The Weekly Newspaper of Inglewood Daily News on a Weekly Basis - Herald Publications - Inglewood, Hawthorne, Lawndale, El Segundo, Torrance & Manhattan Beach Community Newspapers Since 1911 - Circulation 30,000 - Readership 60,000 (310) 322-1830 - December 28, 2017 Certified & Licensed Professionals.......................5 Classifieds............................2 Film.........................................2 Finance..................................3 Food.......................................5 Legals............................... 6-7 Looking Up......................... 3 Pets........................................8 Politically Speaking............3 Obituary.................................2 Seniors..................................2 Sports....................................4 Weekend Forecast Friday Sunny 70˚/52˚ Saturday Sunny 66˚/53˚ Sunday AM Clouds/ PM Sun 64˚/52 LA Rams Host Holiday Shopping Spree On December 18 the Los Angeles Rams hosted a shopping spree for 100 children served by the Salvation Army, including those in Inglewood. Eighteen current Rams players (with defensive back Marcus Sayles shown in the photo), alumni, cheerleaders, mascot, staff and members of the team’s Women’s Organization helped guide the youngsters through a Walmart store and load shopping carts with holiday wish list items. Photo Provided by LA Rams Ambulance Services Get Through New Law Loophole By Rob McCarthy ambulance service, including El Segundo A loophole in a consumer protection law that bills $1,850 to respond to a 911 call and aimed at ending surprise medical bills is allowing transport to the hospital. El Segundo residents ambulance companies to bill Medicare recipients have complained in letters to the Herald about thousands of dollars for their services. The new the paramedic-ambulance charge being too law that took effect in July ended the practice high, especially to older residents who live of surprise medical bills for out-of-network on fixed incomes. fees as long as a patient used a doctor, clinic The transport fee issue in El Segundo was or lab in their insurance network. However, raised by several residents who wrote letters people covered through Medicare, Medi-Cal or ahead of the 2016 City Council election. The a self-insured health plan were excluded from City has three emergency ambulances in service, the health care protection in Assembly Bill 72. including two new vehicles that cost $406,000. Only people with private insurance are They replaced two older emergency vehicles shielded from the practice known as balance because of rising maintenance and repair costs. billing. A doctor or provider typically will send The gap in “balance billing” protection for a bill first to an insurer, which pays a flat rate consumers is sizable, the Kaiser Foundation for the service. The doctor, lab or clinic can found. Sixty-one percent of privately insured seek the balance of the charge directly from the employees are covered by self-funded employersponsored patient. Ambulance companies are included, too. plans, it reported. Unless the The Kaiser Family Foundation recently looked Legislature expands the consumer protection for into the continued balance billing practice of all health plans, ambulance company complaints ambulance companies and says it’s not illegal. will continue. Kaiser’s team reported that Unless an ambulance service belongs to a ambulance companies can charge by the mile network, it can set its own rates. and add on costs for oxygen and other services “Most complaints reviewed by Kaiser Health during the ride to the hospital. If paramedics News did not appear to involve fraudulent staff the ambulance rather than emergency charges. Instead, patients got caught in a system medical technicians, then that will hike up the in which ambulance services can legally charge bill charge. Kaiser added, “Even if the patient thousands of dollars for a single trip--even when didn’t need paramedic-level services…” the trip starts at an in-network hospital,” the The 26 ambulance companies found online news division of Kaiser said. that serve the South Bay don’t discuss fees on Ambulance charges that Kaiser reviewed their websites, making it difficult to view local ranged from $3,600 to $8,400. Patients and pricing even for the most basic emergency call. their families who call 911 are vulnerable The California Department of Managed because it’s an emergency and they don’t get Health Care welcomed the patient protection to choose which ambulance company responds. measure in July. The department said AB 72 The Kaiser team said its review of complaints took the consumer out of the middle of billing about ambulance company bills found two disputes between a health care facility and common scenarios. insurance plans for out-of-network charges. In the first scenario. a patient is taken by Consumer groups had complained the billing ambulance to the hospital after a 911 call. The practice was unfair. second and less common occurrence happens Ambulances and diagnostic labs are both when an ambulance service transfers a patient covered under the consumer protection law, yet between hospitals. they’re so different, said the Kaiser foundation “In both scenarios, patients later learn the that studied 350 billing complaints from 32 states. fee is much higher because the ambulance was The patient and families have little control over out-of-network, and after their insurer pays who provides the emergency service, unless it’s what it deems fair, they get a surprise bill for in a city like El Segundo. the balance,” Kaiser’s team said. “Patients usually choose to go to the doctor, City fire departments also provide emergency but they are vulnerable when they call 911, or get into an ambulance,” Kaiser’s team found. “The dispatcher picks the ambulance crew, which, in turn, often picks the hospital.” Patients who show up at an out-of-network hospital might be facing expensive medical bills, even if they are later transferred to their health plan’s hospital of choice. Some of the patients who asked the Kaiser foundation to intervene in their billing disputes wanted the charges lowered. Others thought they should be charged nothing. An expectation of free medical emergency transportation isn’t realistic either, an industry expert told Kaiser. The private ambulance companies are entitled to expect reimbursement that covers their costs of keeping crews ready to respond “even if no calls comes in,” said Jay Fitch, who runs an emergency services consulting firm. Fitch said that private ambulance companies receive no payment unless a person isn’t transported, and that one-third of all calls are freebies. An adult who is mentally capable can refuse to be taken by ambulance. Many ambulance companies reportedly refuse to join health insurer networks because the compensation rate is too low. The California Department of Managed Health Care anticipated some balance billing disputes last July, when it welcomed the health consumer protection law. It offered this advice if a surprise bill from an out-of-network healthcare professional is sent: Dispute it first with your health plan and include a copy of the bill. “Your health plan will review the grievance and should tell the provider to stop billing you,” the health care department said. If the health plan takes more than 30 days to respond or a consumer isn’t satisfied with the response, then file a complaint with the department. The department accepts complaints by phone at 888-466-2219 or online at its web site, www. HealthHelp.ca.gov. The California Association of Health Underwriters supported passage of AB 72, saying that billing disputes that its members handled would start to decline by midyear. The trade association of 2,000 health insurance agents and brokers says they respond to tens of thousands of phone calls per year about out-of-network billings. •
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