Out of network ambulance

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amother

OP ↓

Fri, Aug 09 2024, 2:10 pm

Does anyone know the answer to this?

I went for an in-office procedure. The office was in a building in a hospital.

The dr and the hospital are both in network.

The procedure was preauthorized by insurance.

Something went wrong during the procedure and I needed to be transferred to the ER.

Protocol is that they can't take me down the hall, across the bridge inside the building to the er. Instead, they called an ambulance to take me down the hall, outside into an ambulance, to drive around the block and enter the er through the ambulance bay.

The ambulance that came is not in network.

Because it was an emergency, insurance paid the ambulance company the in-network price.

Ambulance company is now billing me for the balance.

Am I required to pay?

PrairieFairy ↓

Fri, Aug 09 2024, 2:15 pm

Did you sign the papers upon entering the ambulance that you take responsibility for the fee if insurance didn't pay?

Did you consent to the ambulance or where you out of it and the hospital made the choice for you?

tweety1

Fri, Aug 09 2024, 2:20 pm

amother OP wrote:

I was told by my insurance company that if you have insurance they are legally not allowed to bill you. This happened when a radiology department billed me.

2429

Fri, Aug 09 2024, 2:37 pm

Submit this invoice to your insurance company.

amother

↑ OP ↓

Fri, Aug 09 2024, 3:32 pm

PrairieFairy wrote:

I definitely didn't consent. I was almost dead.

The dr made the decision to call 911. I vaguely remember her saying that.

amother

↑ OP ↓

Fri, Aug 09 2024, 3:34 pm

2429 wrote:

Submit this invoice to your insurance company.

Insurance said they paid their rate, so they're off the hook. And they it's up to the ambulance company to decide whether or not to accept that as paid in full.

The balance is about $350. I'd rather not pay if I don't have to.

Right now the ambulance company is threatening to send the balance to collections, so I'd like to know if there's anything I can do, or if I should just pay up.

amother

↑ OP ↓

Fri, Aug 09 2024, 3:35 pm

tweety1 wrote:

I was told by my insurance company that if you have insurance they are legally not allowed to bill you. This happened when a radiology department billed me.

Was that medicaid or private insurance? I think private insurance doesn't have that protection.

amother

Foxglove

Fri, Aug 09 2024, 3:44 pm

There are laws about this but I don't know them well.
Call a malpractice lawyer. Many will answer a quick question like this for free.
Probably the state you're in makes a difference too.
Don't pay. Worse case it goes to collections and you can negotiate
I believe if it was a 911 call the policies about billing are stricter. Maybe your local 311 would know

amother

Papayawhip

Fri, Aug 09 2024, 3:48 pm

For $350 I wouldn’t stress about it. They can send it to collections but they can’t do anything. Medical bills under $600 cannot be put on your credit report

amother

Orange

Fri, Aug 09 2024, 4:06 pm

check. they tacked it on to my Florida property tax

amother

Emerald ↓

Fri, Aug 09 2024, 4:13 pm

They can’t charge you. I’d tell them you aren’t paying and they can fight insurance if they want more money.

amother

↑ OP ↓

Fri, Aug 09 2024, 4:19 pm

amother Emerald wrote:

They can’t charge you. I’d tell them you aren’t paying and they can fight insurance if they want more money.

They say it was a courtesy to even Bill insurance because they're out of network.

I asked them why they came, the hospital has an ambulance company that's in network tyvm.

And they say they were closer and that's how it works in emergency

(Mind you, it took 20 minutes for them to come.)

amother

↑ Emerald

Fri, Aug 09 2024, 4:24 pm

amother OP wrote:

Since you didn’t consent to their out of network charges they can’t push it on you.

↑ PrairieFairy

Fri, Aug 09 2024, 4:27 pm

If you did not sign the papers for the ambulance, find out who did (if anyone).

You need to sign to be charged. However, if you signed for the hospital and their fine print says something about external fees like ambulances, it might be an issue.

Like someone else said, this amount is negligible for records but the idea to call a medical lawyer/or someone skilled in this is good.

The poster before that said they can't charge you....I think it's that they can't charge you before insurance. They have to charge your insurance and go through that process first. But if you signed you are liable for what your insurance doesnt covers, that could be on you.

If you're in the US, are you in a soft medical bill state? Some states will bill you 3x and then write it off. Others are "hard" bill and will send to collections and it will eventually be sent to your employer to come off your wages if you ignore.

Also states that protect against surprise bills and they can't charge more than insurance gives (but that might be if in network).

There are things between ignoring and paying.

As long as you are actively working on it (tell the hospital you're working with the insurance and trying to future it out. Chat them etc), they won't send to collections.

If you are paying, they can't send to collections. You can pay 1 penny a month and then re-negotiate in a year or so. They realize they won't get money (and many know this) so never pay an external medical bill like this without negotiating.

If it goes to collections, do not ever ever accept a call that asks for xyz (your name) and say "yes this is she". Medical laws dictate that the hospital can't give the bills to collections with your info. Once you say "yes this she", you are essentially taking responsibility for the bill. It's their way around medical privacy laws.

Say something like "what is this call for?" Or something. Don't "claim" a collections bill is accurate but rather gather information before next steps.

Just some info. Not all relevant to you but good to keep in mind depending on which approach you take. Definitely find someone irl to ask questions to in your state.

Amarante

Fri, Aug 09 2024, 4:32 pm

This is actually normal for ambulances as most of them are not in network.

You can legally be "balance billed" which is when an out of network provider is paid what insurance would ordinarily pay but less than what they charge. You owe the balance - perfectly legal.

The no-surprises act which covers care in Emergency Rooms doesn't include ambulances and so they can balance bill.

You can attempt to negotiate with them.

amother

Forsythia

Fri, Aug 09 2024, 5:45 pm

Most ambulance companies are out of network. We were charged $8500 after insurance paid for a 25 minute transport from an ER to another affiliated hospital. The ambulance company was affiliated with the hospital. However I got one bill and nothing more. I discussed it with someone locally in the profession and was told they write it off and not to worry about it. This was over a year ago and I haven't heard anything from them nor have I received any more bills.

amother

↑ OP ↓

Fri, Aug 09 2024, 6:41 pm

amother Forsythia wrote:

Lucky you

It's been less than a year and ignoring it didn't work for me.

amother

Seashell

Fri, Aug 09 2024, 9:04 pm

Find out your state law. Balance billings may be illegal.
I believe CA and NY have protections against this. I believe since you have no control over which ambulance you get in an emergency in some states you are only responsible for what an in network provider would cost. And insurance pays them some amount...

amother

Midnight

Sat, Aug 10 2024, 2:24 pm

Where is the doctor's office in all of this? They made an error? Can their malpractice pay the balance?

amother

↑ OP ↓

Sat, Aug 10 2024, 10:37 pm

I'm in NJ.

I haven't discussed it with the doctor since there was absolutely no malpractice involved. My body reacted in an unpredictable way to a simple procedure and I almost died.

If anything, the dr lost money from what I understood tracking my insurance claims,
because insurance denied most of her bills because that's not what they preauthorized.

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