The two thousand dollar bottle of Bulleit
February 4, 2015 8:13 PM   Subscribe

The San Francisco city tax collector just called me about an extremely expensive, 3-year-old ambulance bill I wasn't aware of previously, what are my next steps?

I took a very short ride to the local hospital in 2011 when severely intoxicated. We're talking three blocks maximum. I actually do not even remember the ambulance ride and thought I'd been transported to the hospital by other means. The ER personnel told me I was not sick enough to be admitted and had me sleep in a gurney for a few hours and then I was sent home. I never received a bill and moved shortly thereafter.

Today I got a call from the city tax collector (??) about the ambulance bill, which is a whopping $1700. I argued with them a bit before enough of the evening came back to me that I realized that, yes, an ambulance was involved, not just the hospital denial. They said they had phone call records showing that we did call for an ambulance.

I actually had had two forms of health insurance, one through my previous employer, at least one of which was Blue Cross/Shield. One of the insurance policies is continuous to this day. I guess that no one took my insurance information at the hospital. But I never received a bill, a phone call, or any whiff of this until now. Apparently they were sending bills to my old address, and I wasn't having mail forwarded as I thought I had updated my address with all billers, etc. There weren't any collection efforts, nothing showed up on my credit reports, which I actively monitor. They apparently had my name and birthday, so you'd think they'd have had some way of tracking me down, but yeah, nothing until today.

Yes, I know I'm an idiot for a) getting that drunk and b) not checking in with the hospital billing department shortly after my visit.

The tax collector is mailing me the statement, so I haven't seen it yet. She said that it would be up to me to try to deal with my insurance, and that claims typically need to be filed within a year, not 3+. So, what now? Call the hospital first? the insurance? Pay it right away and try to file a claim with the insurance afterward? Attempt some kind of lawyering or legal aid? The tax collector said the balance with the hospital is zero, now that it has been turned over to them. (Is it even standard procedure to turn this sort of thing over to the "city tax collector"?)

If it matters, I was unemployed at the time, having been laid off a month prior, but I believe I still had that last month of insurance eligibility through my employer, plus a privately held insurance.
posted by ziggly to Work & Money (14 answers total)
Pay it right away and try to file a claim with the insurance afterward?

I can say that i know that this rarely works out easily. You want to call your insurance and talk to them. If you were insured at the time this happened they'll mop it up from there.

I've been in a very similar situation, and i ended up derailing the train just after the insurance company part because i was two days outside my insurance being active(i fucking HATE this country sometimes), but it seemed like if i hadn't been they would have just sorted it then and there.
posted by emptythought at 8:18 PM on February 4, 2015 [2 favorites]

I would call your insurance company first. They were covering you at the time, so you want them to pay.
posted by J. Wilson at 8:32 PM on February 4, 2015

The "tax collector" thing strikes me as weird. This isn't a tax issue. I bet the debt was charged off and this is an unscrupulous collection agency. Wait until you see the paperwork to be sure. Don't pay anything until you've fully investigated their right to collect. You may also want to refer them directly to your insurance company. This sounds fishy.
posted by quince at 8:34 PM on February 4, 2015 [25 favorites]

The "tax collector" thing may be weird and should be fully investigated, but it could also well be legit. In San Francisco, most ambulance calls are handled by the Fire Department and bills come from the city for these services (some calls are covered by commercial ambulance services instead). You could contact their billing department directly if you want to verify who you're dealing with.
posted by zachlipton at 8:39 PM on February 4, 2015 [2 favorites]

Ambulance service being billed through the city is very common in the US. And if you don't pay it is indeed the city tax collector who will eventually come asking for payment, so that is not weird in and of itself. I've seen wages garnished by a city for this very thing (but in NC).

Looks like you can appeal the bill and/or file for financial hardship in San Fran.
Link here

Best of luck.
posted by ZabeLeeZoo at 9:26 PM on February 4, 2015

Response by poster: I know I was supposed to Google before asking the question, not after, but I just saw this. It sounds like outrageous bills were routine in the city even if you weren't transported.

