ug - seeking medical billing advice for ambulance ride

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rasputin
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ug - seeking medical billing advice for ambulance ride

Post by rasputin » Tue Jan 01, 2019 8:52 pm

Mid november I was riding my bike, slipped on a patch of ice (on a city maintained bike path), and ended up calling 911 to go to the er. Nothing was broken although I was in a lot of pain. I was still in some pain for about a month but now I'm just about fully recovered. Thats the good news.

....buuuut I just got the bill for the ambulance. (billed by the city of Madison, WI, where the accident happened and where I live)

Ambulance charged a total of $1150.20. Insurance cited an 'allowed amount' of $761.94 and paid 80% of that - $609.55. Insurance says I owe $152.39 but ambulance is billing me for $540.65, the total unpaid after insurance payment.

Fun fact - insurance says the ambulance is 'out of network' but is calculating and paying rates as though its in network. If it were out of network, a $1000 deductible would apply....although I wonder if there's something difference about billing for emergency services. Additional fun fact - I need to verify this with my insurance company, but it appears there _no_ in network ambulance services where I live.

I can and will talk to the ambulance billing but I'm not optimistic about the outcome.

I feel like I'm getting screwed but maybe this is just how things are 'supposed' to work - insurance and the providers not agreeing on pricing and basically not caring

Any advice on how to handle this?

Chris K Jones
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Re: ug - seeking medical billing advice for ambulance ride

Post by Chris K Jones » Tue Jan 01, 2019 8:57 pm

I have encountered this sort of foolishness in the past with ambulance companies and baby deliveries at a hospital. I take the position that the insurance company and provider may or may not have a contract. IF they do, you cannot know the details. Therefore, I would pay only what the insurance company says you owe. Send a copy of the insurance EOB with your payment to the ambulance company. I probably have been reported to credit agencies for this, but I don't care. Best wishes.

sport
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Re: ug - seeking medical billing advice for ambulance ride

Post by sport » Tue Jan 01, 2019 9:03 pm

Your insurance should pay according to the terms of your coverage. So, they should be able to explain how they calculated the payment. Since the ambulance is "out of network", they have no agreement with your insurance company and are entitled to their full payment. Since it is a significant amount, perhaps you can negotiate a lower price. Something like, "I will have to pay that in monthly payments for six months. However, If you can accept $400, I can pay it all right now". In any case, talk to your insurance company before you try negotiating.

masha12
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Re: ug - seeking medical billing advice for ambulance ride

Post by masha12 » Tue Jan 01, 2019 9:06 pm

Deleted because I misread the post.

Nate79
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Re: ug - seeking medical billing advice for ambulance ride

Post by Nate79 » Tue Jan 01, 2019 9:24 pm

If I understand correctly this is called balanced billing and is legal in many (most?) states.

slick_dealer_05
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Re: ug - seeking medical billing advice for ambulance ride

Post by slick_dealer_05 » Tue Jan 01, 2019 9:29 pm

This is how US healthcare works. Just pay it and move on. Not worth messing up with your credit score.

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rasputin
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Re: ug - seeking medical billing advice for ambulance ride

Post by rasputin » Tue Jan 01, 2019 9:38 pm

Nate79 wrote:
Tue Jan 01, 2019 9:24 pm
If I understand correctly this is called balanced billing and is legal in many (most?) states.
Yes, its called balance billing.

I'm realizing that part of my surprise is because i moved from NY two years ago where this sort of thing is illegal. No wonder why it was a surprise.

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Kenkat
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Re: ug - seeking medical billing advice for ambulance ride

Post by Kenkat » Tue Jan 01, 2019 9:47 pm

Are you a city resident? If you haven’t yet, I would try contacting the city and asking them to waive the additional charge (including any co-pay). My local fire department waived additional charges after insurance after a 911 call and transport to the hospital for my son.

On a related note, I don’t know what the city’s liability is as you were injured on city property, but that might also be something worth considering as it relates to other medical bills.

