Their toddler needed help. The ambulance bill was $2,438.

How a special exemption allows ambulance providers to charge higher prices.
Published: Aug. 8, 2022 at 12:00 PM EDT|Updated: Aug. 9, 2022 at 9:07 AM EDT
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ATLANTA, Ga. (CBS46) - A Roswell couple was stunned when they received a bill for their toddler’s ambulance ride.

Aaron Hawkins and his wife called 911 after their 20-month-old daughter, Ella, suffered a breath-holding spell. The condition affects five percent of children between six months and six years old. It’s triggered by stress and can be terrifying for parents who’ve never seen it. Ella held her breath until she passed out.

Ella was transported by American Medical Response (AMR) to Children’s Healthcare of Atlanta-Scottish Rite, where she received oxygen and was later discharged from its emergency room. The Hawkins’ expected an ambulance bill in the hundreds of dollars but was shocked by the final $2,438 tab.

AMR, one of the nation’s largest ambulance providers, is out-of-network with the Hawkins’ health insurance provider. The bill covered the out-of-pocket charges not covered by their insurance company.

“It’s ambulance chasing,” Aaron Hawkins said, “only the ambulance comes to you.”

Cindi Gatton, a professional patient advocate who negotiates high priced medical bills, said ground ambulances are exempt from the “No Surprises Act of 2022.” The bill was passed by Congress in an attempt to protect people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers.

It also establishes an independent dispute resolution process for payment disputes between plans and providers, and provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they get from the provider.

“In many places in the U.S., ground ambulances are provided by county EMS or governmental entities that don’t contract with insurance,” Gatton said. “The leverage to negotiate those bills is different with ground ambulances than with other healthcare services.”

The exemption keeps the door open for private equity firms to charge higher prices,” she said. AMR’s parent company, Global Medical Response (GMR), is a privately held company employing more than 35,000 workers in 4,000 communities across the U.S.

The higher prices combined with many insurers higher out-of-pocket maximum may seem like a financial fiasco, but for families like the Hawkins, there are options.

Gatton said some providers may be willing to take a lower amount if you offer to pay in full. You can also ask your insurer to advocate on your behalf, even if the provider is out of network.

As of July 1, 2022, the credit bureaus Experian, Trans Union and Equifax are putting less weight on medical debt, and have also agreed to extend the time before a medical debt goes on your report from six months to one year. Any settled medical debt that was settled with a collections agency will no longer appear on your report.

“The last resort is to let it go to collections and the longer a bill sits with a collection’s agency, the more likely they are to negotiate it,” Gatton said. “But early on, what some individuals will opt to do is pay a nominal amount every month until it’s paid, even if it takes years.”

Aaron Hawkins isn’t second guessing his decision to call for an ambulance, but said if there is a next time, he may have to.

“I’d do anything to keep my daughter safe, but now I have to think, can I afford to keep my daughter safe and that’s a huge frustration for me.”

Here is a statement from AMR:

“In general, AMR paramedics and EMTs save lives by delivering timely care to critically injured and acutely ill patients in a way no other service can provide. When patients need medical transport because of a life-threatening injury or illness, our caregivers respond.

“Our cost is driven by the need to maintain a staff of highly trained and experienced paramedics and EMTs who are in a high state of readiness. Also reflected in our charges are the costs of providing critical care, capital equipment costs such as vehicles and medical equipment, fleet maintenance, and extensive training for our caregivers. Additionally, our teams respond at a moment’s notice, without regard for a patient’s ability to pay.

“AMR’s goal has always been to keep the patient out of the middle and work with private insurers to achieve tangible solutions that provide patients with the medical transport services they need without putting them in financial hardship. We actively negotiate fair and reasonable in-network insurance agreements in markets across the country in the interest of protecting our patients, stabilizing operations, and easing the administrative burden of claims processing.

“We work with all government payors including Medicare, Medicaid and the United States Department of Veterans Affairs. As care providers, we understand the importance of these agreements and their impact on our patients, and we work continuously with insurance providers to establish in-network agreements whenever possible.

“Our team of patient advocates work with insurance, Medicare, or Medicaid to process claims, or work directly with patients if they are uninsured to find appropriate payer sources that might assist with reimbursement (i.e., Crime Victims, Medicaid, or coverage through auto or third-party liability insurance). Unfortunately, we are seeing insurance companies increase denials and put more and more financial responsibility on the patient with high deductible health plans and limited benefit plans. If a balance is left over after appeals are exhausted, our patient advocates will work with patients, based specifically on their ability to pay, to come to a satisfactory resolution.”

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