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.
3
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.