(InvestigateTV) — When Georgia resident Yvette Hammonds saw her 9-year-old daughter having trouble breathing, she dropped what she was doing and took her straight to a nearby emergency room.
Her daughter, who had recently been diagnosed with asthma, was having an asthma attack, doctors determined. They decided she needed to be transferred via ambulance to another hospital.
“We got there and realized that she really was struggling, and they needed to transfer her to the children’s hospital in Atlanta,” Hammonds said. “What we didn’t realize though was that was out of network. We went from an in-network hospital to an in-network hospital with an ambulance company that was provided by the hospital, and that ended up being out of network and that’s where the problem came.”
Her daughter was ultimately treated and released from the hospital.
But in February, four months after the scary ordeal, Hammonds was shocked to learn that that 40-minute ambulance ride between hospitals racked up a nearly $1,000 bill.
Consumer advocates say that the cost of patients using ground ambulances has slipped through the cracks of a new federal law requiring transparency in healthcare prices — and needs a fix.
Without it, they say Americans will continue to face massive bills for a service they assumed would be covered by insurance.
“We were just assuming it was in network. There was no time to do research,” Hammonds said.
Hammonds contacted her insurance company’s customer service, which directed her to the ground ambulance company for help.
“I asked them for their published rates and where do you inform people how much you’re charging them,” Hammonds said. “They told me to check online, and there’s nothing online that I could find.”
InvestigateTV searched the hospital’s online cost estimate tool and found prices for specific procedures, such as CT scans, but could not locate any price estimator for ambulance rides.
“We wouldn’t have changed anything. We still would’ve needed that medical transport to get my daughter safely down to Atlanta. But we should know what to expect to budget accordingly and do what we need to do to get our finances in order for that,” Hammonds said.
Hammonds’ insurance company explained her total amount was $972.00. Insurance covered $106, dropping what she owed to $865. But for Hammonds’ family of six, that is still an expensive bill.
“People should know they’re going to get charged,” Hammonds said. “They should know what to expect and there needs to be accountability for how much these ambulance companies charge.”
Hammonds said her insurance company told her in an online response that “ambulance providers are not offered an in-network contract with a medical plan.” The company added the ambulance company may still bill her for more because they’re not in-network with her plan.
Dr. Elisabeth Rosenthal is the Senior Contributing Editor of KFF Health News which has studied other cases of ground ambulance medical billing disputes. She said Hammonds case is unique, but not uncommon.
“It’s talking in circles to patents, and you know in some ways she’s lucky because ambulance providers are generally out of network and at least her plan has agreed to pay some of the bill. We get a lot of bills where the insurer just says, ‘It’s out of network, you’re on your own,’” Dr. Rosenthal said.
She added that the monetary strain put on patients is often unavoidable.
“When you need an ambulance, you need an ambulance. And that’s the worst time in your life to be a consumer — when you have no choice,” she said.
She also said patients don’t always understand exactly what they’re being charged for following an ambulance ride.
“Not only are they charging for the ride, they’re charging by the mile. They’re charging if they put oxygen probes up your nose. Every little bit of services is charged for. And I just think, if they think of it as a municipal service, we should pay for it with taxpayers’ dollars. Not by grabbing money from poor patients who have no choice,” Dr. Rosenthal said.
The choices are slimmer considering it’s an emergency and a law established to protect consumers doesn’t even apply to an ambulance ride.
In 2022, the No Surprises Act went into effect, capping unexpected emergency bills from out-of-network providers at in-network rates. The law covers air ambulance services, such as helicopter rides to the hospital, but not ground ambulances.
“The big gap with the No Surprises Act was the fact that every state and every community treats those entities in different ways. And so, it’s super complicated to come up with a national solution for ground ambulance surprise billing, but we definitely need to have one,” said Patricia Kelmar, senior director for healthcare campaigns for U.S. PIRG, a nonprofit, nonpartisan research group.
Kelmar is also on the Advisory Committee on Ground Ambulance and Patient Billing, which is made up of consumer advocates, EMS officials and representatives from the ground ambulance industry.
According to U.S. PIRG’s ground ambulance billing research, 13 states have enacted laws to protect patients against out-of-network bills from ambulance companies.
However, even in those states only patients who are insured by a state-regulated health plan are protected.
“We really need a federal solution to make sure that all insured Americans have a chance to be protected from ambulance surprise bills and just pay their normal in-network rates,” Kelmar said.
InvestigateTV reached out to several representatives from various ambulance and EMS associations for an explanation of the costs from a business perspective. None responded or agreed to an interview.
In a May meeting of the advisory committee, representatives affiliated with the industry spoke about their need to keep ambulance companies functioning from a financial standpoint.
The committee has been tasked with streamlining the ground ambulance billing process. Its report with findings and recommendations is required to be completed by November 1, 2023.
InvestigateTV reached out multiple times to the ambulance service that transported Hammonds daughter, as well as her insurance company. Neither responded to requests for comment.
Meanwhile, Hammonds is still working on paying off her daughter’s bill.
“I’m sure it’s not just a problem here. It’s all over and people really need to know what they should be expecting as far as bills,” Hammonds said.
While the ride was out-of-network, Hammonds’ insurance did apply the amount she paid toward her in-network deductible because no ambulance service is considered an in-network provider under her plan.
This story is in partnership with KFF Health News. If you have a medical bill that’s been frustrating, you can submit it to the Bill of the Month project here.
Copyright 2023 Gray Media Group, Inc. All rights reserved.