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SevenBridgesRoad
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Re: ug - seeking medical billing advice for ambulance ride

Post by SevenBridgesRoad » Tue Jan 01, 2019 9:59 pm

Ambulance services are highly regulated, usually by city or county authories. This includes rate-setting. Here’s Madison’s info I found:

https://www.cityofmadison.com/finance/a ... erates.cfm

I’d suggest you check in with your city council person. The link suggests insurance should cover most of the service. A bit vague admittedly.

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Kennedy
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Re: ug - seeking medical billing advice for ambulance ride

Post by Kennedy » Tue Jan 01, 2019 10:11 pm

I had pretty much the exact situation as OP. My spouse was transferred from one in-network hospital to second in-network hospital for a higher level of care. Hospital one arranged the ambulance transport between the two facilities. It never occurred to me to ask if the ambulance company (the city) was in network. It wasn't, of course.

The insurance company paid the ambulance company a little over half of what they billed. Insurance co stated they used a third party service to calculate how much the fees should be, and that's what they paid. The ambulance billed us for the balance. I had several phone calls with the ambulance company separately as well as a three-way call between ambulance, insurance and me. Bottom line: Ambulance refused to decrease the amount they said we owed. Refused in no uncertain terms.

I gave up and paid them $100/month for almost a year instead of paying it off at once, just for spite.

123
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Re: ug - seeking medical billing advice for ambulance ride

Post by 123 » Tue Jan 01, 2019 10:28 pm

You might want to check with your auto insurance carrier if you have "Medical" coverage. It may be a stretch but since auto insurance seems to cover you if you are liable in a car versus bike incident as a cyclist it may also cover you if you are in a single vehicle (bicycle) accident(at least insofar as the "Medical" coverage pays. Even if that were the case I don't know that it's worth it to have an "incident" on your insurance record that could lead to higher premiums.
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Re: ug - seeking medical billing advice for ambulance ride

Post by SoonerD » Wed Jan 02, 2019 12:14 am

slick_dealer_05 wrote:
Tue Jan 01, 2019 9:29 pm
This is how US healthcare works. Just pay it and move on. Not worth messing up with your credit score.
OP, as long as you fear the credit score boogey man you will always lose billing disputes. I have no such fear so here is how I handle this. I call the ambulance company and offer them what I'm willing to pay. If they reject I ask to speak to a manager. Then I make the same offer and let the manager know after I hang up my offer goes to zero and I will never pay them anything. That's it.

In the past I used to get companies to accept 75% of the balance due for an immediate payment. These days it doesn't work and I pay nothing.

I had a hospital A.R. rep explain that they can't negotiate anymore because of ACA. She said accepting a lower payment would violate the law by allowing those with insurance to negotiate lower rates (than already negotiated by the insurer) than those without insurance - or something like that. I don't know if it's true but I do know that I can't seem to get medical companies to accept my 75% offers and it used to always work for me.

NOLA
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Re: ug - seeking medical billing advice for ambulance ride

Post by NOLA » Wed Jan 02, 2019 1:01 am

Sorry to hear about your fall, but great to hear that you are feeling better! Unfortunately, i can’t offer you any advice, but interesting(scary) thread regarding how little say we sometimes have.

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Re: ug - seeking medical billing advice for ambulance ride

Post by southerndoc » Wed Jan 02, 2019 1:13 am

rasputin wrote:
Tue Jan 01, 2019 9:38 pm
Nate79 wrote:
Tue Jan 01, 2019 9:24 pm
If I understand correctly this is called balanced billing and is legal in many (most?) states.
Yes, its called balance billing.

I'm realizing that part of my surprise is because i moved from NY two years ago where this sort of thing is illegal. No wonder why it was a surprise.
NY ties payments to the FairHealth database. Meaning insurers can't just say we'll pay $100 for your ER bill. They base their payment that is required by law for out-of-network facilities based on fair market value. It keeps insurance companies from low balling a contract. If they are out of network, they may have to pay even more than what they are offering.

Most providers try to stay in-network. However, nobody should accept 10% of fair market value for services rendered (yes, we've been offered that by one insurer before).

Balance billing is legal in most states, and until insurance reimbursement comes up, it will continue to be present in American healthcare.

