The last thing Americans need to fret about as they struggle to keep down medical costs is worrying about getting hit with a surprise bill for a ride in an ambulance. Just how ridiculous can those bills be? Think thousands of bucks for a few miles.
The independent and nonpartisan Kaiser Health News service and the Washington Post deserve credit for their recent story on how companies slam patients with huge tabs for transporting them in dire medical circumstance. Ambulance rides, the news organizations have reported, based on a review of 350 consumer complaints in 32 states, “can leave patients stuck with hundreds or even thousands of dollars in bills and with few options for recourse.”
Lawmakers in 21 states have passed measures to protect consumers from “surprise” medical bills, many inflicted on them for “out of network services” by profit-seeking medical providers. But as much as patients would like legal protections against getting gouged by ambulance services —some run by local governments, including police and fire agencies —the issue gets complex and daunting.
Many jurisdictions, for example, have laws in place that push services to take patients to the nearest emergency facilities that can take them, not necessarily to hospitals their medical insurance cover.
If a patient is in bad enough shape to need emergency transport, they also aren’t typically well enough to do much more than rely on first-responders to get them to a facility that may not be able to handle given medical cases.
This has meant that one patient got stuck with a $3,666 bill for a four-mile emergency trip, while another was charged $8,460 for transport to different hospitals, one that did not offer the needed medical services and another that did, the news organizations have reported.
They said it is difficult for patients to dispute big ambulance bills and to get them lowered. Many health insurers make clear —check this information out during the current open enrollment period — that they won’t cover emergency transport or only a percentage of its cost.
Meantime, the people who provide this service aren’t who might be expected: They’re no longer specialized members of communities’ police or fire fighter forces. Instead, thousands of private companies —many now bankrolled by profit-focused hedge funds (!) — offer this niche service. The providers say it isn’t a cheap business. They argue that they spend a lot on medical equipment and trained staff, both of which must be at the ready 24/7 in decidedly difficult circumstance.
But it’s also true that patients may not need a highly skilled paramedic or emergency medical tech to get them from a site to a hospital, or even between hospitals. Sorry, local governments and private providers still will hit consumers with the cost.
Uncle Sam offers some helpful checks on emergency transport costs for Medicare and Medicaid patients. Too many consumers who need an ambulance, however, aren’t part of these programs. They’re privately insured. By the way, insurers tussle with these companies sufficiently about price and can’t seem to agree with them so that the ambulance firms take their own path. They decline to join provider networks, thereby increasing the likelihood that patients that ride with them will pay more for out-of-network care.
In my practice, I see not only the major harms that patients suffer while seeking medical services but also their heart-wrenching struggles to pay for medical care. The Kaiser-Post article includes stories of patients who are in declining health, saddled with giant medical bills—and frustrated and rightly angry that they then also must fight what they term exorbitant bills for a collateral service like an ambulance ride. The news organizations offer some ideas to avoid and deal with these big bills. But Congress needs to not only join the states in helping patients avoid surprise medical bills but especially outrageous charges for ambulances.
If you need emergency care, here’s hoping that a trained dispatcher can help you through some basic questions to determine they urgency of your transportation needs. Time can be of the essence in neurologic and cardiopulmonary crises, when patients can benefit a lot by getting to hospitals fast, with medical care starting along the way, then speeded along on arrival in an emergency room.
Medical transportation, in fact, is a huge issue altogether that federal lawmakers should tackle. Some poor and even middle-class patients may be hampered from getting needed and available medical care because they just can’t find a way to get to it. Other patients, especially younger and more savvy consumers, shouldn’t be thinking that they can reply on on-demand services like Uber in medical emergencies. And, in case you’re wondering, if you find that you need to be air-lifted by a private company for emergency care, the costs there can be dubious and sky-high—tens of thousands of dollars.