Have you ever received a surprise medical bill . I hope you have not. And I hope you never do. I never knew what a surprise medical bill was until my wife had to be taken to the hospital by ambulance. I now empathize with anyone who has to deal with a surprise medical bill.
We had a scary moment when my wife had difficulty breathing and collapsed on our bedroom floor. She was having severe chest and back pain. I called 911. The paramedics arrived and then the ambulance followed. Based on her condition, my wife was transported to the emergency room by ambulance. Fortunately, later that night she stabilized and was discharged.
A week later, I received a notice from our medical insurer that the ER bill – totaling more than $18,000 – was paid and we only had a $100 co-pay. Great.
Fast forward a month. After a long and exhausting day, my wife opened her email to find an e-bill from the ambulance vendor that transported her to the ER. The bill was $4299.65! I thought it was odd we received an invoice from the ambulance provider and had not yet heard anything from our health insurer. I thought the ambulance bill would have been resolved because I provided our insurance information to the EMT, who drove my wife to the ER. The e-bill my wife received did provide an option for us to enter our insurance information. I figured there was some clerical error or there was some delay in paperwork. So, my wife entered our insurance information and I thought everything would be taken care of – even though in the back of my mind something felt off.
About a week later, my wife opened her email to find another bill from the ambulance provider. The bill stated that our insurance was not applied and she was responsible for the entire $4299.56 bill. Not something you want to see before you go to bed. I immediately started doing research.
I was completely shocked to learn that many people, who have insurance, can still end up responsible for an ambulance bill. Numerous articles noted that approximately 50% of insured individuals end up responsible to pay out-of-network surface ambulance bills. It appeared I received an ambulance “surprise bill” from an out of network provider.
Interestingly, in December 2020 legislation called the No Surprises Act passed and went into effect January 2022. The act aims to protect individuals from surprise medical bills, particularly those arising from emergency services and certain out-of-network care. For example, let’s say a patient had a surgery at an in-network hospital, but the anesthesiologist who provided care was not in the patient’s health insurer network. Even though the consumer did not have a choice in who their anesthesiologist was, that anesthesiologist bills the patient directly out-of-network. The patient would be responsible for the bill. Or imagine a patient being responsible for a medivac bill for hundreds of thousands of dollars after being air lifted in an emergency situation. While the No Surprises Act remedied the examples above, there was one exclusion – surface ambulance rides. You can get an idea of what a nightmare some people go through after taking an emergency ride in an ambulance.
Many states have passed laws, or like California are working to resolve the issue with surface ambulance billing.
We were very fortunate. When I checked our insurance plan, it provided for coverage for all medically necessary ambulance rides. I filed a claim for the ambulance bill directly with my insurance company. However, I was not sure if our insurer would still deny payment for some reason. Fortunately, for us, the bill was covered leaving us with only a $50 co-pay.
While my wife and I did not have to deal with a surprise medical bill, I am now aware that they exist. Please know that even if you have insurance, you can still be liable for an outrageous medical bill (or a good portion of it). From what I have read, whatever part of the bill an insurer does not cover, the patient will in fact be responsible to pay the balance. You will receive no sympathy from either the provider or the health insurer. So make sure you check your coverage so you don’t end up surprised.