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8foot7
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Re: ug - seeking medical billing advice for ambulance ride

Post by 8foot7 » Wed Jan 02, 2019 8:52 am

SoonerD wrote:
Wed Jan 02, 2019 12:14 am
slick_dealer_05 wrote:
Tue Jan 01, 2019 9:29 pm
This is how US healthcare works. Just pay it and move on. Not worth messing up with your credit score.
OP, as long as you fear the credit score boogey man you will always lose billing disputes. I have no such fear so here is how I handle this. I call the ambulance company and offer them what I'm willing to pay. If they reject I ask to speak to a manager. Then I make the same offer and let the manager know after I hang up my offer goes to zero and I will never pay them anything. That's it.

In the past I used to get companies to accept 75% of the balance due for an immediate payment. These days it doesn't work and I pay nothing.
I agree fully with this, and now with the changes to FICO scoring around medical debt the practical consequences are at their least severe in recent history.
If all else were equal I'd prefer to have a high credit score, but people sure pay a ton of money to insure that high score that they most likely don't need to.

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Re: ug - seeking medical billing advice for ambulance ride

Post by Shallowpockets » Wed Jan 02, 2019 9:07 am

Who called 911 for the ambulance? If it was you then you had your choice at that time. If you were alert enough to get out your phone and call then you probably did not need a 911 response.
You did what the prevailing system tends to do and now the ambulance it doing what their system does.
Think here, you were concerned enough to feel you needed 911, an emergency. Fast aid to your fall. Now you are contesting this response and aid. You should be paying gladly for the fact that you were taken care of in such a fashion. I am glad you are OK. This seems to be the problem. That you are OK. If the hospital had found something greater to have to treat you would you then be unconcerned about the ambulance bill because the injuries were greater and you would be in a different frame of mind.

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Re: ug - seeking medical billing advice for ambulance ride

Post by Jack FFR1846 » Wed Jan 02, 2019 9:14 am

Some options:

Get an ambulance chaser lawyer and sue the city for the ice, which caused the fall. To stress the point that you're simply looking to nix the ambulance charges, sue for the amount of the ambulance ride plus the lawyer's cut.

Maybe keep Uber on your phone so next time, you can call for an uber van (I don't know what they're called...I don't use Uber) and let them bring you to the hospital.
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Re: ug - seeking medical billing advice for ambulance ride

Post by bob60014 » Wed Jan 02, 2019 9:33 am

Jack FFR1846 wrote:
Wed Jan 02, 2019 9:14 am
Some options:

Maybe keep Uber on your phone so next time, you can call for an uber van (I don't know what they're called...I don't use Uber) and let them bring you to the hospital.
Friends of mine on the PD, FD and in ER's are seeing a uptick of this, using Uber for avoidance of the ambulance fee and other reasons, even when one is having major issues. Obviously they are very concerned that this will become even more commonplace and fear the consequences. Not recommended, imho.

To the OP, go back to the city, to the department that handles the ambulance billing, and check if there is any relief possible. Before I retired, my town would be flexible in some cases. It doesn't hurt to ask.

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Earl Lemongrab
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Re: ug - seeking medical billing advice for ambulance ride

Post by Earl Lemongrab » Wed Jan 02, 2019 2:00 pm

Shallowpockets wrote:
Wed Jan 02, 2019 9:07 am
Who called 911 for the ambulance? If it was you then you had your choice at that time. If you were alert enough to get out your phone and call then you probably did not need a 911 response.
That's nonsense. The OP is not a medical professional trained to evaluate the situation. It's also unfair to expect a cab or Uber driver to transport a injured patient. What happens if, during the ride, something develops into an emergency? There's no one trained to deal with it. The mere act of getting into the car without trained assistance could exacerbate an injury.

