Surprise bill from California ambulance ride
July 9, 2019 3:45 PM   Subscribe

We recently had to call 911 related to a medical situation, and they sent an ambulance. After providing minimal care, the ambulance drove us two miles to the hospital, for which we were billed thousands of dollars. The ambulance is "out of network," so insurance covered only a small portion, and the ambulance has billed us for the rest. We are in California. We have Blue Cross Blue Shield (of AZ) PPO insurance. What do we do? Can we negotiate this down? Is this even legal? (And if so what can I help do about that??)

I've been trying to sift through AB 72 and various news articles about "balance billing" and "surprise billing" and ambulances, but they are all either hard to understand or pretty general. Does anyone know? Thanks!
posted by slidell to Work & Money (18 answers total) 3 users marked this as a favorite
I do not know the answer to your question, but if I were in your shoes I would contact the California State Bar Lawyer Referral Service and speak to an attorney.

I work for the state bar in Oregon and residents here can speak to an attorney for $35 and find out what their rights are. It's a great resource for complicated questions like yours.
posted by tacodave at 4:14 PM on July 9, 2019 [3 favorites]

First double check if the ambulance is really out of network. In California they should bill their local BC/BS (either Anthem Blue Cross or Blue Shield of California) and not send the bill directly to BCBS of AZ.
posted by metahawk at 4:19 PM on July 9, 2019 [1 favorite]

Health Consumer Alliance:
The Health Consumer Alliance (HCA) offers free assistance over-the-phone or in-person to help people who are struggling to get or maintain health coverage and resolve problems with their health plans.
Center hotline is 1-888-804-3536, or you can search "health consumer alliance" and your given county. In the Bay Area that is the Health Consumer Center of Bay Area Legal Aid, in other parts of Northern California that is the Health Center of LSNC, in Los Angeles it's Neighborhood Legal Services of Los Angeles. I think there are seven more but I don't know who they are offhand.

I just doublechecked with someone who has recently worked at one of these hotlines and they confirmed generally speaking all these hotlines (1) can help even if you are not low income, (2) can help given that the cost is in CA even though you are not from CA.
posted by peppercorn at 4:23 PM on July 9, 2019 [1 favorite]

We had a situation where my husband had a bicycle accident and was taken by ambulance to a hospital. We also have out of state insurance, BCBS of Texas - we live in PA. There is a PPO sign on the front of the card.

I called the ambulance company after we got a bill for $2000 to give them the insurance info - my husband was out cold and barely had ID. Then I called the insurer - even though they didn't have a contract with the ambulance company they were successful in reducing the charge to a less stratospheric level, just over $1000. This is in line with what they reimburse for in-network ambulance companies. We were then charged 10% and the insurer paid the balance.

Can you talk to your insurer about challenging the total charge? That seemed to make the biggest dent in the out-of-network bill.

I handled this - to this day my husband has no memory at all of that day or his accident.
posted by citygirl at 4:24 PM on July 9, 2019 [4 favorites]

can help given that the cost is in CA even though you are not from CA

By the way, we do live in CA. My husband's employer's headquarters are in AZ, but they have an office out here.

I'm really appreciating all the answers so far. Two of us were transported so I'm waiting for the second person's bill to be denied or whatever the terminology is before starting all the phone calls, but this is super-helpful so far, and I will update the thread with what happens as it goes along.
posted by slidell at 4:42 PM on July 9, 2019

Oh great, then you are even more likely to be eligible :) And I wanted to clarify that the HCA services do provide legal advice, not just technical assistance etc! Best of luck with this.
posted by peppercorn at 4:54 PM on July 9, 2019

Yes, I would expect this insane bill. I always drive myself and family to the ER if at all possible and not obviously dangerous. Even if the ambulance is already there. Because it's a waste of 2k.

It sucks this is how US healthcare is but yup.
posted by Kalmya at 7:29 PM on July 9, 2019 [3 favorites]

I had a similar situation and called my insurance provider, who was able to waive the entire charge, if I remember correctly. This was a while ago, so I wouldnt guarantee that outcome, but I nth talking to your insurance company.
posted by lazuli at 8:12 PM on July 9, 2019 [1 favorite]

I mean, ambulance rides and the treatment beforehand are expensive, and I think by calling 911 and agreeing to transport, you've consented to covering the cost.

