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NFT: Out of Network Ambulance charges

bhill410 : 3/11/2018 11:51 am
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.
NBC had a story in  
GmeninPSL : 3/11/2018 12:21 pm : link
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
RE: NBC had a story in  
NDMedics : 3/11/2018 3:30 pm : link
In comment 13858622 GmeninPSL said:
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.
Hello 911, I need an ambulance for a cardiac arrest !!  
RobCrossRiver56 : 3/11/2018 5:21 pm : link
Before I give you the address, can you tell me if the responding EMS is in network with SWSCHP?

I'll wait, Thanks..
RE: RE: NBC had a story in  
ctc in ftmyers : 3/11/2018 5:40 pm : link
In comment 13858923 NDMedics said:
Quote:
In comment 13858622 GmeninPSL said:


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
RE: Hello 911, I need an ambulance for a cardiac arrest !!  
NDMedics : 3/12/2018 10:11 am : link
In comment 13859076 RobCrossRiver56 said:
Quote:
Before I give you the address, can you tell me if the responding EMS is in network with SWSCHP?

I'll wait, Thanks..


Exactly, NY State insurance regulations prohibit this practice for just that reason.
Normally, In Network is  
section125 : 3/12/2018 10:19 am : link
covered at a better rate at the reduced provider discount - say 90% of the reduced rate so your out of pocket is 10 % of the reduced contracted rate. (yours may have different %s)

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.
This is not exactly the same scenario, but may apply  
Matt M. : 3/12/2018 1:16 pm : link
NYS and many other states have a process for unexpected emergency medical expenses. When my son was in urgent care and they called in an out of network plastic surgeon, he charged his regular fee and my carrier initially paid a small amount plus applied another small amount to my deductible. The plastic surgeon balance billed me for ~$3K. I had to fill out a form, which essentially requires the provider to negotiate a payment with the carrier, absolving the patient from the balance.
When you call 911  
Bubba : 3/12/2018 1:25 pm : link
is there a protocol they follow when contacting ambulance services?
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