn’t an emergency, I don’t know what is!

Back in '95, when I broke my leg, I had Blue Cross, and they did not cover the ambulance. Nor did they cover the claim for the ER doctors.

Here’s the thing: Blue Cross is a Preferred Provider Organization (PPO). This means that they have contracts with certain health care providers, who agree to accept lower rates than they would normally charge in exchange for BC’s guarantee of payment (not to mention directing business their way). In my case, and I suspect in yours, the ambulance company is not a preferred provider – BC, in such a case (in California, anyway), will only pay 50% of the amount that they would have paid a PP. This is usually a small fraction of what the ambulance company actually wants. I have no quibble with this – I pretty much knew going in that ambulance companies weren’t on my list.

The thing with the doctors was sneakier; while I was taken to a hospital that accepted BC, the “Emergency Medical Group” was a separate business unit that did not take BC (i.e., the doctors wanted more than BC would pay); this was supposedly posted on the wall, but staring at the ceiling waiting for painkillers was not conducive to searching the area on the off chance that a disclaimer might show up. Again, BC paid 50% of what their customary amount (their customary amount was about a third of what the doctors billed). I complained, the doctors explained, and BC gave in - a little. They agreed to pay 80% of their customary amount, which still left me on the hook for several hundred dollars. I told the doctors what I thought of their business practices and sent them what they had coming: a copayment of 20% of the “customary amount.” They billed me for the rest – they’re still waiting, and the lingering debt has affected neither my sleep nor my mortgage.