In the past, ambulance services were often free or provided by town fire departments using local tax money. But many are now run by private companies with venture capital funding and charge by the mile, or for each service provided like oxygen. The resulting bills can be thousands of dollars.
The 13 HELP Team has heard from several people who say they’ve been billed for ambulance services they don’t remember receiving or didn’t need. Some of the patients fought the charges and won, but others were not so lucky. We recently met with a couple who says they’re still fighting a bill from American Medical Response, or AMR.
AMR is the largest emergency medical transport company in the country, with a network of more than 45,000 workers and 4,000 ambulances. The company has been in the news for its shady practices involving Medicare and Medicaid. It was accused of overcharging both the government and private insurers for ambulance rides by classifying them as advanced vs. basic life support, charging for more services than were actually delivered and billing Medicare and Medicaid for higher-level care than was received by the patient. The company was fined by the federal government in 2016.
Many people think they’re protected against surprise ambulance bills because their insurance provider pays the bill, but that’s not always the case. Almost half of all ambulance trips made by people with private health insurance last year were billed on an out-of-network basis, according to a study. And if an ambulance service can’t agree on a price with a private insurance company, they decline to join the network and then balance bill patients.
Most states have passed laws protecting consumers from surprise medical bills, but the rules largely exclude ground ambulance rides. That loophole leaves consumers with hundreds or even thousands of dollars in bills and few options for recourse, a Kaiser Health News review of consumer complaints found. The CARES Act, which President Trump signed into law in March 2020, might offer some protection. Healthcare providers that took money from the CARES Act Provider Relief Fund aren’t allowed to balance bill patients for COVID-19 care.
In addition to being unable to agree on a fair price with private insurance companies, some ambulance services are stretched thin by very low Medicare and Medicaid reimbursement rates. Those rates are below the cost of providing the service, so many providers must decline to accept network contracts and balance bill patients instead.
To try to combat these issues, some communities have set up “ambulance membership programs,” in which people pay an annual fee — typically around $75 — and then are eligible for reduced-price ambulance services when needed. But Consumer Reports has found that these programs can backfire and lead to unexpected, high bills. Some of the best options for avoiding surprise medical bills are to avoid calling 911, and to take an active role in negotiating with your insurance provider if you receive a hefty ambulance bill. American Medical Response Billing