The OP did the correct thing. The money is a different story.
This week's fortune cookie: "Your financial life will be secure and beneficial." So I got that going for me, which is nice.

fru-gal
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Re: ug - seeking medical billing advice for ambulance ride

Post by fru-gal » Wed Jan 02, 2019 10:10 pm

Earl Lemongrab wrote:
Wed Jan 02, 2019 2:00 pm
Shallowpockets wrote:
Wed Jan 02, 2019 9:07 am
Who called 911 for the ambulance? If it was you then you had your choice at that time. If you were alert enough to get out your phone and call then you probably did not need a 911 response.
That's nonsense. The OP is not a medical professional trained to evaluate the situation. It's also unfair to expect a cab or Uber driver to transport a injured patient. What happens if, during the ride, something develops into an emergency? There's no one trained to deal with it. The mere act of getting into the car without trained assistance could exacerbate an injury.

The OP did the correct thing. The money is a different story.
I agree with Earl. i was sent home with pneumonia by a idiot ER and a day or so later I wound up calling 911. The ability to pick up a phone and talk is not the same as the ability to even get up off the floor or road, let alone go anywhere.

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munemaker
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Re: ug - seeking medical billing advice for ambulance ride

Post by munemaker » Thu Jan 03, 2019 7:39 am

My wife fainted in a public area. A bystander called 911 and an ambulance showed up (it is stationed about a block away from the incident). She recovered in a few minutes and declined the ambulance and did not receive any services. We received a bill for...I think it was $100. We live in a small town and did not want to create any bad feelings so we paid it after it was declined by insurance. And of course it should have been declined - no services were requested or provided.

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Re: ug - seeking medical billing advice for ambulance ride

Post by dumbbunny » Thu Jan 03, 2019 9:15 am

I needed ambulance service after going into anaphylaxis. The billing song and dance for me was the same as your situation. I called to see if I could get a break and they wouldn't waver. Bottomline is the paramedics saved my life and $750 is a small price to pay for that convenience.
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tibbitts
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Re: ug - seeking medical billing advice for ambulance ride

Post by tibbitts » Thu Jan 03, 2019 9:26 am

I think you should pay the bill and use this experience as a reminder to not ride a bicycle when there is even the slightest possibility of ice. Riding a bike is a fairly high-risk activity even in the absence of ice, so I think you have to figure some medical bills into the cost of the activity. Of course for some of us, walking can be a fairly high risk activity too - but impacts are likely to be at lower speed.

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Watty
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Re: ug - seeking medical billing advice for ambulance ride

Post by Watty » Thu Jan 03, 2019 9:32 am

Just be glad that it was not a helicopter life flight.

Having an "out of network" life flight can leave you with a $40,000 bill for what the insurance companies will not cover and this is a common problem.

https://abcnews.go.com/US/sky-rage-bill ... d=37669153

A lot of commercial air ambulance companies are set up with this business model to charge excessive fees.

My wifes cousin was in a car accident and had a life flight that left her with a a $23,000 bill that she paid after her insurance paid their part. She was unconscious and had no say in what was done, in her case the life flight was appropriate for the situation.

Evacuating someone by helicopter is very expensive and I have no problem with that but the way insurance covers less than a reasonable cost and the company bills a lot more than a reasonable cost is insane.

jj45
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Re: ug - seeking medical billing advice for ambulance ride

Post by jj45 » Thu Jan 03, 2019 9:58 am

I was in a similar situation, appealed the insurance company decision, and they ended up paying the balance. Find out the procedure for appealing their decision. Each insurance company is different. The explanation of benefits should have something about appealing. Write a letter with all the details, explaining the situation and asking them to cover the bill. Here is a sample letter: http://www.medicalclaimshelp.org/usual_ ... rk__0.aspx

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Re: ug - seeking medical billing advice for ambulance ride

Post by Trism » Thu Jan 03, 2019 10:00 am

rasputin wrote:
Tue Jan 01, 2019 8:52 pm
Mid november I was riding my bike, slipped on a patch of ice (on a city maintained bike path), and ended up calling 911 to go to the er. Nothing was broken although I was in a lot of pain. I was still in some pain for about a month but now I'm just about fully recovered. Thats the good news.

....buuuut I just got the bill for the ambulance. (billed by the city of Madison, WI, where the accident happened and where I live)

Ambulance charged a total of $1150.20. Insurance cited an 'allowed amount' of $761.94 and paid 80% of that - $609.55. Insurance says I owe $152.39 but ambulance is billing me for $540.65, the total unpaid after insurance payment.

