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 again,'” Miele said. “It might be better for me to die at home than incur any more medical expenses.”
California’s new law, which goes into effect on January 1, targets a type of “surprise” ambulance bill that Miele’s family would be saddled with 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. By contrast, people with commercial health insurance could save about $44.5 million in direct charges for ambulance rides, according to the law’s analysis.
Katie Van Dins, legislative advocate for California Health Access, said the legislation closes a long-standing gap in California consumer protections against surprise medical bills for commercially insured people. . california health accessConsumer advocacy groups 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. An analysis by the Kaiser Family Foundation found that in 2018, 73% of ground ambulance transports in California resulted in out-of-network charges to people covered by large-scale employment insurance. California has the highest median emergency ambulance bill in the nation, at $1,209, according to a study released last year by the U.S. Public Interest Research Group.
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 everyone should think about when calling 911 is whether they can afford to ride in an ambulance,” Werner said in a statement.
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.
The law does not protect the approximately 6 million Californians who have federally regulated health insurance, but the national commission has established the U.S. Surprise Act, which protects Americans from various types of surprise charges, including for ambulance transport. Working on solutions to the law. However, ground ambulance rides are not covered. Generally, these are Californians who work for large multistate or multinational private companies with self-funded health insurance. Californians can ask their employers what types of health plans they offer.
$4,400 bill for ambulance for newborn
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 normally and required admission to the neonatal intensive care unit. An ambulance came and took him away.
Within the next month, letters started arriving from the ambulance company. Arevalo owed $4,400 for transportation, she said.
“Less than two months after I gave birth, they told me they were going to collect my baby, and now I’m here,” Arevalo said.
Insurance covered nearly all of Brady’s five-day hospital stay, which totaled $109,000, but did not pay for the 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 surprise bill and one that I’m still paying,” Arevalo said.
Supported by the California Healthcare Foundation (CHCF). The foundation works to ensure people have access to the care they need, when they need it, and at an affordable price.visit chcf.org You can learn more.
This article is from Bay City News Service and first appeared on Karmatters.