How Long Do You Have To Pay An Ambulance Bill

Last year, Jennifer Reisz’s college-age daughter, Megan, was kicked in the chest multiple times by the family’s horse. Megan fell to the ground, unable to move or speak. Though she was alone, her Apple Watch detected her distress and called 911.

A series of columns by Bernard J. Wolfson addressing the challenges consumers face in California’s health care landscape. Send questions to [email protected].

She was taken to a hospital in Clovis, a city in Fresno County, near where the Reisz family lives. But the severity of Megan’s injuries — four broken ribs and a partially collapsed lung — prompted doctors to transport her 12 miles by ambulance to the Level I trauma center at Community Regional Medical Center in Fresno.

While Megan was still recovering at home from her injuries, she received a $2,400 bill from the ambulance company — after the family’s health plan had paid nearly $2,200.

“When we received the bill, I thought our insurance company was processing the claim incorrectly,” says Jennifer Reisz. An attorney, Reisz says she then spent hours on the phone with the health plan, the ambulance company, and a few consumer advocates. She learned that the ambulance company was not in the health plan’s network and was permitted to bill patients for any uncovered portion of its charges — a practice known as balance billing.

Starting Jan. 1, ground ambulance operators will be barred from doing that, thanks to a new law signed by Democratic Gov. Gavin Newsom. California is the 14th state to provide some protection against balance billing for ground ambulance rides.

At the federal level, an advisory committee established under the No Surprises Act is working on a plan to address the problem nationally.

Both the federal law, which took effect in 2022, and a California law that predates it largely banned balance billing for hospital care and air ambulance services, but not ground ambulance services.

And that is hardly fair, since patients have zero control in a medical emergency over which ambulance company responds, whether it is in network, or how much it will charge.

In California, nearly three-quarters of emergency ground ambulance rides result in out-of-network bills. The average surprise bill for a ground ambulance ride in California is $1,209, the highest in the nation, according to a December study.

The new law, which applies to about 14 million Californians enrolled in state-regulated commercial health plans, limits how much a non-network ambulance operator can charge patients to the amount they would pay for an in-network ambulance.

The law also caps bills for uninsured people, stipulating they can’t be charged more than the Medi-Cal or Medicare rate, whichever is greater. (Medi-Cal is California’s Medicaid program, providing coverage to people with low incomes or disabilities.) And it prohibits ambulance operators and debt collectors from reporting patients to a credit rating agency or taking legal action against them for at least 12 months after the initial bill.

Under current law, people in distress sometimes decline to call an ambulance for fear of a huge bill, putting themselves or a loved one at risk, says Katie Van Deynze, policy and legislative advocate for Health Access California, which sponsored the legislation. With the new law, she says, “they will have peace of mind.”

Existing laws already protect Medicare and Medi-Cal beneficiaries from surprise ground ambulance bills. The new law does not cover the nearly 6 million Californians enrolled in the subset of employer-sponsored health plans that are federally regulated.

The advisory committee working on a federal fix agreed last week on nonbinding proposals that would, among other things, prohibit balance billing for the vast majority of ambulance rides and cap patients’ financial liability at $100. The committee plans to formally report its recommendations to Congress early next year for potential legislation.

Under California’s new law, patients can expect to save an average of nearly $1,100 per emergency ambulance ride and over $800 per nonemergency ride in the first year, according to a legislative analysis conducted earlier this year.

Health plans will be required to pay ambulance operators the rates set by county authorities, which the study said would increase the average amount insurers pay per ride by around $2,000.

Since ambulance rides account for a tiny percentage of overall health plan spending, those increases should not raise premiums by much.

But local authorities might be tempted to hike ambulance rates over time to increase revenue for publicly run ambulance operators, such as fire departments, says Loren Adler, associate director of the Brookings Schaeffer Initiative on Health Policy. That could prompt health plans to raise ambulance copays, offsetting some of the consumer savings from the new law, Adler says.

