An ambulance ride is often a hidden (and costly) expense
Kaiser Health News just published an article about patients being stuck with outrageously high bills for ambulance rides.
One patient got a $3,660 bill for a 4-mile ride. Another was charged $8,460 for a trip from one hospital that could not handle his case to another that could.
Several years ago when my husband ended up in an emergency room (long story—read my About page), he needed to be transferred to another hospital that was about half a mile away.
The ambulance ride for that short trip cost close to $3,000. Our insurance company, however, only “allowed” about $450—we were out of pocket for the rest, and it didn’t even count towards our deductible!
The Kaiser Health News article explains:
Today, ambulances are increasingly run by private companies and venture capital firms [In other words, for profit]. Ambulance providers now often charge by the mile and sometimes for each “service,” like providing oxygen. If the ambulance is staffed by paramedics rather than emergency medical technicians, that will result in a higher charge — even if the patient didn’t need paramedic-level services.
What can you do to prevent getting stuck with an unaffordable charge for an ambulance ride?
Know your insurance benefits!
First, if you have health insurance, check your policy. There should be a line item for ambulance services. For example, my current insurance policy says I am responsible for 20% of the allowed amount, subject to deductible.
Ask if your insurance company uses specific “in network” ambulance companies.
If an ambulance company is “out of network,” you could be held responsible for hundreds or thousands of dollars over the allowed amount, and it might not be put against your deductible.
The core of the problem is that ambulance and private insurance companies often can’t agree on a fair price, so the ambulance service doesn’t join the insurance network. That leaves patients stuck in the middle with out-of-network charges that are not negotiated, Imholz said.
This happens to patients frequently, according to one recent study of over half a million ambulance trips taken by patients with private insurance in 2014. The study found that 26 percent of these trips were billed on an out-of-network basis.
Related post: Surprise medical bills
Unfortunately, there is no way to know the “allowed amount” until you get the bill. Most insurance companies negotiate reduced rates, but charges can still be high if you need highly-skilled care while in transit.
When should you call for an ambulance?
Even if an ambulance ride is with an in-network company, insurance companies won’t pay at all if they decide the trip was not medically necessary.
So the other way to protect yourself from unnecessary medical expenses is to know when an ambulance is medically necessary.
The American College of Emergency Physicians (ACEP) offers these tips for helping make that decision.
Should You Drive or Call an Ambulance?
If you answer “yes” to any of the following questions about a person experiencing a medical emergency, or if you are unsure, it’s best to call an ambulance, even if you think you can get to the hospital faster by driving yourself.
- Does the person’s condition appear to be life-threatening?
- Could the person’s condition worsen and become life-threatening on the way to the hospital?
- Could moving the person cause further injury?
- Does the person need the skills or equipment employed by paramedics or emergency medical technicians?
- Would distance or traffic conditions cause a delay in getting the person to the hospital?
ACEP also offers this advice on when to call 911:
Emergency physicians believe it is the responsibility of every individual to learn to recognize the warning signs of a medical emergency.
Warning Signs and Symptoms
- Difficulty breathing, shortness of breath
- Chest or upper abdominal pain or pressure lasting two minutes or more
- Fainting, sudden dizziness, weakness
- Changes in vision
- Difficulty speaking
- Confusion or changes in mental status, unusual behavior, difficulty waking
- Any sudden or severe pain
- Uncontrolled bleeding
- Severe or persistent vomiting or diarrhea
- Coughing or vomiting blood
- Suicidal or homicidal feelings
- Unusual abdominal pain
Sometimes, though, 911 is called for less emergent reasons. Even if a trip to the ER is recommended, ask the paramedics if an ambulance is necessary. In my experience, they are usually sympathetic to us wanting to save money and will give you helpful advice.
Bottom line: Understand your insurance benefits regarding ambulance transport, and—if the situation allows—consider whether an ambulance is necessary, or if a $10 Uber might be a better choice.