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ug - seeking medical billing advice for ambulance ride
Posted by: mattkime
Date: January 01, 2019 05:36PM
Mid november I was riding my bike, slipped on a patch of ice, 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.

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.

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

Any advice on how to handle this? I feel like I'm getting screwed.

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Additional fun fact - I need to verify this with my insurance company, but it appears there _no_ in network ambulance services where I live.

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I think this is a case of the insurance and the providers not agreeing on pricing and basically not caring.







Edited 2 time(s). Last edit at 01/01/2019 06:20PM by mattkime.
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: Dennis S
Date: January 01, 2019 05:41PM
After you work out all the legalities and technicalities and get down to a solid figure, dicker like crazy on that amount.
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: mattkime
Date: January 01, 2019 05:54PM
So, it seems that there _might_ be a legal argument that by accepting payment from the insurance company they've agreed to the negotiated rate.

Obviously I need more research - but at this point I see myself putting on my nicest suit and going to the office to discuss the situation and offering a payment of no more than $152.39 as specified by my insurer.



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Re: ug - seeking medical billing advice for ambulance ride
Posted by: Dennis S
Date: January 01, 2019 05:59PM
Call your State Insurance Commissioner and see if they have any tips. It might be fruitless, but they know stuff we don't. And some of the staff there love to stick it to insurance companies.
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: Buzz
Date: January 01, 2019 06:11PM
Just explain to the billing rep, that you were waiting for the in-network ambulance, and that their rig jumped the shark to snap you up to try to collect a fee they weren't entitled to. Offer 'em the in-network $152.39 balance. If they accept, done. If not, get the rep's name, his/her supervisor's name and their address. Send them the same offer in writing, giving them whatever the appropriate statutory period is your jurisdiction to respond, stating that if they don't accept within that period, it is your position that you owe them nothing, but will arbitrate the dispute thru whatever the authority is that governs emergency response in your area.
Good luck.
==
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: Carm
Date: January 01, 2019 06:18PM
They shouldn’t be charging you more than the “negotiated rate”. That’s the discounted rate they agreed to with the insurance company and what the insurance company says you owe is what you owe.

Edit: What Buzz said.



Edited 1 time(s). Last edit at 01/01/2019 06:20PM by Carm.
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: anonymouse1
Date: January 01, 2019 06:20PM
Nice response!

Quote
Buzz
Just explain to the billing rep, that you were waiting for the in-network ambulance, and that their rig jumped the shark to snap you up to try to collect a fee they weren't entitled to. Offer 'em the in-network $152.39 balance. If they accept, done. If not, get the rep's name, his/her supervisor's name and their address. Send them the same offer in writing, giving them whatever the appropriate statutory period is your jurisdiction to respond, stating that if they don't accept within that period, it is your position that you owe them nothing, but will arbitrate the dispute thru whatever the authority is that governs emergency response in your area.
Good luck.
==
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: dk62
Date: January 01, 2019 06:34PM
The last time I had such an issue,the insurance company and the ambulance company worked it out.my recollection is that the insurance company ended up paying the full amount requested by the ambulance. Rules and regulations may differ where you live.
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: mattkime
Date: January 01, 2019 06:54PM
Quote
dk62
The last time I had such an issue,the insurance company and the ambulance company worked it out.my recollection is that the insurance company ended up paying the full amount requested by the ambulance. Rules and regulations may differ where you live.

Wisconsin has been 'open for business' for the past eight years which means that there's not much in the way of consumer protections.
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: Ombligo
Date: January 01, 2019 06:55PM
Your insurance company directly paid 80% of the usual and customary rate for that service in your area - that rate is based solely on the insurance company estimations.

As the Ambulance company is NOT an network member (few are), they may set their rate at whatever they wish and bill you for that amount. You are responsible for the amount they bill regardless of what insurance says.

If the ambulance was from a network provider, then you would only owe the $152 (20% copay). It was not a network provider, and there was no contracted rate between the Ambulance and your Insurance - so you owe the $540.

You can try to negotiate a rate, but the Ambulance Company holds all the cards. I would be surprised if they discount the rate as they are under no obligation to do so. As I mentioned, few ambulance companies are in any insurance network (note I do not include non-emergency medical transport in that group). They tend to be the only game in town, and used only in emergencies - no one calls around for a network provider in an emergency. Because of that, they have a trapped customer and no need to discount.

