Ambulance bill

[slowsynapse]

Late in 2020, my wife had a very bad stroke that left he in the ICU for several weeks. When she was released from ICU and sent to a long term care hospital she was largely paralyzed and on a ventilator so the hospital arranged for an ambulance to do the 12 mile transfer. In the chaos of events like this, you don't really think about the cost of every little item as a proper Mustachian would do.

Fast forward about 10 months and we get a surprise bill from the ambulance company for $1,800. Unlike other threads I have read, my insurance company immediately paid a little more than $1,200 of the original $3,000 bill with no hassle. They said that they paid the max allowable under our plan. Additionally, the insurance company was amazing under the circumstance and covered virtually everything with no issues. The ambulance company, however, has said I am responsible for the remainder and that they do not accept discounts in any circumstance and have no contract with any insurance company. I tried very hard negotiate this bill down and they simply will not budge. Are we just out of luck and forced to pay this? I feel a little fleeced by the amount of their billing. Any advice is greatly appreciated.

[lhamo]

This long article from Consumer Reports shows your experience is common.  Unfortunately the law congress recently passed to disallow balance billing does not cover ground ambulances.  There might be a state law you can turn to (Ohio has one that they mention).  Otherwise keep trying to negotiate.  You probably will have to pay something, though.

https://www.consumerreports.org/medical-billing/your-ambulance-ride-could-still-leave-you-with-a-surprise-medical-bill-no-surprises-act-a2373503204/

[slowsynapse]

Thanks so much, Ihamo. There is good advice in that article particularly about the part of not charging for Covid care cases if they took Cares Act money. Even with the dollar amounts, that article was spot on to my experience. I am going to keep negotiating with them although I am pretty sure I am going to have to pay up.

There are several financial lessons learned from my experience. I have started to write them down to share in hopes to help others build their fire plan with at least a consideration for large medical events.

[sailinlight]

What is the worst thing that could happen if you don't pay? Presumably you didn't sign any contract with them, so I can't see how they could sue you.

[GuitarStv]

What is the worst thing that could happen if you don't pay?

They can tank your credit, send your account to debt collectors.

[yachi]

What is the worst thing that could happen if you don't pay?

They can tank your credit, send your account to debt collectors.

I think they can also put your house on a "do not service list"

[lhamo]

I have somewhat mixed feelings about this.  On the one hand, I do NOT like the fact that at least one big ambulance company (AMR which serves our area) apparently is now owned by a private equity fund.  Screw those capitalists.  On the other hand, having lived in China where ambulance service is spotty at best and you are often better off hopping in the first taxi or rideshare vehicle you can snag to get to the hospital, I would not want to see these services disappear or be practically unavailable to those in need.

If you have true financial hardship from paying the bill, maybe see if there is a way to get it reduced -- media attention from a local television consumer advocate or similar channel might help.  Also bring it to the attention of your local elected officials, since local laws can outlaw this kind of thing.  But if you can afford it?  I would just go ahead and pay it. 

[yachi]

If you have true financial hardship from paying the bill, maybe see if there is a way to get it reduced -- media attention from a local television consumer advocate or similar channel might help.  Also bring it to the attention of your local elected officials, since local laws can outlaw this kind of thing.  But if you can afford it?  I would just go ahead and pay it.

Isn't this just acknowledging that the system needs to change, but placing responsibility for the change in the hands of those least likely to be able to do something about it? -- If FIRE status has placed you in the position where you have the time and money to bring attention to this issue, just roll over and pay the bill.  If you're working 2 jobs just to put food on the table and this bill means you have to choose between paying rent or buying food this month, then contact your local TV channel and elected officials, and spend lots of precious time fighting it.

Honestly, so many people in the can't afford it category go without paying this bill anyway, that the Ambulance company is hardly losing any money when they agree to reduce the bill under media attention to one person in a particularly-sympathetic financial situation.

I would say fight against it and bring attention to it if you're up to the work it entails, because changing this is beneficial to others with lesser means.  If you're not up to it, pay it if you can afford to.

[jac941]

This is common and unfortunately perfectly legal. I had a very similar thing happen - I required an ambulance transfer between hospitals. I actually got it pre approved through insurance, and they still didn’t pay in full. I was told that pre approval is acknowledgment of medical necessity but not a guarantee of payment.

I managed to get the ambulance company to knock about 1/3 off the bill for that ambulance and then just paid. I have plenty of other medical bills to argue about - the ambulance bills are all excluded from the laws and it’s pretty hard to win an argument.

At least the private ambulance was reasonable and knocked off some cost. The  ambulance that did the emergency transport for the original injuries that landed me in the hospital in the first place was part of the fire department. There was no negotiating there. I just paid.

[lutorm]

I'm sorry, this sounds like a terrible experience. Not because of the bill...

Some thoughts: Most insurance plans have a coinsurance amount, ie they will only pay X% of the cost. X is typically higher for "in-network" than "out of network" providers, but the killer is that for OON they will only pay X% of what they think it should cost ("usual and customary expenses") not X% of what you were actually charged. Then there's usually a out-of-pocket max.

The only circumstance in which you should have expected to pay nothing would be if it's in network and you've hit your out of pocket max. It sounds like in this case it was out of network since they don't have any contracts, and you didn't realize this?

