r/HospitalBills • u/Deep-Examination7086 • 19d ago
How to handle ambulance bill
My newborn needed a transfer from the ER to a NICU, and the hospital arranged the ambulance transfer within their system. I just received a bill for over $5,600 from the ambulance company. My insurance has an allowable amount for the service, but I’m being charged the difference between that allowable and the full billed amount.
The ambulance provider was out-of-network according to them and my insurance, and these extra charges aren’t applying toward my in-network out-of-pocket max. It’s worth noting I hit that OOP max of $6500 during the NICU stay, so I have nearly $12,000 of bills coming my way.
Since this was a medically necessary transfer arranged by the hospital, I’m confused and frustrated about this huge bill and the balance billing situation, especially since I had no choice in the provider.
My insurance is through GEHA and they had me contact ClearHealth to negotiate costs but to me it doesn’t seem like this should need to be negotiated and my insurance should cover the entire bill with in-network benefits. I have reached out to everyone I can possibly think of, ambulance company, insurance, the hospital. And everyone I talk to just points the finger at eachother. I have an appeal in process with my insurance company but do not have high hopes that they will change their decision. Shit like this just makes me want to give up.
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u/Tina271 19d ago
I did this fight for a couple of years. Write a nicely worded letter with an appeal stating that it was medically necessary. See if the ambulance company will help you. If the two of you get on the phone and call the insurance that might work as well. They want their money too. I have done that.
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u/Deep-Examination7086 19d ago
Someone mentioned to me that the hospital might be responsible as well? Since the transfer was to a magnet hospital in the same network and they had their nursing staff in the ambulance with my son. I had no idea that could do this and assumed everything would be in-network as they told me they were calling “their” ground transport team.
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u/Mountain-Arm6558951 19d ago
Unfortunately not, the hospital may not had the service available such as staff or equipment.
It would not hurt to call the hospital and see if they can get the EMS provider to do a discount..
The only time I have seen a hospital to be responsible if a patient shows up at a free standing ER that the hospital system owns and had to be transferred to the main campus.
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u/Alive-Plankton6022 19d ago
This is a misconception. This has nothing to do with being magnet or the hospital have the availability of speciality services at the current hospital or providing staff during the transport, that is actually common if needed for acute speciality care. Few ambulance services/care are in network. If this is a transport service provided by the hospital, not the county or private you should hopefully have better luck negotiating with them.
Hoping your baby is doing better. Sorry you are dealing with it on top of an already stressful time.
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u/throwawayeverynight 16d ago
The hospital isn’t responsible, they have no control which ambulance service will arrive. Also just because something is medically necessary doesn’t mean it’s covered in full. Unfortunately American Healthcare has a ton of out of network providers that you can encounter at the hospital.
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u/Tina271 19d ago
Unfortunately the expectation is while you are freaking out over the health of your newborn you should be focused on making sure that each aspect of care is by an insurance approved provider. Can't make it up.
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u/Deep-Examination7086 19d ago
I had no idea what was going on at the time and had so many forms being thrown in front of me, I could’ve signed over my soul to the devil and wouldn’t have known it.
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u/EfficientBadger6525 19d ago
I have had this feeling and wouldn’t wish it on my worst enemy. Hugs to you. So sorry you are dealing with it on top of everything else.
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u/Mountain-Arm6558951 19d ago
Unfortunately few issues..
Most if not all EMS providers are out of network with insurance carriers.
GEHA is federal employees insurance and at the federal level they do not have any laws regarding ground ambulance balance billing.
I would get the medical records from the hospital and the EMS provider and file an appeal with your carrier. I would also contact HR of your agency and the office of personnel management (opm) and see if they can do anything.
In your appeal letter I would CC the office of personnel management (opm), your senator and congressman.
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u/Deep-Examination7086 19d ago
Yeah, I’ve come quite the expert on surprise billing over the weekend. That’s good advice. Thank you.
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u/Mountain-Arm6558951 19d ago
Yeah, they need to fix the Federal No surprises Act to include ground ambulances.
Also it not hurt to ask for a itemized statement to make sure its correct. I was charged for IV supplies and IV that was already in my arm from the hospital.. So billing mistakes do happen.
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u/QuantumDwarf 19d ago
Every single one of these posts I think ‘please please contact your congressman’. They are the ONLY people who can fix this.
Ambulance companies will not negotiate fair prices because they don’t have to.
