Curious if anyone has any experience with this since I have a feeling I am about to get placed in the middle of a tug of war between my insurance and a provider.
My son needed an ambulance earlier this year which was out of network. My insurance is supposed to pay out of network ambulances at 100 percent. However, they only paid their in network rate and the ambulance company is coming after me for balance. I am curious if anyone knows if insurance companies have some crazy loophole on the concept of paying 100 percent out of network that is going to make me blow a gasket tomorrow when I call them up.
My suggestion is if you get the shaft, FIGHT IT HARD until they reduce the charge. Good Luck
My suggestion is if you get the shaft, FIGHT IT HARD until they reduce the charge. Good Luck
First of all, the distance to the hospital is irrelevant to the cost. The cost of readiness is VERY expensive. Paramedics and EMT's are paid while waiting for someone to have their medical emergency. Not to mention the cost of liability insurance, benefits, building, vehicle expense, and maintenance. Yes, high deductible health insurance plays a role but you might be surprised to know that you can opt out of ambulance coverage and many people do to save on premium cost. My experience is that is the vast number of people complaining are these people.
As far as seniors go, Medicare pays the bill and in the absence of a secondary insurance the patient will get a small bill ($40 avg.) for their co-pay, otherwise, it's paid in "full". Ambulance Companies must accept Medicare as payment in full. Usually around 40 -50% below the actual cost of providing the service. In my company, Medicare beneficiaries make up about 60% of our total users. This creates a huge operating shortfall. This story, while interesting for its shock value (1.7 miles), doesn't tell the whole story.
I'll wait, Thanks..
Quote:
Friday's newscast with Lester Holt and this is happening all over communities in America. The featured story dealt with a man that called an ambulance for his son and since his insurance network did not have a deal with the ambulance company he was charges almost $2,000 for a ride that was 1.7 miles from his home to the Hospital.
My suggestion is if you get the shaft, FIGHT IT HARD until they reduce the charge. Good Luck
First of all, the distance to the hospital is irrelevant to the cost. The cost of readiness is VERY expensive. Paramedics and EMT's are paid while waiting for someone to have their medical emergency. Not to mention the cost of liability insurance, benefits, building, vehicle expense, and maintenance. Yes, high deductible health insurance plays a role but you might be surprised to know that you can opt out of ambulance coverage and many people do to save on premium cost. My experience is that is the vast number of people complaining are these people.
As far as seniors go, Medicare pays the bill and in the absence of a secondary insurance the patient will get a small bill ($40 avg.) for their co-pay, otherwise, it's paid in "full". Ambulance Companies must accept Medicare as payment in full. Usually around 40 -50% below the actual cost of providing the service. In my company, Medicare beneficiaries make up about 60% of our total users. This creates a huge operating shortfall. This story, while interesting for its shock value (1.7 miles), doesn't tell the whole story.
This
I'll wait, Thanks..
Exactly, NY State insurance regulations prohibit this practice for just that reason.
Out of network, there is no contractually reduced rate and the insurance pays a lesser percentage of the rate.
Mine is 90% in network and 80% out of network
I don't see how you'd be covered 100% out of network. I apologize in advance for incorrect interpretation since I don't know your plan. Just that normally, out of network costs you out of pocket more than in network.