The Sticker Shock of Ambulance Transport

Anyone who has been transported by ambulance knows that the cost can be astonishing. A generation ago, as reported by the New York Times, ambulance rides often were free of charge, provided as a municipal service or by volunteers. Now, like most of the U.S. health-care industrial complex, most ambulance services are businesses that charge whopping fees.

As The Times story explains, an ambulance might be summoned by a bystander, a 911 dispatcher or the patient or family member, but the cost almost always is billed to the patient. And it can be as high as thousands of dollars.

Sometimes insurance subsidizes the costs, sometimes it doesn’t.

Ambulances might get paid only 30% to 40% percent of the bill, so they often try to charge more for patients with insurance and individuals who can pay. And you don’t always know where your service might fall along the spectrum of possibilities, because ambulances come from a range of providers – fire departments, hospitals, private companies and volunteer groups. Some services are included in insurance networks, others aren’t.

A fire department doesn’t charge for coming to your house to extinguish a fire, but it does charge to transport you to a hospital by ambulance.

Costs also vary according to the skills of the crews that staff them.

As The Times explains, if 911 receives an emergency call, dispatchers decide which ambulance to send, depending on where they are located. Most ambulance companies bill according to crew capability, not the medical needs of the patient. So even if your problem is broken teeth and a bleeding mouth , courtesy of a bike accident, if the crew staffing the ambulance that arrives to help you is certified to administer advanced cardiac life support, it will cost more than one with only basic first aid training.

Distance isn’t a big contributor, but a mileage might be added to the fee. And some companies, says The Times, charge significant amounts if someone accompanies the injured person.

It’s difficult to know how much high-priced ambulance transport adds to the U.S. $2.7 trillion health-care bill, The Times says, and total out-of-pocket expenses individuals incur for them also are difficult to tally.

Medicare tracks these costs, and pegs them at nearly $6 billion a year; in 2002, they were $2 billion. Medicare’s reimbursement for ambulance rides, ranging from $289 to $481 in 2011, is far lower than commercial rates.

Ambulance companies claim that Medicare rates don’t cover the cost of what, according to The Times, “are essentially mobile emergency rooms staffed by highly trained professionals.”

The Affordable Care Act (ACA, or “Obamacare”) requires insurance policies to include some coverage for emergency care, including ambulance transport. But the transportation and the emergency care provided at its destination are billed separately. Some popular insurance plans on the government exchange require patients to pay an initial copay of $250 for the emergency room and $250 more for the transport, for example.

And that cost can be complicated by the insurance plan’s evaluation if the service was really necessary – was it a true “emergency” requiring an ambulance?

Some plans might grant coverage based on the destination – an emergency room – regardless of the patient’s status. Others might pay only if the patient was admitted to the hospital, indicating the problem, indeed, was serious.

But if you’re ill or injured, and an ambulance arrives that you or your loved ones did not summon, you might think you have no choice but to take that ride, unaware of what it’s going to cost you.

One woman’s experience should serve as a cautionary tale for you to understand the ambulance coverage offered by your insurance, or to investigate what the range of costs would be in your area if you don’t have such coverage.

Suffering from a bad headache and a fever, she went to an urgent care center near her home in New York City. The doctor there recommended that she go to a hospital for further evaluation, and offered to call an ambulance.

Even though she could have walked, she felt so lousy she agreed to the two-block ride. The bill? $900.

“It was crazy,” she said. “All they did was put a paper mask on me so I wouldn’t infect anyone else.”

She ended up having a spinal tap at the hospital, and was admitted for a few days. She’s not yet sure what her insurance will cover.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
Washingtonian Top Lawyer 2011
Avvo Rating 10.0 Superb Top Attorney Best Lawyers Firm
Contact Information