Now I am recalling that an ambulance was called, that personnel arrived, but I am confident I never actually set foot inside the ambulance, in case the distinction matters.
posted by ziggly at 9:39 PM on February 4, 2015

Call the insurance company first, don't pay anything until the insurance company(ies) are involved. Be honest with them about blacking out and either not remembering the ride or not being sure. Was there anyone else there that evening that you are still in contact with that you could talk to about what really happened?
posted by pwb503 at 9:44 PM on February 4, 2015

If you contact the Fire Department, they'll have records from your ambulance call. Those records should detail when they arrived, what tests they performed, and whether they transported you. Ask for copies.

Ultimately, if they provided you with medical services, and especially if they transported you to the hospital, you're pretty much responsible for the bill. Your options basically boil down to:
  • Try to get insurance to pay for it. This may be difficult because they'll probably say it's too late to file a claim. Other people may have suggestions here
  • Work out a payment plan and discount with the City. They may be willing to come down on the price, especially if you make it clear you're paying yourself and insurance won't be covering it.
  • Pay in full
  • Don't pay. Risk hurting your credit and having collections action taken against you.

posted by zachlipton at 10:00 PM on February 4, 2015 [3 favorites]

I have a horror story re: SF ambulances, city billing practices, and murder (!) but it is such a downer I'll refrain from sharing here.

Since your CBS 5 link mentions a much lower price that the private ambulance company was shamed into billing, I wonder if using a medical advocate would make sense. I don't know what they charge and I don't know if there is a minimum amount where it makes sense to use one.

Good luck!
posted by potsmokinghippieoverlord at 10:22 PM on February 4, 2015

Just a couple of notes that are typical of an ambulance service:
- No matter who makes the call on your behalf, you're responsible for the ambulance charges.
- If you don't take the ride, you're still responsible for the ambulance arriving amount.
- If you're under 18, I believe you aren't 'allowed' to refuse the ride.
posted by artdrectr at 11:10 PM on February 4, 2015 [1 favorite]

I had a hospital bill go to collections (I got several other bills from the same visit because America, which I settled up, but the fourth bill never actually reached me -- the hospital's own billing department didn't even know about the last bill or who to put me in touch with at first [!]).

I resolved it by calling the hospital directly and explaining the situation. There was definitely a lot of phone tag and being shuttled around between various hospital employees but I did finally get to someone who could help me. Basically, because it was pretty recent, they were able to pull the debt back from the collectors, wrangle my insurance and settle with me directly. Wrangling insurance is hard on your own; health care providers in the USA do it full-time so you want to let them do it if at all possible. I was pretty broke at the time but they were very cool about letting me pay back the remainder extremely gradually. The catch is that this was only a few months, not four years, and it was a private collections agency, not a municipality, but it's worth a try. The worst they're going to tell you is "no, you have to settle with the city" or "you can settle with us but your insurance won't cover it."

Even if your insurance won't take it, you may still be able to cut a deal with the ambulance billing department for less than the total quoted amount of money. Insurance may have negotiated their full-price rate down a bit anyway, and if it's really a private company, I bet they are not getting much money back from the city through collections as it stands now. Bill collectors buy debt very cheaply.

I really feel your pain about the unfortunately pretty typical cost of your ambulance ride. Mine was only a few blocks.
posted by en forme de poire at 11:38 PM on February 4, 2015 [2 favorites]

You can try to contact your insurance, but 3 years is way, way past even the most lax timely filing limits (the most I've seen is a year and that's for government plans; commercial plans are usually closer to 3-6 months), so I think you're going to be SOL there. Give a shot, ask if there's any options, but don't spend too much time chasing that option.
posted by ThePinkSuperhero at 5:07 AM on February 5, 2015

Let me recap, if I understand. You are being asked to pay a debt that you were not billed for in the period in which your insurance normally covers it, which is not actually your fault. You need specific advice on what to do next from a legal practitioner who wants you to get the best deal you can.

This is so obviously Lawyer Time that I'm kinda surprised no one has said that you need one yet.

So: You need a lawyer.
posted by migrantology at 12:32 PM on February 5, 2015 [1 favorite]

Get a lawyer. Check out Bay Area Legal Services. They have some excellent consumer advocates.
posted by Handstand Devil at 8:26 AM on February 7, 2015

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