Fun fact - insurance says the ambulance is 'out of network' but is calculating and paying rates as though its in network. If it were out of network, a $1000 deductible would apply....although I wonder if there's something difference about billing for emergency services. Additional fun fact - I need to verify this with my insurance company, but it appears there _no_ in network ambulance services where I live.

I can and will talk to the ambulance billing but I'm not optimistic about the outcome.

I feel like I'm getting screwed but maybe this is just how things are 'supposed' to work - insurance and the providers not agreeing on pricing and basically not caring

Any advice on how to handle this?
$540.65 OOP for transportation to receive urgent medical care seems reasonable.

Forget about what the bills says, what do you think it's worth?

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Re: ug - seeking medical billing advice for ambulance ride

Post by socaldude » Thu Jan 03, 2019 10:07 am

No more bike riding and when you are injured use Uber to get to the ER. Modern healthcare/America, what a country.

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DanMahowny
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Re: ug - seeking medical billing advice for ambulance ride

Post by DanMahowny » Thu Jan 03, 2019 10:22 am

Seems like you got a bargain to me. I'd pay it without hesitation.

You received expert medical care and a ride.

If I was in the same situation, I doubt I would've called an ambulance. Nothing in your post indicates a life threatening situation.
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Re: ug - seeking medical billing advice for ambulance ride

Post by Broken Man 1999 » Thu Jan 03, 2019 10:26 am

Earl Lemongrab wrote:
Wed Jan 02, 2019 2:00 pm
Shallowpockets wrote:
Wed Jan 02, 2019 9:07 am
Who called 911 for the ambulance? If it was you then you had your choice at that time. If you were alert enough to get out your phone and call then you probably did not need a 911 response.
That's nonsense. The OP is not a medical professional trained to evaluate the situation. It's also unfair to expect a cab or Uber driver to transport a injured patient. What happens if, during the ride, something develops into an emergency? There's no one trained to deal with it. The mere act of getting into the car without trained assistance could exacerbate an injury.

The OP did the correct thing. The money is a different story.
Yes, your ability to be alert after an accident doesn't really determine the severity of your injuries. When I had my accident I chatted with the folks cutting me out of my car, and the helicopter pilots Air EMTs as they flew me to a trauma center. I'm pretty sure I needed medical care despite my ability to be alert enough to converse with those helping me.

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EDited to correct.
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Re: ug - seeking medical billing advice for ambulance ride

Post by abner kravitz » Thu Jan 03, 2019 10:40 am

I would pay it and move on. $500 for an ambulance seems like a bargain based on bills I get for health care

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Re: ug - seeking medical billing advice for ambulance ride

Post by Shallowpockets » Thu Jan 03, 2019 11:01 am

You are right, alertness to make a phone call may not correlate with injuries. However, I think people can assess themselves when they fall off a bike. I crashed, broke collarbone. Walked bike back to car, drove home, then went to hospital. Another time mountain biking, crashed, broke hip (did not know at the time, rode bike out of forest back to car. First time, EMS and 911 was not the prevailing attitude as now. Second time I had no choice.
Now for whatever reason, the OP did call 911. All well and good, but then you have to pay the piper so to speak. Would they have gladly paid if the injuriy had been severe? Or is it that the injuries turned out not to be so severe and they were sent home after evaluation?
This seems to be that you should rate how much you should pay after the facts. But the response of the ambulance was not predicated on future results. You need them, you called, they responded. End of story.
It is well known, or should be, that EMS being covered by your insurance is an iffy thing. Most have no problem with it if the emergency plays out as an emergency. If they are sent home after a evaluation they seem more miffed than if there was a problem needing such care.

Lesson learned.

