Out of network ambulance

amother

Peach

Sat, Aug 10 2024, 10:39 pm

amother OP wrote:

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.

Honestly 350 may just be your out of network deductible no?

amother

↑ OP ↓

Sat, Aug 10 2024, 10:41 pm

amother Peach wrote:

Honestly 350 may just be your out of network deductible no?

No.

I don't have oon of coverage, but because this was an emergency insurance covered it anyway.

Anyway, I maxed out my deductible by having the procedure, and all services that day were included in that one copay. Smile

Also, it's not 350. It's like 348.64 or 352.17. A random number.

amother

Saddlebrown

Sat, Aug 10 2024, 10:59 pm

amother OP wrote:

I believe since Covid the Governor of NJ passed a law that medical bills cannot go on your credit record. So basically collection agency have no way to force you to pay and for $350 they definitely will give up after a while. I have $7k in medical bills that they gave up after 2 years

momX4 ↓

Sun, Aug 11 2024, 12:04 am

My pediatrician once used the wrong lab, it was out of network. There are laws about this. (We didn't have to pay, our insurance has a department that handled it)

See here for some information
https://www.dfs.ny.gov/consume.....s_act

amother

↑ OP ↓

Sun, Aug 11 2024, 12:38 am

So I should call back the insurance company and ask them? The ambulance company that sent the bill? Wait for it to go to collections and then tell the collections agency that it's illegal to charge me?

What's my next step?

amother

Sapphire ↓

Sun, Aug 11 2024, 1:30 am

Amarante wrote:

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.

@Amarante
It seems like quite a business. You don't need to advertise because 911 directs calls your way. Once you show up there's no competition because the patient is desperate (and sometimes not conscious). And then you get to name your charge afterward. Is there really no regulation?

How can the insurer say the in-network rate applies? Wouldn't they need a contract with the ambulance company? Wouldn't the allowable rate be more applicable?

↑ momX4

Sun, Aug 11 2024, 1:37 am

amother OP wrote:

Call your insurance and ask to speak to someone about a Suprise bill. You can mention the Suprise Act

amother

↑ Sapphire

Sun, Aug 11 2024, 1:51 am

amother OP wrote:

After a family member had an expensive hospitalization, I called the insurance company to address every bill we received. For each claim, I provided the justification (the reason for the emergency visit, the unavailability of necessary services at the first hospital which necessitated a transfer etc). For several of the bills the person on the phone said she would "send the claim back for them to re-process". Once they were re-processed, we owed much less.

If you do this, be sure to do two things
1. Get a reference number for every call (this is true any time you call insurance)
2. Call the number on the bill from the ambulance company and let them know you're working on the bill with your insurer. Ask them to put the bill on hold.

amother

↑ OP

Mon, Aug 12 2024, 1:46 pm

Update so far.

The federal no surprises act doesn't regulate ground transportation, only air transportation, because most states already had rules regarding ground transportation.

It isn't clear if NJ has such a law.

So for now I'm submitting a complaint to the NJ Department of Banking and Insurance (as instructed)
and I emailed the ambulance company to tell them balance billing is illegal (is it? Laugh

) and I called the insurance company and asked them to deal with it. But the insurance representatives seemed pretty lost about the whole thing, didn't even grasp the part that the ambulance company is out of network.

So 2 hours spent. Not sure there was a point. I might be better off just paying the $392 and change.

Stay tuned for episode 3!