Insurance won't pay DH's ambulance bill. Any experience here?

[barrelomonkeys]

DH had atrial fibrilation episode a couple of months ago.  Went to urgent care, got hooked up to an EKG and docs immediately shipped him off to the ER in an ambulance, since time was of the essence.  Got a cardioversion that zapped his heart back into rhythm and he's a-okay now.  Almost immediately after this episode, we got a bill from the ambulance carrier for ~$1400 for the 8 mile trip with a note saying that they aren't contracted with my insurance carrier (Anthem), but to pay them and Anthem would reimburse.  I wasn't buying it, so I let the bill sit while my insurance carrier processed claims (I've overpaid thousands to providers in the past and never been reimbursed).

Well, the claim was denied since it was out-of-network.  Called my insurance company, since it appears from looking through my benefits that they will pay out-of-network ambulance services if it is an emergent situation.  Got through to someone who said they absolutely wouldn't cover it, but I should call the provider to see if I can negotiate the bill down.

Reading through the internets, it looks like somewhere between 80-90% of people are out-of-network for their ambulance rides and are balance billed, but it looks like several of them had their insurance companies pay a portion of it, even if it was out of network.  I can't get my insurance company to even pay the allowable ~$400 that they say they will in an emergent situation. 

Apart from trying to get media attention to shame the insurance company, has anyone had a good strategy they've used?  It sounds like recent legislation both in our state and nationally has decreased the amount of balance billing that occurs in emergency situations, but it hasn't touched ambulance services. 

Thanks in advance.

[katsiki]

No advice really but we were hosed on an ambulance bill years ago.  We tried to fight it to no avail.  We were out of state on vacation.  Emergency happened.  Ambulance was required, ER visit ensued.  All seemed like an emergency to me but BCBS would not budge.   Good luck.  Hope others have ideas for you.

[reeshau]

Well, I thought I might have had something to add, but a little further research shows that ambulance services are excluded from the federal surprise billing legislation last year.

https://www.kff.org/private-insurance/issue-brief/ground-ambulance-rides-and-potential-for-surprise-billing/

You might check if your state has separate surprise billing legislation that might be applicable.  Texas passed a bill in 2019.  I was able to challenge lab billing this year under both laws.

[neophyte]

I successfully got my insurance to pay an out of network ambulance bill they initially refused a few years ago. In my policy it specifies that they pay 80% of out of network emergency expenses after the deductible has been met. If yours is similar, the next thing I would check would be to make sure whatever code you were billed for is considered an emergency not just a transfer or something. If it's coded as something non emergency, have the ambulance company fix that.

My insurance refused to pay beyond what they would allow for an in network ambulance, and I was balanced billed. Then I went through the employee assistance program at work. It took several phone calls back and fourth, but insurance eventually had to pony up.  Ultimately, it will probably depend on what your policy covers.

[MayDay]

Ditto those who said to go through your company.

We got a verbal approval for an very $$$$$ evaluation for our child and then got a bill for the whole thing. Assholes.  Only way we got it paid for was H emailing successively higher ups at his company.

[LaineyAZ]

Also look into contacting your state's insurance department.  They ostensibly oversee the credentialing of insurance companies allowed to do business in the state and so if your insurer gets a letter from the state insurance agency that definitely gets their attention. 

[barrelomonkeys]

Wow, guys, this is great--thanks.  Definitely going to try some of this.  Glad to hear some success stories.

Ironically, I actually set up the insurance for my husband's company.  Go figure. 

[Sibley]

Also look into contacting your state's insurance department.  They ostensibly oversee the credentialing of insurance companies allowed to do business in the state and so if your insurer gets a letter from the state insurance agency that definitely gets their attention.

They do oversee, and the DOIs have teeth (varies on state of course, but in general, they have teeth). Filing a complaint with the DOI will get attention - it's legally mandated. And at least the states I'm familiar with, the insurance company has to explain themselves to the DOI as well as the consumer.

[bryan995]

We were once billed $2600 for a 3 minute ambulance ride from the pediatrics office to the ER. The PED suggested it since it would skip the ER line … once we arrived the ER discharged us within 15 minutes.

After a lot of back and forth, we seemed to have caused enough of a technicality that now the bill is lost in the system. We argued that since the PED ordered the ambulance we could not refuse etc. Then they offered in network charges (CA law) and some other jumbo jumbo. We paid something like $600 OOP. Insurance ended up paying the rest. Later insurance then decided they later paid too much and now want a refund from the ambulance company. Which then will cause a new bill on our end.

