In summary
After a medical emergency, surprising ambulance costs can leave families in significant debt. A new state law requiring insurance companies to negotiate payments is expected to save Californians tens of millions of dollars a year.
The COVID-19 pandemic has taken a toll on Danielle Miele's family, but two exorbitant ambulance bills have left her afraid to call 911. ing.
Miele said her teenage son attempted suicide in 2022. His mental state worsened during the pandemic, requiring an ambulance ride from an emergency room in Roseville, and Miele took him to a treatment center in San Mateo. The ambulance company charged Miele a $9,000 out-of-network fee, which was sent to collections “almost immediately,” she said.
The virus also caused Miele to suffer symptoms similar to a heart attack. When Miele had her first seizure, she called 911. Without insurance, her 15-minute ride to the hospital cost him $4,000.
“When I had my last seizure, I basically said, 'I'm going to die here at home…I'm not going to call an ambulance anymore,'” Miele said. “I might be better off dying at home than incurring any more medical expenses.''
a new california law Effective January 1, it targets a type of “surprise” ambulance bill that Miele's family ended up in debt even though they had medical insurance. These bills take the form of out-of-network charges for commercially insured patients who have no control over which ambulance company responds to their requests for help.
Under the new law, patients only have to pay the same amount they would pay for in-network services. Health insurance companies and ambulance companies must settle bills directly, even if there is no existing contract.
Supporters of the new law say it will make a huge difference for thousands of families like Miele. The second time Miele's son needed emergency psychiatric hospitalization, the ambulance company that arrived was in the family's insurance network. Their out-of-pocket cost: $83.
Ambulance companies did not oppose the bill, which also guarantees reimbursement for services by health insurance plans.
Californians hit with surprise multi-million dollar bills
The California Association of Health Plans, which represents insurance companies, opposed the bill before it became law, saying it could raise premiums by $67.3 million across the state. In contrast, people with commercial health insurance can save about $44.5 million on health insurance. directly Ambulance fareaccording to the legislative analysis.
Katie Van Dins, legislative advocate for California Health Access, said the legislation fills a long-standing gap in California. consumer Protection against surprise medical bills For those with commercial insurance. Health Access California, a consumer advocacy group, sponsored the new law.
“This is the last remaining gap, but it's a very large gap,” Van Dinze said. “You might have insurance, but it doesn't matter.”
Approximately 14 million Californians enrolled in state-regulated commercial health plans would benefit from the law's protections. According to an analysis by the Kaiser Family Foundation, 73% of all ground ambulances transport California experienced out-of-network claims in 2018 among people with large employer insurance plans. Also in California Highest median emergency bill amount for an ambulance According to a study published last year by the U.S. Public Interest Research Group, the domestic price is $1,209.
Rep. Tasha Boerner, a Democrat from Carlsbad who authored the bill, said in a statement at the time of the bill's passage that the public cannot control which ambulance company comes to pick them up in a crisis.
“The number one thing to consider when calling 911 is whether you can afford to ride in an ambulance,” Werner said in a statement.
Learn more about the legislators mentioned in this article
State House, District 77 (Solana Beach)
State House, District 77 (Solana Beach)
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2018—present
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The law also protects the uninsured from expensive ambulance bills by limiting their out-of-pocket costs to Medi-Cal or Medicare rates, whichever is greater. Medi-Cal, the state health insurance program for very low-income people, already protects members from these types of claims.
About 6 million Californians with federally regulated health insurance are left without the law's protections, but a national commission is working on a solution to the problem. we no surprise methodIt protects Americans from various types of surprise charges, including air ambulance transport, but does not cover ground ambulance rides. Generally, these are Californians who work for large multistate or multinational private companies with self-funded health plans. Californians can ask their employers what types of health plans they offer.
Charged $4,400 for newborn ambulance fee
Laney Arevalo and her family are grateful that future emergencies will be covered in California. Her health insurance company doesn't have a contract with the ambulance company in San Luis Obispo County, where they live, so she has no choice but to pay out of pocket.
Minutes after Arevalo gave birth to her son, Brady, in September, doctors made the decision to transfer him to a larger hospital about 32 miles away. Brady was not breathing properly and required admission to the neonatal intensive care unit. An ambulance came and took him away.
Over the next month, letters started arriving from ambulance companies. Arevalo owed $4,400 for transportation, she said.
“I was told less than two months after giving birth that I was going to be picked up, and here I am now,” Arevalo said.
Insurance covered nearly all of Brady's five-day hospital stay, which totaled $109,000, but did not pay for an out-of-network ambulance trip, Arevalo said. After Arevalo filed a complaint, insurance eventually paid about a third of the bill, but the remaining unexpected expenses continue to strain the family's finances. She ended her maternity leave early to help pay her living expenses, and she returned to her job as a special education teacher. She is on her $200 monthly payment plan.
“It was definitely a surprising bill and we are still paying it,” Arevalo said.
Supported by California Healthcare Foundation (CHCF) People will be able to receive the care they need, when they need it, at an affordable price.visit www.chcf.org You can learn more.