The largest one in West Michigan is owned by a member of the family that owns the largest grocery chain in the Midwest. Literally one of several billionaires in his family. But is threatening to depar because he knows he can balance bill and people will blame their insurance while he gets richer and richer.
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u/Mountain-Arm6558951 19d ago
The issue OP has that they have a federal plan so its exempt from any state consumer protections. So a congressman will have the pull to fix OPs issue.
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u/QuantumDwarf 18d ago
Right but very few states have ground ambulance surprise billing regulations. Even the ones who do only applies to insurance companies they oversee. So if your coverage is with Blue Cross of MI and you get a surprise bill while in CA, the state legislation does not apply. So we need a federal change. So all plans are covered.
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u/Mountain-Arm6558951 19d ago
You can also file a complaint with the Attorney Generals office on the EMS provider if they will not work with you. Also it would not hurt to contact your local news station.
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u/noachy 19d ago
Just curious wouldn’t state law against balance billing etc, by ambulance providers still apply? The laws say the providers have to accept in network rates and not balance bill rather than require insurance to do something, generally isn’t it?
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u/Mountain-Arm6558951 18d ago
It would depend on what types applied and how its applied.
Some laws state in order to be protected you must have a health plan that was sold in that state and not self funded. Then some laws are aimed at the provider to not to balance bill and it would only apply to health plans that the state regulates and not self funded.
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u/SupermarketSad7504 19d ago
Call Geha theyre paid by the insurance to negotiate the pricing and if they can get an acceptable price the insurance would pay it ans you would not have a bill. Call them.
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u/Deep-Examination7086 19d ago
Yeah I spoke to clearhealth today and they said it would take up to 6 weeks for their negotiation process.
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u/ADrPepperGuy 19d ago
You might consider writing a hardship letter to the ambulance company as well.
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u/Ok-Seaworthiness-542 19d ago
This happened to me once when my wife needed an ambulance after a car wreck. I fought it and they changed it to in-network.
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u/traumahawk88 19d ago edited 19d ago
How long ago were they born? Apply for child health plus through your state marketplace.
$0 copays. That included everything from when my second daughter was born, inc the NICU transport and all involved in her stay there. Zero. Just the $45 monthly bill. I got her added like a week after she was born and it was retroactive back to her birthday.
My wife and I make a little more now than back then, but we were just over 6 figures even then and qualified still. Even now when we're making even more on top of that, and yes, have updated the program with our income info, we still have that insurance for the girls. Costs more up front than adding to our ppo, but with zero copays for anything it quickly balances out.
My wife was admitted (emergency cesarian and all that) so our emergency room visit for her was $200 via my employer sponsored insurance (BCBS), and then everything billed to our daughter was just ... Covered.
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u/flag-orama 18d ago
Don’t pay it. You never agree to their price or to use an out of network service. You are being taken advantage of. There are disclosures laws that were not followed.
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u/OtherwisePumpkin8942 18d ago edited 18d ago
This is terrible advice. Ambulance agencies are private businesses. They will send you to collections and they will tank your credit score.
Many ambulance agencies do offer payment plans. Call the agency and see what plans they have available for payment. Companies are usually willing to go with whatever terms are most sufficient for the client since they would rather get paid over time than not at all.
The cost to operate a single ambulance with its equipment and the 2 personnel on board would be quickly unsustainable if companies were only allowed to accept the low insurance pay outs without the ability to balance bill.
Unfortunately, if ambulances were included in the No Surprises act, many agencies would simply cease to exist. I don’t need to explain how that would be catastrophic for the community at large.
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u/Deep-Examination7086 18d ago
More catastrophic than these outrageous surprise bills?
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u/OtherwisePumpkin8942 18d ago
Yes. If ambulances don’t exist, you are looking at having no one arrive if you call 911. Would you rather that instead?
The cost is astronomical but the basis of this issue is that ambulances are not considered essential services. This determination of it being nonessential birthed private ambulance agencies and is the reason why many counties refuse to initiate a tax-based ambulance service for their citizens. Instead they contract these private agencies because it’s cheaper than buying and operating several ambulances.
So if I had to run the choice of dealing with a bill or just having ambulance not exist. I’d choose the bill through and through. Imagine calling 911 and then saying that help is 2 hours away or worse, they aren’t coming. This actual happens in some rural communities. Money isn’t everyone’s top priority. And while I do recognize that sudden bills can be burdensome I would still rather have a 911 service to turn to if I ever need it.
