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/Mountain-Arm6558951]

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.

[u/QuantumDwarf → u/Mountain-Arm6558951]

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.

[u/Mountain-Arm6558951 → u/QuantumDwarf]

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.

[u/QuantumDwarf → u/Mountain-Arm6558951]

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.