For now I am just sitting and waiting. But total nonsense. Will never use an ambulance against unless on a HMO or know for sure that speed is of the essence, which is a very sad things to be saying living in this country.

[jac941]

Earlier this year I was taken to the hospital by ambulance. I was seriously injured - there was no alternative. A week or so later, I needed a second ambulance to transport me from one hospital to another and that one was pre approved by the insurance company. Turns out pre approval is “an acknowledgment that something is medically necessary and is not a guarantee of payment.” Who knew?!?

My insurance company paid a (small) portion of each ambulance bill and then the ambulance companies balance billed me. I’m in California where balance billing is illegal, but apparently ambulances are excluded. Also, when I filled a complaint with the state insurance board (or whatever it’s called) for another balance bill, I found out that the employer based insurance we have is “level funded” and is therefore not considered insurance in California and therefore doesn’t need to comply with California law.

Finally, I filed appeals with the insurance company for everything unpaid (to at least create a headache for them) and called the ambulance companies and asked for a discount to pay the bill on the spot.

After taking all of those steps, the insurance company didn’t pay anything more, the ambulance company knocked 30% off the balance bill, and I paid the balances.

TLDR - Appeal with the insurance company, file a complaint with the state, and ask the ambulance company for a discount. And then just pay whatever you’re stuck with. Healthcare in the United States is a criminal enterprise.

[Visitation]

All I have to say is hope you never need a life flight.  My brother is the Director of Nursing at a small regional hospital.  His wife had a heart attack.   Had to be life flighted from the region hospital to a main hospital in the city.  The hospital he worked at wrote off all of his out of pocket, but he still had to pay $10K for the life flight.  That was one expensive helicopter ride.

Sent from my SM-A505U using Tapatalk

[slackmax]

Good luck, OP.  Appealing with your ins co may be the way to go.

Ambulance company owners are the among the worst scumbags on the planet.

Even if your insurance pays for it, there is a huge copay you have to pay, like $350.

 

[Zamboni]

Another vote for filing a formal written complaint with your state's Department of Insurance. Keep a pile of written records (like phone notes with dates and names of who you talked with) and send all of that along with your complaint. In my experience, that is the only thing that gets their attention. Every time I have filed a formal complaint with DOI, then insurance company has responded by paying the bill within a month (along with documenting some completely BS excuse about why they didn't pay it in the first place.) They fear their govt regulatory agencies because they have been fined tens of millions of dollars by those agencies in the past.

Meanwhile, please don't pay the ambulance bill. And don't waste a lot more of your time on it . . . just file the DOI complaint.

The entire situation in the US is absurd. My Mom was in an accident that literally broke her back and insurance initially refused to cover the ambulance on the grounds she wasn't unconscious or bleeding profusely. Without proper transportation into the ambulance on the back board, she could have wound up permanently paralyzed. Shameful!

[chemistk]

I can't offer much, and this will probably make the situation more depressing, but if you want some (profane, advanced warning) good summaries into the issue with EMS in the US, John Oliver actually covered it a couple weeks ago as the primary piece on Last Week Tonight: https://youtu.be/Ezv8sdTLxKo

Basically, EMS in the country is horribly underfunded and many (if not most) EMS services actively choose to not make themselves in-network with most (and in some cases, all) insurance providers. Fun fact - EMS is not considered an 'essential service' in all but 11 states!

Good luck, OP!

[jac941]

Meanwhile, please don't pay the ambulance bill. And don't waste a lot more of your time on it . . . just file the DOI complaint.

The entire situation in the US is absurd. My Mom was in an accident that literally broke her back and insurance initially refused to cover the ambulance on the grounds she wasn't unconscious or bleeding profusely. Without proper transportation into the ambulance on the back board, she could have wound up permanently paralyzed. Shameful!

I wish this worked for me. My state DOI did respond when I filed a complaint
… as I said above they said that the type of insurance policy we have through an employer is somehow not viewed as insurance and therefore not regulated by the DOI. It was easy to file the complaint though, so I still recommend the OP try it. We’re now complaining to the employer regarding this and they’re working through their broker to try to get some traction.

Sorry to hear about your mom! I also broke and dislocated my neck in multiple places and I was unconscious and I had other less urgent but still serious injuries. I would be paralyzed or dead without the ambulance. Insurance company agrees the ambulance was medically necessary. They just won’t pay more than 1/3 of the bill. And they won’t count the balance towards our out of network out of pocket maximum either because it’s more than they allow.

[Zamboni]

^Wow, that's awful! Sorry to read that, and hope you are able to make some progress.