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u/Deep-Examination7086 18d ago
Maybe they should work with insurance instead of lobbying to be exempt to increase profit margins. The fact that these companies can call themselves “non-profit” is laughable
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u/McNallyJoJo34 18d ago
I don’t know of any ambulance company that calls themselves “non-profit”. Private ambulance companies are a business. They make profits.
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u/Secret-Rabbit93 14d ago
The profit margins on ambulance services are already razor thin. It takes a crap ton of money to buy ambulances, stretchers, cardiac monitors, insurance, pay for 2 people 24 hours a day and you need enough of them to handle surges in call volume so those spend a decent portion of their day not actually generating revenue but just sitting. The smaller services are hanging on by a thread and are quickly being taken over by big conglomerates. And they’ve tried working with insurance companies. The vast majority give us the run around and don’t want to negotiate in network status let alone agree to pay enough to make that viable.
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u/Deep-Examination7086 14d ago
Yeah I really don’t give a fuck about your profit margins. In no world is sending people into mountains of medical debt for emergency transport (that they didn’t arrange) ethical by any means.
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u/Secret-Rabbit93 14d ago
So what would be ethical? In your world. Ford wants money for the chassis. Fraser wants money for the box. Stryker wants money for the stretcher and monitor. We’re about half a million at this point before adding employees who want to feed their kids. Insurance companies don’t pay enough to keep the wheels rolling. Most EMS services receive no tax funding. So where does the money come from? Things don’t magically appear. You want to pay less for medical care? So do I. You can vote people in who will properly fund EMS. You could vote people in who will force insurers to properly cover transports.
Until then this is the system and it’s not the ambulance companies fault.1
u/flag-orama 18d ago
hospitals total abuse patient transport. the only reason OP was forced to use an amblance was to reduce the hospital's risk. I have no doubt the patient could have been safly transported by the parents. i would never pay this bill and nobody dings credit scores for hospital bills.
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u/OtherwisePumpkin8942 18d ago edited 18d ago
The baby went to a Neonatal Intensive Care Unit (NICU). A patients, child or adult, being transferred to an intensive care unit is not stable by any means. ICUs are reserved for those requiring the most intense care. The hospital could have not recommended any less transport than an ambulance. I’m sure these parents would rather have an ambulance bill and a baby rather than the other way around.
Idk where you got the information that no one dings credit for hospital bills. There’s millions of people with medical bills on their credit. There is no such law that prevents that. The Biden era attempt at a law was shot down before it could even take effect. Hospitals literally sue patients to recoup medical bills. It’s not a great practice but health care is a business in this country and is treated that way. Hospitals could care less what kind of grief they cause patients as long as they get their dime. Hospital bills and ambulance bills are separate by the way. And working for an EMS agency has taught me that they’d send anyone to collections in a heart beat.
I do feel for the parents. This is a shit situation. Americans are taxed at 33% with no government funded healthcare, 100% parental leave, full disability pay etc. Healthcare shouldn’t be a business but here we are.
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u/flag-orama 18d ago
Do you really think the ambulance people did anything other than just drive the baby across town? I would bet $20 the baby never even needed to go to a NICU. The entire US health care game is about risk reduction and extracting $. The last thing you ever want to happen to you is to wind up in the ER with good insurance. If you do, the hospital will give you every medical intervention known to mankind and you will wind up in a deeper health hole then you could imagine. AVOID US hospitals at all costs. They will either kill you or maim you while robbing you of your financial future.
This will only stop when we stop throwing our money at them.
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u/OtherwisePumpkin8942 18d ago
I see this conversation is going no where. You’re responding based on your feelings. I’m responding based on experience and facts. Neither of which you seem interested in. Keep on keeping on. Have a good day.
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u/flag-orama 18d ago
Sorry I can't give your the details but my comments are based on experience. let that soak in.
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16d ago
These prices are insane and not justifyable. The entire healthcare system has made up prices and then operates on enormous discounts. Unfortunately, non discounted prices get pushed out to people like you in certain situations. The system is broken in so many ways.
Do whatever you can to get it covered or get that price down. It's BS math. If they made that much from each ambulance ride, we would have ambulances on every corner.
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u/Deep-Examination7086 16d ago
I work in healthcare. In my field I am not allowed to charge more than the Medicare reimbursement schedule. I’m not sure why these services think they can upcharge Medicare reimbursement by 5x
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16d ago
That's the I discounted price. Medicare works on discounts because that is the concept. The government decided that if they get an 80% discount then they are getting a good deal. Well hospitals just raised their prices by 5x so they would still make money.