Jenn Engstrom, director of CalPIRG, an advocacy group that helped shepherd the law through the legislature, notes there will be built-in accountability, since the legislation requires public reporting of ambulance rates. “If we notice that things start to skyrocket, there will be a need for legislative action or local action,” Engstrom says.

Reisz says the ambulance company that transported her daughter wrote off the bill after she made it clear she had no intention of paying it — and after her health plan ponied up a little more. But as she notes, not everyone is a lawyer adept at arguing their cause.

Even if you are no rhetorical wizard, you can take simple steps to protect yourself against errors or ambulance operators that disregard the new law.

Check your insurance policy to know your deductible and any copay or coinsurance should you ever need an ambulance. If you get an ambulance bill, don’t pay it right away. Check your insurer’s explanation of benefits to make sure what it says you owe matches what you think your cost-sharing amount should be. If the bill is higher, the ambulance company may be trying to pull a fast one. Call the ambulance company and tell them they need to knock the bill down. If they don’t, file a complaint with your health plan and include a copy of the bill.

If you disagree with your plan’s decision, or it takes more than 30 days for the plan to respond, take your complaint to the regulator.

The new law requires your insurer to tell you if your health plan is regulated by the state and thus subject to the statute. If it is, the regulator is likely to be the Department of Managed Health Care. You can contact that agency online (www.healthhelp.ca.gov) or by phone at 1-888-466-2219. If your health plan is regulated by the Department of Insurance, you can file a complaint online (www.insurance.ca.gov) or call 1-800-927-4357.

Another good resource is the Health Consumer Alliance, which offers free legal assistance in multiple languages. Call 1-888-804-3536.

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Q&A: Paying For Ambulance Services

FAQ

What is the new law for ambulance in California?

These new California laws take effect in 2024. The new law says that patients will only have to pay as much as they would have for an in-network service. The ambulance and health insurance companies will have to pay the bill directly, even if they don’t have a contract with the hospital.

What happens if an ambulance bill goes to collections?

Once medical bills enter collections, they are often reported to consumer credit reporting companies. It may be harder to find a job and buy or rent a home if you have medical debt collections on your credit report. The costs of car insurance and rent may also go up.

How long does it take to get an ambulance Bill?

ER doctor bill: If the ER doctor is not in your insurance network, it could take up to 6 months to get a separate bill from them. Their billing and coding process takes longer. Bill for an ambulance: Most ambulance bills arrive within two to three months, but sometimes it can take up to a year. Operated by local municipalities, billing may be delayed.

Do ambulance patients get a surprise bill for out-of-network services?

One study found that between 2010 and 2016, 85% of ambulance patients got a surprise bill for services that weren’t covered by their insurance. This is also called a balance bill. The size of the bill can vary tremendously among states.

How many ambulance patients get a surprise bill?

Every year, about 3 million people take ambulances to the hospital. A consumer advocacy group says that more than half of those people will get a surprise bill. According to a study, between 2010 and 2016, 85% of ambulance patients got a surprise bill for services that weren’t covered by their insurance. This is also known as a balance bill.

Can a ground ambulance be a surprise medical bill?

Ohio passed a law in January that, like the No Surprises Act, will stop medical bills from coming as a surprise starting in 2022. The law also covers ground ambulances. Out-of-network providers in New York can’t charge insured patients more than in-network rates in an emergency. This includes ground ambulances but not transports between facilities.

When should you not pay an ambulance bill?

You shouldn’t have to pay for an ambulance ride if: the illness that caused the call wasn’t serious enough to need transportation to the hospital; 2. The ambulance was not dispatched in a timely manner.

What happens if you get a surprise bill from an ambulance?

Healthcare experts say the impact of surprise bills from ambulance rides may go beyond financial risk for patients. Chhabra says, “If sick people don’t want to call an ambulance and go to the hospital, that can have consequences.” “That’s why we need to protect patients from these kinds of bills. ”.