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/flag-orama]

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.

[u/OtherwisePumpkin8942 → u/flag-orama]

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.

[u/Deep-Examination7086 → u/OtherwisePumpkin8942]

More catastrophic than these outrageous surprise bills?

[u/[deleted] → u/Deep-Examination7086]

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.

[u/Deep-Examination7086 → u/[deleted]]

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

[u/[deleted] → u/Deep-Examination7086]

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.