What Happens If You Don’t Pay 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.

You must credit us as the original publisher, with a hyperlink to our californiahealthline.org site. If possible, please include the original author(s) and “California Healthline” in the byline. Please preserve the hyperlinks in the story.

It’s important to note, not everything on californiahealthline.org is available for republishing. If a story is labeled “All Rights Reserved,” we cannot grant permission to republish that item.

Copy And Paste To Republish This Story

We encourage organizations to republish our content, free of charge. Here’s what we ask:

You must credit us as the original publisher, with a hyperlink to our californiahealthline.org site. If possible, please include the original author(s) and “California Healthline” in the byline. Please preserve the hyperlinks in the story.

It’s important to note, not everything on californiahealthline.org is available for republishing. If a story is labeled “All Rights Reserved,” we cannot grant permission to republish that item.

What Happens If You Don’t Pay Ambulance Bill? – CountyOffice.org

FAQ

What happens if my 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.

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 should I do if I can’t pay my ambulance Bill?

If you can’t pay your ambulance bill right away, ask the company to delay billing or set up a payment plan. Most ambulance companies will work with people who can show they can’t pay for their services in full at the time of service (5). When you can’t afford to pay the bill ).

What if the ambulance doesn’t get my insurance?

When you need help right away, the ambulance company might not be able to get your insurance or the hospital might not be open, so you want to make sure that your insurance has paid the bill. “The ambulance company may send you a bill the next day, so make sure this is the last bill,” Kelmar said. 4.

Who is responsible for paying an ambulance bill?

You should use your health insurance to pay for the ambulance bill if you have it, since it was sent there for your safety. If you don’t have insurance, you might be able to work out a deal with the person who called the ambulance or the ambulance company.

Should you pay for an ambulance if you don’t need one?

1. When the ambulance was not medically necessary. You might not have to pay the bill if you called for an ambulance but didn’t need medical help. If you passed out at work and your coworkers called an ambulance, but you were fine by the time they got there, you shouldn’t have to pay for the ride.

What should you do if your ambulance bill is out-of-network?

Companies that offer ambulance services are often willing to make deals like 20% off if the person pays by the end of the day, according to Kelmar. He suggested putting these charges on a credit card with a high interest rate. 3. Make sure the bill went through insurance. Even if you are not in the insurance plan’s network, they should still pay a portion of what you paid, so make sure that has happened.

Could a no surprise bill still be a problem for ambulances?

The No Surprises Act asked for a committee of government officials, consumer advocates, insurers, and ambulance providers to study ways to better protect consumers from getting unexpected bills for ground ambulances. This may still happen. Medicare and Medicaid, which already ban balance billing on ambulance services, may also play a role.