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Earl Lemongrab
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Re: ug - seeking medical billing advice for ambulance ride

Post by Earl Lemongrab » Thu Jan 03, 2019 12:32 pm

I definitely wouldn't just give up and pay. Man, people are quick to recommend that on the forum. I'll fight over $50 let alone $500. Press the insurance company. This is really their responsibility. It's not like you had an opportunity to sort through a bunch of ambulance companies and make sure you had one that was in-network.
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rasputin
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Re: ug - seeking medical billing advice for ambulance ride

Post by rasputin » Wed Jan 09, 2019 8:28 pm

abner kravitz wrote:
Thu Jan 03, 2019 10:40 am
I would pay it and move on. $500 for an ambulance seems like a bargain based on bills I get for health care
You're missing the point in the same way a lot of people do - its not about the expense. Nobody should be surprised that anything medical is expensive. Its about whether there is sufficient insurance coverage. Seems like both the insurance provider and the insurance companies have found loopholes.

Bruce T
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Re: ug - seeking medical billing advice for ambulance ride

Post by Bruce T » Wed Jan 09, 2019 9:06 pm

Rasputin,

At least Madison is transparent in their ambulance billing practices: https://www.cityofmadison.com/finance/a ... erates.cfm
... that's a lot better than many medical providers!
Note that the link suggests a waiver for limited income cases... probably not too useful to many BHs... looks like the waiver gives a break below 53K of income.

If you go the route of negotiating w/ the city, as an earlier poster suggested, then note that bike lane vs. snow//ice policies are addressed here ... perhaps there is either ammo or something to dissuade you from that course of action: https://www.cityofmadison.com/residents ... edures.pdf

Good luck and congrats on living in a great city with bike paths, lanes and ambulances!
Cheers,
Bruce
PS - I am not a lawyer/detective ... but I play one on Boggleheads.org ... :wink:

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Re: ug - seeking medical billing advice for ambulance ride

Post by SrGrumpy » Wed Jan 09, 2019 9:18 pm

Earl Lemongrab wrote:
Wed Jan 02, 2019 2:00 pm
Shallowpockets wrote:
Wed Jan 02, 2019 9:07 am
Who called 911 for the ambulance? If it was you then you had your choice at that time. If you were alert enough to get out your phone and call then you probably did not need a 911 response.
That's nonsense. The OP is not a medical professional trained to evaluate the situation. It's also unfair to expect a cab or Uber driver to transport a injured patient. What happens if, during the ride, something develops into an emergency? There's no one trained to deal with it. The mere act of getting into the car without trained assistance could exacerbate an injury.
Uber makes sense if one is not having a stroke, baby, O/D, or similar. It seems OP got a nasty fall and with possibility of a fracture or sprain. Hopefully a helmet was worn. Not only would I take an Uber, but I am so cheap I'd make it an Uber Share. What happened to the bike, btw?

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rasputin
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Re: ug - seeking medical billing advice for ambulance ride

Post by rasputin » Wed Jan 09, 2019 11:28 pm

SrGrumpy wrote:
Wed Jan 09, 2019 9:18 pm
Not only would I take an Uber, but I am so cheap I'd make it an Uber Share. What happened to the bike, btw?
Helmet was worn, always is. Probably did prevent a nasty concussion.

Helpful neighbor took the bike and returned it later that evening. We have good neighbors here.

I do realize that in the larger picture I'm just complaining but ultimately things worked out for me. That said, I think this is a collectively offensive way to fund ambulance services. Hopefully we'll find a better way.

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Re: ug - seeking medical billing advice for ambulance ride

Post by germark » Wed Jan 09, 2019 11:40 pm

rasputin wrote:
Wed Jan 09, 2019 11:28 pm
That said, I think this is a collectively offensive way to fund ambulance services. Hopefully we'll find a better way.
I agree.

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Earl Lemongrab
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Re: ug - seeking medical billing advice for ambulance ride

Post by Earl Lemongrab » Thu Jan 10, 2019 12:43 am

SrGrumpy wrote:
Wed Jan 09, 2019 9:18 pm
Uber makes sense if one is not having a stroke, baby, O/D, or similar. It seems OP got a nasty fall and with possibility of a fracture or sprain. Hopefully a helmet was worn. Not only would I take an Uber, but I am so cheap I'd make it an Uber Share. What happened to the bike, btw?
It certainly does not make sense. How would the OP know that there wasn't a blood clot? Or an injury not properly stabilized that got worse by getting in and out of the car?
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Re: ug - seeking medical billing advice for ambulance ride

Post by southerndoc » Thu Jan 10, 2019 12:49 am

Watty wrote:
Thu Jan 03, 2019 9:32 am
Just be glad that it was not a helicopter life flight.

