SAN ANTONIO – Surprise medical bills are nothing new, but Congress has finally taken some action to help.
Still, ground ambulances were left out, meaning unsuspecting patients can be on the hook for hundreds or even thousands of dollars.
Last March when Donna Rosato had a high fever and cough, she went to her local ER where they rushed her to a larger hospital by ambulance.
“I went to the emergency room, where I suddenly became unable to breathe,” Rosato said. “I was put on a ventilator for 10 days and spent a few days in an intensive care unit where I slowly recovered from the flu and pneumonia.”
Rosato, a writer for Consumer Reports, finally returned home only to to be greeted by a pile of medical bills. Fortunately, she had insurance through her employer. So, even though the charges for her care totaled about $330,000, she owed about $3,100 out of pocket.
The largest bill she owed was for the ambulance ride, which was not covered by her insurance company. She is not alone.
When she was released from the hospital to go home, she was greeted with a pile of medical bills. But she was fortunate to have good insurance through her employer. Even though the charges for her care totaled about $330,000, she owed only a little over $3,100 out of pocket.
It might be surprising to learn that the biggest bill she owed was for the ambulance ride, which was not covered by her insurance company. And she is not alone.
A recent study found more than three out of four ground ambulance rides could result in an out-of-network bill.
Those bills may not go away any time soon. They are not part of new legislation called the No Surprises Act, which is aimed at eliminating surprise medical bills that can arise from out-of-network providers, often in emergencies.
“The No Surprises Act is a huge victory for patients, but lawmakers left a loophole for ground ambulances. If we’re protecting patients from surprise billing inside the ER, what about protecting them for the ambulance trip that brings them there?” said Consumer Reports’ Chuck Bell.
Ambulance providers and insurers often disagree on what is a fair rate for this essential life-saving service.
Ambulance companies say they provide costly, labor-intensive services, and insurance reimbursements are too low for them to be in-network. That means patients are often left footing a hefty bill.
A few states like Ohio, New York, Colorado, and Maryland have passed laws against surprise medical bills that include restrictions on ground ambulance billing.
Texas has its own patient protection law curbing surprise medical bills, but it also left out ground ambulances. Currently, the state legislature is considering a bill that addresses the issue, particularly where it involves county or city ambulance services.
San Antonio EMS ambulances are out-of-network with insurance carriers, as are most. Tax dollars cover a large portion of costs.
In the meantime, if you receive a surprise ambulance bill, ask your insurer to review the claim. If it’s still not covered, ask the ambulance company if they will reduce the bill or offer a payment plan.
As for Rosato, talking to her insurer paid off.
“A few weeks later, I got a notice that Aetna paid the ambulance provider an additional $1,500, covering all but $283 of the original $3,000 bill,” she said.
The No Surprises Act will go into effect in January 2022.