Page 2 January 4, 2018
Ambulance Services Get Through Loophole
Seniors
in New Health Care Law
Don’t Get Hacked! Time to get Serious about Password Safety
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The six-month-old law didn’t stop surprise medical bills for ambulance services.
By Rob McCarthy
A loophole in a consumer protection law
aimed at ending surprise medical bills is
allowing ambulance companies to bill Medicare
recipients thousands of dollars for their
services. The new law that took effect in July
ended the practice of surprise medical bills
for out-of-network fees as long as a patient
used a doctor, clinic or lab in their insurance
network. However, people covered through
Medicare, Medi-Cal or a self-insured health
plan were excluded from the health care
protection in Assembly Bill 72.
Only people with private insurance are
shielded from the practice known as balance
billing. A doctor or provider typically will
send a bill first to an insurer, which pays a flat
rate for the service. The doctor, lab or clinic
can seek the balance of the charge directly
from the patient. Ambulance companies are
included, too.
The Kaiser Family Foundation recently
looked into the continued balance billing
practice of ambulance companies and says
it’s not illegal. Unless an ambulance service
belongs to a network, it can set its own rates.
“Most complaints reviewed by Kaiser Health
News did not appear to involve fraudulent
charges. Instead, patients got caught in a
system in which ambulance services can
legally charge thousands of dollars for a
single trip--even when the trip starts at an
in-network hospital,” the news division of
Kaiser said.
Ambulance charges that Kaiser reviewed
ranged from $3,600 to $8,400. Patients and
their families who call 911 are vulnerable
because it’s an emergency and they don’t
get to choose which ambulance company
responds. The Kaiser team said its review of
complaints about ambulance company bills
found two common scenarios.
In the first scenario. a patient is taken by
ambulance to the hospital after a 911 call.
The second and less common occurrence
happens when an ambulance service transfers
a patient between hospitals.
“In both scenarios, patients later learn the
fee is much higher because the ambulance
was out-of-network, and after their insurer
pays what it deems fair, they get a surprise
bill for the balance,” Kaiser’s team said.
City fire departments also provide emergency
ambulance service, including El
Segundo that bills $1,850 to respond to a 911
call and transport to the hospital. El Segundo
residents have complained in letters to the
Herald about the paramedic-ambulance charge
being too high, especially to older residents
who live on fixed incomes.
The transport fee issue in El Segundo was
raised by several residents who wrote letters
ahead of the 2016 City Council election. The
City has three emergency ambulances in
service, including two new vehicles that cost
$406,000. They replaced two older emergency
vehicles because of rising maintenance and
repair costs.
The gap in “balance billing” protection
for consumers is sizable, the Kaiser Foundation
found. Sixty-one percent of privately
insured employees are covered by self-funded
employer-sponsored plans, it reported. Unless
the Legislature expands the consumer
protection for all health plans, ambulance
company complaints will continue.
Kaiser’s team reported that ambulance
companies can charge by the mile and add
on costs for oxygen and other services during
the ride to the hospital. If paramedics staff
the ambulance rather than emergency medical
technicians, then that will hike up the bill
charge. Kaiser added, “Even if the patient
didn’t need paramedic-level services…”
The 26 ambulance companies found online
that serve the South Bay don’t discuss
fees on their websites, making it difficult to
view local pricing even for the most basic
emergency call.
The California Department of Managed
Health Care welcomed the patient protection
measure in July. The department said AB
72 took the consumer out of the middle of
billing disputes between a health care facility
and insurance plans for out-of-network
charges. Consumer groups had complained
the billing practice was unfair.
Ambulances and diagnostic labs are both
covered under the consumer protection law,
yet they’re so different, said the Kaiser foundation
that studied 350 billing complaints from
32 states. The patient and families have little
control over who provides the emergency
service, unless it’s in a city like El Segundo.
“Patients usually choose to go to the doctor,
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. •
and symbols. Another way to do it is by
using the “passphrase” approach, meaning
string together words that create a phrase.
Be sure to steer clear of birthdays, anniversaries,
street names and other specific
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Use it as a teaching moment: Have a talk
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they need. •