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/OtherwisePumpkin8942]

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.

[u/Deep-Examination7086 → u/OtherwisePumpkin8942]

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

[u/Secret-Rabbit93 → u/Deep-Examination7086]

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.

[u/Deep-Examination7086 → u/Secret-Rabbit93]

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.

[u/Secret-Rabbit93 → u/Deep-Examination7086]

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.