Consumer Reports Investigates Balance Billing in Ambulances

 

In the wake of COVID-19, many Americans are skipping visits to doctors and hospitals. And that’s a problem for ambulance companies, which often get paid far less than the cost of the services they provide. To make ends meet, many of them turn to balance billing—where patients get hit with out-of-network charges for ambulance rides, which insurers do not cover. Consumer Reports has heard from hundreds of people who have faced this issue. Some of their stories are eerily similar, and some include allegations of fraud.

The issue is complicated by the fact that ambulance services must decline insurance network contracts to avoid paying rates that are below their costs, says Imholz. It’s also exacerbated by the fact that demand for ambulance services is down during the pandemic, and people may be reluctant to call one out of fear of contracting or spreading the virus.

A recent study found that over a million ambulance trips taken by private health insurance customers in 2014 resulted in out-of-network charges. That’s because the billed charges exceed the insurer’s allowed payment rates, and because most ambulance services don’t negotiate with insurers, as other medical providers do.

That’s a lot of money that could be going to other health care providers, and patients. Consumer Reports has seen examples of egregious ambulance-billing practices—one patient was charged thousands for a four-mile ride; another received a bill of more than $18,000 for a trip to the hospital that started at her house. But most complaints reviewed by CR don’t involve fraudulent charges and are simply the result of a lack of bargaining power between insurers and ambulance services.

The Hagas, for example, were billed $2,438 for taking their daughter to the closest appropriate facility after a seizure. They got nowhere with the company when they called to ask about the bill. “We’ve been calling for a month and they never get back to us,” Mike Haga said. “It feels like a scam.”

Patients can take steps to protect themselves, starting with making sure their local ambulance service is in their health plan’s network. (This isn’t always easy: A recent study found that 52 percent of non-emergency ground ambulance transports could result in out-of-network charges.) They can also try to negotiate with their insurer and, if they can’t resolve the issue, file an appeal. (A guide from the Patient Advocate Foundation offers step-by-step instructions.)

Another option is to consider an ambulance-service membership program, which costs $30 to $75 a year for individuals. Those that have regular need for ambulance services, such as someone with a chronic condition that can trigger seizures, may benefit from these programs, which allow members to ride for free. However, beware of companies that claim to offer such a program but only bill insurance directly and collect out-of-pocket payments from members. Doing so could violate HIPAA and other privacy laws. (Doing so is also illegal in some states.) Finally, consumers can file a complaint with the Better Business Bureau.American Medical Response Billing