Having an "out of network" life flight can leave you with a $40,000 bill for what the insurance companies will not cover and this is a common problem.

https://abcnews.go.com/US/sky-rage-bill ... d=37669153

A lot of commercial air ambulance companies are set up with this business model to charge excessive fees.

My wifes cousin was in a car accident and had a life flight that left her with a a $23,000 bill that she paid after her insurance paid their part. She was unconscious and had no say in what was done, in her case the life flight was appropriate for the situation.

Evacuating someone by helicopter is very expensive and I have no problem with that but the way insurance covers less than a reasonable cost and the company bills a lot more than a reasonable cost is insane.
Air ambulances are overutilized. I'm medical director of several fire departments, and I review every request for a helicopter. We have trauma and comprehensive stroke/cardiac centers <25 miles from nearly every part of each county where I'm medical director. The time savings for using a helicopter are not that great. There is a higher level of care (in Georgia, there is a nurse and a paramedic on each flight). Many helicopter services carry blood products, can place chest tubes/central lines, and can perform rapid sequence induction for securing an airway. Most ground services do not do this, and in Georgia, it's not within scope of practice for a paramedic to administer a paralytic agent to secure an airway (flight paramedics are excluded from this rule).

I work in a tertiary care center and we receive a LOT of trauma/stroke/cardiac transfers. I'm amazed at the number of stable patients that get flown in. Every time I hear the helicopter land, I think of the 40+ thousand dollar bill that's about to be generated to the patient. I've seen some minor stuff flown in: hip fracture, migraine headache (yes, a migraine who I discharged <60 mins after arriving in the ER), etc.

As I said, they are overutilized.

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unclescrooge
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Re: ug - seeking medical billing advice for ambulance ride

Post by unclescrooge » Thu Jan 10, 2019 1:47 am

southerndoc wrote:
Thu Jan 10, 2019 12:49 am

Air ambulances are overutilized. I'm medical director of several fire departments, and I review every request for a helicopter. We have trauma and comprehensive stroke/cardiac centers <25 miles from nearly every part of each county where I'm medical director. The time savings for using a helicopter are not that great. There is a higher level of care (in Georgia, there is a nurse and a paramedic on each flight). Many helicopter services carry blood products, can place chest tubes/central lines, and can perform rapid sequence induction for securing an airway. Most ground services do not do this, and in Georgia, it's not within scope of practice for a paramedic to administer a paralytic agent to secure an airway (flight paramedics are excluded from this rule).

I work in a tertiary care center and we receive a LOT of trauma/stroke/cardiac transfers. I'm amazed at the number of stable patients that get flown in. Every time I hear the helicopter land, I think of the 40+ thousand dollar bill that's about to be generated to the patient. I've seen some minor stuff flown in: hip fracture, migraine headache (yes, a migraine who I discharged <60 mins after arriving in the ER), etc.

As I said, they are overutilized.
Who decides when to use a helicopter?

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southerndoc
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Re: ug - seeking medical billing advice for ambulance ride

Post by southerndoc » Thu Jan 10, 2019 1:48 am

According to EMTALA, it's up to the sending facility. The migraine came from an ambulance provider about 2 hours from us (by ground).

dphilipps
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Re: ug - seeking medical billing advice for ambulance ride

Post by dphilipps » Thu Jan 10, 2019 6:55 am

How about:

"Since I was never given the opportunity to negotiate and agree to your charges, why don't we go to court and let a judge (or jury) decide what would be reasonable compensation for your services?"

tarmangani
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Re: ug - seeking medical billing advice for ambulance ride

