Surprise bills: Ambulance charges slam consumers up to $37K per ride

Florida consumers generally have no way to shop around in an emergency, but they have reported being stunned by out-of-pocket charges of up to $1,000 or more for ground ambulance rides and more than $37,000 in the air during the last three years, a state working group heard this week.

It’s an unresolved issue because ambulances were exempted from a bill that passed last spring to limit surprise medical bills when consumers have little choice of medical providers.

Florida insurance consumer advocate Sha’Ron James convened a panel of industry representatives and consumer advocates Monday to look for possible solutions over the next year regarding ambulance services, which typically decline to join insurer networks.

A big part of the problem comes when ambulances and insurers disagree on an appropriate charge for the service and the consumer gets a bill for the difference. That’s sometimes called “balance billing” and it can mean several hundred dollars to more than $1,000 for ground rides, complaints show. Air ambulance cases can involve far larger amounts, including a consumer billed $25,000 in Indian River County another hit with a $35,000 charge for a ride from Key West to Miami, state officials said.

Ambulances represent “a very big hole in consumer protection,” said Wences Troncoso, vice president and general counsel for the Florida Association of Health Plans.

Federal rules may limit the ability of states to regulate prices on air travel, including ambulances, but Troncoso said a potential prohibition against balance billing by ambulances could protect consumers without directly setting prices and provide some incentive for ambulances to join networks and negotiate prices.

But ambulance services said the charges consumers pay for ambulances can be the result of high deductibles in their insurance plans, not anything the ambulance service did. And they are wary that insurers want to set reimbursement far too low. As for the scope of the problem, they expressed surprise that fewer than 60 complaints were reported by two state agencies since 2014 even as emergency transporters provided millions of rides each year.

“This almost sounds like a solution looking for a problem,” said Mac Kemp, deputy chief of clinical affairs for Leon County Emergency Medical Services, representing the Florida Association of Counties.

Most ambulances are operated by counties and cities, and any solutions that force them to join networks could force local taxes to go up or services to be cut, ambulance representatives said.

Despite the emphasis on consumer charges, the first consideration for patients should be “did they survive to complain about the bill in the first place?” Kemp said.

Sean Dugan, a health policy analyst for the National Association of Insurance Commissioners, said the costs consumers pay should not be written off as a minor secondary issue. He said it’s a big problem that can haunt families for years, or push some into bankruptcy. He cited a Montana man who said he would rather have bled to death rather than incur so much expense from emergency transportation that it threatened his ability to pass on his farm to his family.

James said complaints to state agencies often represent the “tip of the iceberg” as many people complain to providers or insurers but do not necessarily know what government agencies might be able to help.

As The Palm Beach Post has reported, consumers like Penny Farrow of Boynton Beach found “outrageous” charges such as the $600 bill she faced for a ground ambulance trip even though she had insurance. The way many consumers see it, they often pay local taxes for ambulances and premiums for insurance only to get whacked with further surprise charges again when they call 911.

A bill signed this year by Gov. Rick Scott to hold consumers harmless for so-called surprise medical bills carved out ambulance service even as it limited what medical providers such as radiologists and anesthesiologists can charge consumers in situations where patients have no meaningful choice of providers.

The national advocacy group Consumers Union said the legislation put Florida at the leading edge of efforts to fight surprise medical bills.

“The involvement and feedback from folks in Palm Beach County was crucial in highlighting the face of the issue,” James said at the time. “As a result of the Post’s interest in the issue, we received many phones calls and messages from consumers who had experienced surprise medical bills.”

Consumer feedback about ambulance charges could matter a lot as the panel prepares for its next meeting, tentatively set for early February and focusing on ground ambulance charges.

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