Now the whole industry works on imaginary prices. Then they act shocked when people can't pay their insanely inflated prices.
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u/Secret-Rabbit93 14d ago
To me at least me or my baby being dead would be more catastrophic than any bill so yes more catastrophic than surprise bills.
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u/Deep-Examination7086 14d ago
I bet it is, because you work for the people gaming the system.
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u/Secret-Rabbit93 14d ago
You think my tiny EMS employer is gaming the system, really? It’s them and not blue cross Cigna and united? I guess that’s one thought.
You’re acting like I’m taking in all these profits. I make 18 dollars an hour. With almost 15 years experience, management experience critical care training a degree all the things. And I will stand on the hill that my kids being alive outweighs any imaginable bill.1
u/Deep-Examination7086 14d ago
Maybe it’s time to find a better career path if you’re making less than a McDonald’s employee after 15 years lol
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u/Calm-Vegetable-2162 18d ago
Given the situation,,, your newborn may be entitled to Medicare/Medicaid coverage which possibly cover the ambulance bill.
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u/DrinkHonest7795 18d ago
They tried this with me and I refused to pay it because they are contracted by the allowable amount. After a year, they stopped sending me letters.
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u/Last-Scratch9221 18d ago
My aunt also received a crazy bill for an emergency transfer between hospitals. It was life or death for her so there wasn’t really a choice. When she got the 25k bill (transport across state lines) she was extremely upset and even stated that next time she will “hitch a ride” even if she might die. Which is totally crazy but people do actually make decisions like that because if the cost. She simply wrote them a letter and told them she was told that their transportation was her only option and she could not pay their bill. So instead they had her pay the normal “insurance rate” of $500. She was shocked as she thought for sure she was heading to bankruptcy.
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u/DAWG13610 18d ago
Is your baby alive? I’d start there. Call the ambulance company and negotiate a settlement.
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u/Deep-Examination7086 18d ago
This was 6 months ago. Baby is fine. I’m not negotiating shit. They can take my in-network cost sharing amount or leave it. I don’t pay my insurance premiums to be extorted like this.
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u/DAWG13610 18d ago
WOW, wonder if you would have thought that way when the baby was in crisis.
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u/Deep-Examination7086 18d ago
I expected insurance to apply the benefits I pay for. How do those boots taste?
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u/McNallyJoJo34 18d ago
A private ambulance company absolutely will send you to collections and tank your credit just fyi.
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u/Wild_Buffalo_5128 17d ago
I’m not sure about all states, but in Oklahoma, we can pay for ambulance as a utility. Specifically emsa-care is a 7 dollar monthly charge on our water bills. A lot of people don’t realize they have it and pay their ambulance bill anyway.
May be worth checking if your city or state has a similar program. I’d be surprised if Oklahoma was the only one.
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u/ProposalNo1468 17d ago
Is this employer insurance? If so, ask HR/Benefits to ask the broker to request that insurance refile the claim as in network since you had no control over the picking the ambulance service. The broker is paid to handle this kind of stuff.
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u/LowParticular8153 16d ago
Ambulance companies are rarely in network.
Did the insurance company process the claim as an emergency transport? If insurance company handled claim as non emergency appeal.
If baby was in NICU often case managers in hospital will see if can get family Medicaid- retroactive. Medicaid would be last payer
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u/Safe_Conference5651 16d ago
I live in a major metropolitan area with exactly 1 ambulance company. They do not take insurance because they do not need to. I have paid three times for their amazingly high prices. Once, my 4 yo had "low blood ox" at a pediatrician's office, the office "insisted" we get an ambulance. I followed, at regular speed with no flasher on the ambulance. The ER asked us "why are you here, your daughter is fine". The second time my wife went to an urgent care with a massive headache, urgent care "insisted" she had to go in an ambulance. I followed in my car, at regular speed, no flashers on the ambulance. She has a migraine. Then I had a collapsed lung, I drove myself to the hospital, they inflated it, then made me take an ambulance to a different hospital for the surgery. Again, no flashers. In every case, the bill for the ambulance was WAY MORE than every other bill put together. Yes, I got my lung reinflated at one hospital, had major surgery at a different hospital with multiple days in the ICU, week total in the hospital and STILL the ambulance was by far and away my biggest cost.
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u/SleepyEMT10 19d ago
Few if any ambulance companies are in network with any insurance providers. Ground based ambulance services are exempt from the surprise billing act as well. You can try writing and explaining things to all sides. You might have some success getting the hospital to cover it because it was a medically necessary transport within their system.