Ambulances are supposed to be there for us in emergencies, but they can leave us with huge bills. Some ambulance companies charge by the mile and even for services like providing oxygen. In a few states, there are laws to protect patients from these charges but they’re rarely enforced. And the problem is getting worse. In the past decade, private equity firms have taken a shine to the ambulance industry. Today about 10 percent of ambulance providers are owned by these companies, and they often try to collect from patients for costs that insurance or Medicare doesn’t cover. Betsy Imholz, special projects director for Consumers Union, the nonprofit policy and advocacy group affiliated with the product-testing and rating publication Consumer Reports, has collected more than 700 stories of surprise medical bills, and at least a quarter of them involve ambulances.
Unlike hospitals, ambulance services do not typically negotiate rates with individual health insurance plans. That’s because the fees they get from insurers are often less than what it costs them to operate. So most ambulance services decline to become part of health insurance networks. It’s not out of greed, but because they can’t agree to terms with insurance companies.
But that leaves the ambulances vulnerable to being billed at much higher prices by private patients and insurance companies. And it allows these companies to slap on extra charges, called balance billing, that aren’t covered by their contracts with insurers.
A few years ago, a Seattle man named John Parker got hit with a $1056 bill for a five-mile ambulance ride that his wife took shortly before she died of a self-inflicted gunshot wound. Parker didn’t dispute the charge, but two years later AMR began attempting to collect from his estate. That type of collection is called a lien and is illegal in many states.
Consumers can help by asking questions before taking an ambulance. Call the company and ask whether it’s in your insurance network. In an emergency, it’s usually too late to check on that, but for non-emergency trips it’s worth a quick phone call.
Another option is to sign up for an ambulance membership program, which can save money on rides. These programs are offered by ambulance companies and some fire departments. Patients pay an annual fee to be members, and in exchange they receive discounted fares. But it’s important to note that most such discounts are not available for ambulance trips to the hospital, which are almost always out-of-network. And many patients don’t think about signing up for these programs when they take a ride to the emergency room. In fact, only about half of all ambulance trips result in a potential surprise bill, according to recent research from Karan Chhabra, a surgical resident at Brigham and Women’s Hospital in Boston. The other half, to a patient’s home or a rehab facility, aren’t billed at all. But a patient still might be subject to the same kind of charges, including balance billing, that can arise from other physician specialists at an out-of-network hospital. American Medical Response Billing