If it makes you feel better, it wasn't a medivac flight. Some insurance companies view a medivac transport as exactly the same as an ambulance ride. So insurance would have paid the same $610, allowing you to pay the remaining $15,000 bill (though you may have a max out-of-pocket clause for non-network coverage). -- INFO on Air Ambulance coverage: [www.thebalance.com]



“No persons are more frequently wrong, than those who will not admit they are wrong.”
-- François de La Rochefoucauld
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: Sarcany
Date: January 01, 2019 07:28PM
Quote
Carm
They shouldn’t be charging you more than the “negotiated rate”. That’s the discounted rate they agreed to with the insurance company and what the insurance company says you owe is what you owe.

It depends entirely on state laws whether they have any obligation to do so.

The medical system in this country is heavily rigged against the patient. Worth a try, but understand that you have a minuscule chance of success at any sort of negotiation. Some people have had luck with the aid of patient advocacy groups, but most of those are actually scams so finding a good one in your area is a crapshoot.

Best approach may be to have a lawyer friend make a pro bono call on your behalf. The only people who get heard in these matters are lawyers.



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Re: ug - seeking medical billing advice for ambulance ride
Posted by: mrbigstuff
Date: January 01, 2019 07:42PM
Buzz is the man. Ambulances are one is the biggest scams going, but they provide a necessary service, so there are no challenges to their fiefdoms. It's all eaten up in that "healthcare industrial complex" that we're now all a part of.

At least around here, the ambulance services bill under the heading of the fire department. Yeah, you get a bill from the service with the seal of the cityand the fire ddepartment. Nice, huh?
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: Carm
Date: January 01, 2019 07:54PM
Thanks Doc (Sarcany) for mentioning that, each state has its own laws with regards to what you are obligated to pay.
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: macphanatic
Date: January 01, 2019 08:02PM
if they won't budge, make arrangements for a payment plan. Tell them that you can only afford $10/month.
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: space-time
Date: January 01, 2019 08:10PM
I just went through this, although my bill was $920. That was with my old insurance plan (high deductible) and I was able to use HSA funds.

The new plan is much better, I should be covered for cases like this.

I didn't hesitate paying the bill. They came fast and did an excellent job. I with ambulance service would be as good in my former home country.
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: Filliam H. Muffman
Date: January 01, 2019 08:14PM
Do any of your local TV channels have a consumer advocate reporter you can complain to?



In tha 360. MRF User Map
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: Sarcany
Date: January 01, 2019 08:17PM
Quote
macphanatic
if they won't budge, make arrangements for a payment plan. Tell them that you can only afford $10/month.

You're pushing against an immovable object when you try to negotiate a payment plan. Good luck with that!

Tried negotiating a payment plan with a Hospital once when insurance refused to pay for emergency care. (Pre-ACA. Obamacare got rid of the loophole that they used.)

The only "payment plan" the hospital offered was 50% now, 50% in two weeks. Plus a hefty fee for accepting it in two payments. And that only would have settled the part of the bill for the use of the premises, medications and on-staff physicians. The many other doctors and some nurses (most of whom I never had any contact with at all, but apparently they were supervising various rooms or were consults or somesuch) billed separately for their "services" and the hospital wouldn't negotiate on their behalf.

(Got to put "services" in quotes because I'm confident that most of those doctors weren't even on the premises when I was hospitalized. It's a racket.)



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Re: ug - seeking medical billing advice for ambulance ride
Posted by: mattkime
Date: January 01, 2019 08:36PM
Quote
space-time
I just went through this, although my bill was $920. That was with my old insurance plan (high deductible) and I was able to use HSA funds.

I have good insurance and my bill on a $920 ride would have been $320. Not sure if thats your idea of 'much better'.



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Re: ug - seeking medical billing advice for ambulance ride
Posted by: raz
Date: January 01, 2019 09:20PM
Can we please get single payer?



--------------

Embarassing myself on the Internet since 1978.
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: Wags
Date: January 01, 2019 09:30PM
Quote
macphanatic
if they won't budge, make arrangements for a payment plan. Tell them that you can only afford $10/month.

I had my only ambulance ride (knock on wood) in the 80's, in a Buck Ambulance. At the time I was an itinerant musician living cheap and when they sent me a bill for $740 I knew I couldn't pay it. So I went down to their office and gave the lady at the front desk $5 towards my bill and asked for a receipt. I did this for a year or two, every month.