Post by tarmangani » Thu Jan 10, 2019 7:24 am

Shallowpockets wrote:
Wed Jan 02, 2019 9:07 am
Who called 911 for the ambulance? If it was you then you had your choice at that time. If you were alert enough to get out your phone and call then you probably did not need a 911 response.
You did what the prevailing system tends to do and now the ambulance it doing what their system does.
Think here, you were concerned enough to feel you needed 911, an emergency. Fast aid to your fall. Now you are contesting this response and aid. You should be paying gladly for the fact that you were taken care of in such a fashion. I am glad you are OK. This seems to be the problem. That you are OK. If the hospital had found something greater to have to treat you would you then be unconcerned about the ambulance bill because the injuries were greater and you would be in a different frame of mind.
I made it a point to log in before work just to state that this position is completely absurd. You must work for these price gougers. Someone who can call 911 is alert enough to not justify an actual emergency? The amount of counterexamples I, or any reasonable person, could readily summon proves that this is insane. Also, nice results-oriented exploitation framework. If OP had something seriously wrong with them, then it'd be justifiable for the ambulance/hospital/whoever to rip them off because they'd be in a "different frame of mind."

mw1739
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Re: ug - seeking medical billing advice for ambulance ride

Post by mw1739 » Thu Jan 10, 2019 8:46 am

southerndoc wrote:
Thu Jan 10, 2019 1:48 am
According to EMTALA, it's up to the sending facility. The migraine came from an ambulance provider about 2 hours from us (by ground).
My son and I were transported by helicopter (2 separate helicopters actually!) from a rural hospital to a trauma center roughly a 2 hour drive away. I was barely conscious, but I remember the ER doc at the rural hospital telling me that there were only 2 hospitals in the county and they weren't going to use both of them to send us to the other hospital. My son wound up with a concussion and 3 stitches. I highly support the best medical care possible for my children, but regardless the helicopter seemed excessive, at least for him.

I was ecstatic about two months later when I found out that insurance paid the $130,000 bill ($65,000 x 2) in full.

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JonnyDVM
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Re: ug - seeking medical billing advice for ambulance ride

Post by JonnyDVM » Thu Jan 10, 2019 8:48 am

Earl Lemongrab wrote:
Wed Jan 02, 2019 2:00 pm
Shallowpockets wrote:
Wed Jan 02, 2019 9:07 am
Who called 911 for the ambulance? If it was you then you had your choice at that time. If you were alert enough to get out your phone and call then you probably did not need a 911 response.
That's nonsense. The OP is not a medical professional trained to evaluate the situation. It's also unfair to expect a cab or Uber driver to transport a injured patient. What happens if, during the ride, something develops into an emergency? There's no one trained to deal with it. The mere act of getting into the car without trained assistance could exacerbate an injury.

The OP did the correct thing. The money is a different story.
Ah yes there it is. The attitude that sums up what’s wrong with the American Health Care system. OP was badly injured buuuut not so injured that he should have limped his way to the hospital or at the very least called his insurer to verify he was covered before getting into the ambulance. So rude if someone else called an ambulance on OPs behalf. How dare they do such a thing! Do they have any idea how much an ambulance ride costs?????? They should have called an Uber for him instead. Preferably an XL so OP could lie down in the back if there wasn’t any surge pricing at that moment.

I will say OP got off relatively easy. We’ve probably all read the horror stories of individuals getting hit with surprise bills in the tens of thousands of dollars. Even in cases where the hospital was in network but one doctor seen by the patient wasn’t. Sorry. Even though you were unconscious you should have asked if I took your insurance. Here’s a bill for $20,000. OP all you can do is try to negotiate the bill down. After that, it’s a matter of what your credit score is worth to you. If it was me I’d no doubt wind up paying it and yelling at the sky.
Sometimes the questions are complicated and the answers are simple. -Dr. Seuss

First2college
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Re: ug - seeking medical billing advice for ambulance ride

Post by First2college » Thu Jan 10, 2019 1:51 pm

sport wrote:
Tue Jan 01, 2019 9:03 pm
Your insurance should pay according to the terms of your coverage. So, they should be able to explain how they calculated the payment. Since the ambulance is "out of network", they have no agreement with your insurance company and are entitled to their full payment. Since it is a significant amount, perhaps you can negotiate a lower price. Something like, "I will have to pay that in monthly payments for six months. However, If you can accept $400, I can pay it all right now". In any case, talk to your insurance company before you try negotiating.


Make sure to get anything agreements in writing before paying.

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