I don't think this is good or right, but I've never had luck trying to negotiate the cost of an ambulance ride.
posted by easy, lucky, free at 8:58 PM on July 9, 2019

an ambulance came after i dialed 911 in CA, where i'm resident. the medical emergency resolved itself at home but the ambulance still took the patient to hospital as a precaution without any sirens etc. hospital was about 12 miles away i think. initially insurance indicated they'd take care of the eye watering bill leaving a bill of maybe $200. cool. then they said the ambulance was out of network (like i had a choice) and i was then liable for around $4000. naturally i got onto the insurance company and personally pleaded my case to whoever answered the call. to my surprise and relief i ended up being liable for just north of $1000. which was still high but doable. and the ambulance company put me on a 12 month payment plan interest free. the most expensive glorified taxi ride i've ever dealt with.
posted by iboxifoo at 9:14 PM on July 9, 2019 [3 favorites]

You have to appeal to the insurance company. The more reasonable and determined you sound when you call them, the more likely it is that they will pay for the ambulance.

BC/BS has a long history with me of denying claims, then grudgingly paying them when I questioned the denial. It's part of their business plan. They are not unique in that. Every health insurer I've dealt with has at some point added hassles to what should be a straightforward process. The more people they can get to accept their denials, the better their profits.
posted by Kirth Gerson at 4:47 AM on July 10, 2019 [2 favorites]

I'm an EMT, and where I practice, a call to the ambulance that uses only lower-level EMTs (BLS rather than ALS), with minimal or no care provided, costs around $2000. For ALS care or more intensive engagement with the patient, the costs go up quickly. Most patients I have transported in the ambulance actually should have driven or walked to the ER rather than calling an ambulance, as an ambulance wasn't needed and costs thousands. Speaking as an EMT, I and my family always walk or have drive to the ER rather than take an ambulance, unless it is absolutely urgent and really needs in-ambulance emergency medical care.
posted by ClaireBear at 6:04 AM on July 10, 2019 [2 favorites]

The other factor is that ambulance companies generally choose not to be "in network" for anybody, because they can and do badger insured folks -- people with GOOD insurance -- to pay the outstanding balance.

This is their business plan.
posted by uberchet at 7:53 AM on July 10, 2019 [1 favorite]

What is the health insurance company's incentive to waste time on the phone trying to talk down this bill? They've already established what they will and won't pay, so why should they help us reduce the bill? Edit: I'm not intending to argue with you all but to ask, how do I approach them to get them to work their magic?
posted by slidell at 8:15 AM on July 10, 2019

Your argument is that ambulances are by definition used in emergencies, you did not have a choice about which ambulance arrived, and insurance should cover the bill because "out of network" is obviously a pointless term for an emergency situation. But argued in a tone of "We're both on the same side here," not "You are an awful person and you screwed up."

Are there even "in-network" ambulances where you live? The insurance company is acting like you had a choice; the goal would be to convince them that you did not. It may not work, of course, but it's worth a try.
posted by lazuli at 2:46 PM on July 10, 2019 [5 favorites]

Also, we have had good success negotiating down from the cash/uninsured cost on behalf of a family member with limited income. Said family member also paid full price on a payment plan when he fainted while walking along Route 1 years ago. He didn’t know then that he could negotiate
posted by childofTethys at 7:34 AM on July 12, 2019 [1 favorite]

They covered it! Remember how I was waiting for my daughter's claim to be reviewed so that I could protest them both at once? They approved hers at 100 percent! So all I had to do was call Blue Cross and ask about the difference, and they said that the first bill was a mistake. (I was suspiciously prepared to hear some story about how a different paramedic who was IN network had helped her, but that would've been nonsense, as we were transported together with one person in the back. Fortunately, the conversation didn't go that way.)

So everyone's advice to just calmly call Blue Cross and reiterate the circumstances was correct. They knew the ambulance was out of network but allowed it in full anyway. I hope everyone who finds this thread in the future has similar luck or is at least able to get help from some of the resources that people provided. Thanks!
posted by slidell at 11:57 AM on July 16, 2019 [4 favorites]

By the way, I marked as Best Answer the answers that applied directly to me and also those that gave me peace of mind and a sense that I could get help in the meantime. Thanks again!
posted by slidell at 12:03 PM on July 16, 2019 [1 favorite]

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