Finally they called me and told me I had to start paying more, that the paperwork they were doing every month was costing them more than what they were getting out of it. I think that was probably an exaggeration. I was playing keys in a wedding band and the guitar player happened to have a law degree. He said that when they accepted the first payment for $5 it established some sort of de facto contract. So that's what I told them, and went on paying for a few months more. They eventually sent me a letter saying they were forgiving the debt.
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: Grateful11
Date: January 01, 2019 10:57PM
My ambulance ride back in August or Sept. was $681. and they say I owe $300. They also had my insurance on the statement as an HMO, I don't have an HMO I have Premier PPO. I called the billing center and they would refile it.



Grateful11
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: decay
Date: January 02, 2019 08:55AM
I got jammed on this once, too. Didn't even really NEED the ride, it was recommended. I was taken A CITY BLOCK. I wasn't injured, and could have walked.

I forget how much I ended up being charged, but it was a lot. I just paid it off slowly, like $25-$50 at a time. Make them squeeze it out of you.

[www.fiscaltiger.com]

[blog.credit.com]



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Re: ug - seeking medical billing advice for ambulance ride
Posted by: rjmacs
Date: January 02, 2019 09:14AM
The state where you live makes a big difference here. Dennis S' suggestion above is right on the money, if you are in a left-leaning state or a mid-western state that hasn't gutted its consumer protection laws.

If you're in the South, or somewhere without robust protections, then enjoy your "market-based" health system.



rj
AKA
Vreemac, Moth of the Future
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: raz
Date: January 02, 2019 09:19AM
I suppose we are relatively lucky in Pittsburgh. 911 calls are answered by City EMTs, and the ambulance ride is a flat $125. Insurance picks up 80% of that. Likely, any additional treatment in the ambulance is extra.



--------------

Embarassing myself on the Internet since 1978.
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: Rick-o
Date: January 02, 2019 11:57AM
I needed an ambulance ride at the end of last winter. I had an infected big toe on my right foot and could barely walk. It wasn't a real emergency, but no way could I drive so I called the local police number (police, fire, ambulance are all handled by the same group in my small town) and the receptionist said to call 911 anyway, as that was the proper procedure.

I was shocked at the cost for the ride. Nothing was done to me in the ambulance, I just laid on the gurney and got delivered to emergency. My bill didn't arrive until 5-6 months later, and it was over $1400. before insurance, and I ended up still paying over $300. for a simple ride.

It made me want to start my own ambulance company!



Mr. Lahey: A lot of people, don’t know how to drink. They drink against the grain of the liquor. And when you drink against the grain of the liquor? You lose.

Randy: What the @#$%& are you talking about?
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: Janit
Date: January 02, 2019 12:05PM
I am fortunate to live in an area with good taxi service for the times when I am not able to drive myself. So far my trips to the emergency room have been for urgent care, not the kind of emergency requiring an ambulance.
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: Bernie
Date: January 02, 2019 12:46PM
"By accepting payment from the insurance company they've agreed to the negotiated rate."

Tell them that and see if they bite. If not try it again on the second billing. Tell them you are waiting on an insurance review. See if the amount has changed by the THIRD billing and pay then.

I am bad about this $h!t.




Staunton, Virginia
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: decay
Date: January 02, 2019 01:47PM
Uber would be cheaper and probably faster.



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Re: ug - seeking medical billing advice for ambulance ride
Posted by: NewtonMP2100
Date: January 02, 2019 01:50PM
....hospitals try to take people for a rides........they charge exorbitant prices for even the most basic........like an aspirin.......there is making a profit and then there is gouging.......



_____________________________________

I reject your reality and substitute my own!
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: wave rider
Date: January 02, 2019 03:26PM
Draped over the curb into the street after breaking my femur, I gave a lot of medical info to fire personnel followed by EMTs. When there was a break in the questioning, I said in a loud voice “Thank God I’m on Medicare!”

EVERYBODY laughed.

After reading this thread, I’m thinking they all new about ambulance cost.

The trip to the hospital was less than a mile, my first ambulance ride. SO disappointed I got no lights or siren…



=wr=
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Re: ug - seeking medical billing advice for ambulance ride
Posted by: markmedic
Date: January 02, 2019 07:51PM
I would recommend telling them that balance billing is illegal in your state. Many states don't allow balance billing. Have a lawyer draw it up.
Mark
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