How to handle ambulance bill

[u/Deep-Examination7086]

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.

[u/Tina271]

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.

[u/Deep-Examination7086 → u/Tina271]

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.

[u/Mountain-Arm6558951 → u/Deep-Examination7086]

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.

[u/Deep-Examination7086 → u/Mountain-Arm6558951]

That sounds similar to my situation. Can’t hurt to ask.

[u/Alive-Plankton6022 → u/Deep-Examination7086]

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.

[u/throwawayeverynight → u/Deep-Examination7086]

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.

[u/Tina271 → u/Deep-Examination7086]

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.

[u/Deep-Examination7086 → u/Tina271]

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.

[u/EfficientBadger6525 → u/Deep-Examination7086]

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.