Over the last several weeks, 13 HELP Team has heard from a handful of people who were billed for ambulance services they never received. They all got the bill from a company called American Medical Response, or AMR. AMR says they are a not-for-profit organization that has provided ambulance service in Connecticut for over 50 years. Federal and state investigators say the company overbilled both Medicare and Medicaid. The government alleges that AMR would sometimes send their ambulances to non-emergency calls and then charge for ALS (paramedic) services when the patient was only going to the hospital. In other cases, AMR would charge for ALS services in what are known as “joint response” situations. That’s when police or bystanders call 911 after an accident. The local fire department would respond, but AMR would then rebill Medicaid for the same ALS services the firefighters already paid for.
The federal government sets rates for patients on Medicare and Medicaid, but it doesn’t regulate fees for patients with private insurance. That leaves the 14,000 ambulance services in towns and cities across the country to set their own fees. That means that the cost of a similar ride can vary greatly from one town to the next. And that’s the case even though the average ambulance trip is short, about three miles.
Those differences in price aren’t always explained by factors like distance or time, according to research from the RAND Corporation. Instead, the researchers found that the vast majority of the time, the difference in costs is based on the local ambulance provider’s prices and fees.
A few months ago, a bipartisan group of lawmakers introduced legislation that would help consumers by requiring all ambulance providers to use in-network charges when billing insurers. The bill would also prohibit providers from charging the portion of their negotiated rate that an insurance plan didn’t cover — a practice known as balance billing. The group behind the legislation, which includes representatives from both parties and a number of consumer organizations, says they have gotten strong support from patients and health care providers.
We’ve been hearing from patients who are battling big medical bills, especially for ambulance rides. They’re being slammed with hundreds or thousands of dollars for ambulance services they never received, or didn’t expect and couldn’t control. This has led to public outrage, and prompts 21 states to pass laws protecting patients from surprise bills. But those laws exclude ground ambulance rides, and leave patients struggling to fight their way out of debt. American Medical Response Billing