Amid a national outcry over surprise medical bills, many states have passed laws to protect consumers from out-of-network charges. But those laws largely ignore ground ambulance rides, which can leave patients on the hook for hundreds or even thousands of dollars in unexpected charges. A Kaiser Health News review of consumer complaints found that ground ambulance services often overcharge by using complex billing practices and charging for non-emergency trips.
Mike Haga took an ambulance ride in 2021 after he shattered his elbow playing basketball and was sent to the hospital for treatment. He was given a good faith estimate of about $300, but when the bill came, it was $700. “That is a lot of money for something that was not covered,” Haga says. It turns out the ambulance company overcharged by using a technique known as balance billing, which gives the company extra money for transporting a patient in a non-emergency situation to a facility where the service is typically covered.
For patients, such overcharges can add up quickly. The ambulance industry is a confusing maze of for-profit and not-for-profit providers, some run by local governments via police or fire departments, and others that contract with private insurers for transportation. Ambulances have to be available 24/7, 365 days a year and have skilled crews on standby. That makes them costly to operate, and it’s a big reason they don’t join insurance networks like doctors do.
Ambulance companies and their customers are not always on the same page, which leads to misunderstandings about what is covered. Ambulances charge by the mile and sometimes for each "service," such as providing oxygen, and if they use paramedics instead of emergency medical technicians, the cost goes up. Then there are fees for things such as transporting a person to an out-of-network destination, which isn’t covered by Medicare.
There’s also evidence of waste and fraud, including a case where a for-profit company was caught charging Medicaid $500,000 for an alleged ambulance ride from a suicide scene. Another company was accused of taking payments from the widows and estates of departed veterans for ambulance services they never received, according to a government investigation.
While there’s no quick fix to the problem, Consumer Reports suggests that patients consider an ambulance membership program, which can be as low as $30 to $75 a year for individuals. If you have an underlying condition that could require regular ambulance transport, the membership may be worth it.
The federal and state governments settled a $601,759 civil claim against American Medical Response, resolving allegations that it overbilled the Medicare and Medicaid programs between January 2014 and December 2019. In many cases, the government said AMR improperly billed the Medicare and Medicaid programs for ALS (advanced life support) paramedic services in joint responses with local fire departments in Connecticut.
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