I agree that if your financial situation allows, just pay it. They provided you a service that you needed, after all; $3k for a 12mile ambulance ride doesn't sound terrible, and you probably don't need the stress anyway. If you're already into the six figures and have drained your savings for this ordeal, then the calculation is a bit different.

[KarefulKactus15]

This is common and unfortunately perfectly legal. I had a very similar thing happen - I required an ambulance transfer between hospitals. I actually got it pre approved through insurance, and they still didn’t pay in full. I was told that pre approval is acknowledgment of medical necessity but not a guarantee of payment.

I managed to get the ambulance company to knock about 1/3 off the bill for that ambulance and then just paid. I have plenty of other medical bills to argue about - the ambulance bills are all excluded from the laws and it’s pretty hard to win an argument.

At least the private ambulance was reasonable and knocked off some cost. The  ambulance that did the emergency transport for the original injuries that landed me in the hospital in the first place was part of the fire department. There was no negotiating there. I just paid.

Was the fire department ambulance reasonably priced? I've wondered how that works.  Do they charge "what the market will bear"?    And what stops the actual fire department from doing this? Seems during a fire you would be in a poor position to negotiate, the perfect business!

Sigh*.  The older I get the more traps and cracks I realize there are to fall through in life.

[Psychstache]

Was the fire department ambulance reasonably priced? I've wondered how that works.  Do they charge "what the market will bear"?    And what stops the actual fire department from doing this? Seems during a fire you would be in a poor position to negotiate, the perfect business!

I believe that I read somewhere that this sort of thing is exactly how the roman equivalent of a fire department worked. Show up with the means to stop the fire, then extort the owner to actually do it.

[KarefulKactus15]

Was the fire department ambulance reasonably priced? I've wondered how that works.  Do they charge "what the market will bear"?    And what stops the actual fire department from doing this? Seems during a fire you would be in a poor position to negotiate, the perfect business!

I believe that I read somewhere that this sort of thing is exactly how the roman equivalent of a fire department worked. Show up with the means to stop the fire, then extort the owner to actually do it.

I mean I can support that, as long as they aren't using roman tax coins to support it.

Seems arson would be a big problem though - here I stand conveniently with a fire truck next to this raging fire that I have no idea how started. 

[DeniseNJ]

You can write to your insurance an appeal to pay the full amount explaining that you had no choice in this, the hospital picked the service, etc.  You can also write tot he hospital and ask them to intervene since they picked the ambulance.  You can also write to congress.  Ppl write to their congress people all the time.  I'd start with appealing to your insurance to please cover the entire balance as it was an emergency and the hospital picked the service, you had no choice and were not informed they didn't participate.

[JoePublic3.14]

What is the worst thing that could happen if you don't pay?

They can tank your credit, send your account to debt collectors.

I think they can also put your house on a "do not service list"

So, possibly nothing too bad, depending heavily on OP's current situation and their plans in the future.

OP, sorry for your overall situation.

[BikeFanatic]

I too am so sorry to hear about your situation, your poor wife and you, and now you have to deal with all theses bills on top of that!
MMM comrades, make sure your retirement plan can handle big unexpected expenses is one lesson learned, but how can you prepare and predict for catostrophic events like these? Even with good insurance I still have to dish out 300 every other month as a co pay on labs ( who knew blood work cost a grand) and this is what I have to pay every 2 months. Sometimes these medical expenses come out of the blue and you can not predict them. but in USA the healthcare costs are high IF you get sick, if you need a new medication, and then you may also pay through the nose for insurance that may not cover everything.

[jac941]

Was the fire department ambulance reasonably priced? I've wondered how that works.  Do they charge "what the market will bear"?    And what stops the actual fire department from doing this? Seems during a fire you would be in a poor position to negotiate, the perfect business!

Nope. They were over double the private ambulance. I mean, they stabilized and did the delivery to the trauma center, so it’s not really a fair comparison. But still. I don’t recall the exact cost, but it was well over $1,000 — and that was after my insurance paid their maximum.

[jac941]

MMM comrades, make sure your retirement plan can handle big unexpected expenses is one lesson learned, but how can you prepare and predict for catostrophic events like these? Even with good insurance I still have to dish out 300 every other month as a co pay on labs ( who knew blood work cost a grand) and this is what I have to pay every 2 months. Sometimes these medical expenses come out of the blue and you can not predict them. but in USA the healthcare costs are high IF you get sick, if you need a new medication, and then you may also pay through the nose for insurance that may not cover everything.

I’ve thought a lot about this and don’t have a solution. There’s a reason that medical bills are a top contributor to bankruptcy in the United States.

Even outside of the direct costs for healthcare, all the other expenses incurred with a major medical issue are enormous. Think housekeepers, prepared foods, gardeners, grocery (and everything else) delivery. For physical injuries physical therapy, durable medical equipment (like shower chairs, ice machines, canes, walkers, wheelchairs, etc), massage / body work / chiropractic (if appropriate), mental health support, etc. Transportation to medical appointments if you’re unable to drive or walk to transit, etc. It’s a lot.

If you’re still working / accumulating, lost wages are a huge cost too.

[px4shooter]

Do they offer a pay in full discount? Tell them the problems with your other bills and see if there is a cash discount or any other option. I haven't heard of an ambulance company doing that before, but every area is different.

[PDXTabs]

I had this happen and just ate the $1,600 bill. They said that otherwise they'd go to court and get an order to garnish my assets. I'm not sure who would have won, but I'll pay $1,600 to stay out of court any day. YMMV