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[TN] What can you do if an out-of-network ambulance bills you after an emergency transfer?
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Hello, my question is in regards to an ambulance ride I took interfacility from a hospital in Tullahoma, Tennessee to a hospital in Nashville, Tennessee within the same hospital system. I falsely assumed that since it was hospital to hospital within the same system, it would be their ambulance service. It turns out that it was an out-of-network ambulance, and insurance is only willing to pay partially, which was $1,500. Now I am being billed for the remainder, which totals $7,684.47 for the 74.2-mile ride. The hospital system is in network with my insurance provider; however, it seems the ambulance wasn't, and now I am stuck with this surprise bill, which honestly seems egregiously overpriced compared to national averages and compiled data. I have done some research and found the "No Surprises Act," which covers "AIR AMBULANCES" but not ground, so that doesn't look like it is an option. I am looking for guidance through any options I may have. I do have the ability to pay the total, but it would drain our emergency fund to do so. I have heard of negotiating lump sum payments and such directly with them. Looking for advice from the pros, thank you.
I understand how frustrating it can be to receive such a large unexpected bill for an ambulance ride. Have you already attempted to negotiate the bill with the ambulance service or provider?
No.
Are there any specific details about your insurance policy that you think might be relevant to this situation?
My insurance is in network with the hospital system; however, it seems that the ambulance was not a part of the hospital system even though it was interfacility.
Is there anything else the Lawyer should know before I connect you? Rest assured they'll be able to help with your surprise ambulance bill.
No.
Hey there! Welcome to our service. I'm Andres Sanchez, an attorney with many years of experience. I understand you're dealing with a situation where you received a surprise bill for an out-of-network ambulance ride between hospitals in the same system, and you're looking for guidance on your options. Is that right?
Yes.
Could you let me know if you received any documentation or agreement regarding the cost of the ambulance ride before it was provided?
I am looking for any ammunition or legal guidance you may have to offer, even if it is just trying to negotiate with the ambulance service directly. Any tools in your tool belt?
Have you had any communication with the ambulance service about negotiating the bill or discussing a payment plan?
It was an emergency chest pain visit, and I cannot recall all of the details of what happened. I was on heavy painkillers during the event, but I know that the transport was approved by the physician through a Physician Approved Transport Form due to the risk of death. I have not called or directly communicated with the ambulance company yet, just in case I need to be aware of anything before negotiating.
Based on your situation, there are several legal arguments and consumer protection laws in the United States that could potentially support your case:
- Emergency Medical Treatment and Labor Act (EMTALA): This federal law requires hospitals to provide emergency medical treatment regardless of a patient's insurance status or ability to pay. While it doesn't directly address ambulance billing, it underscores the importance of receiving necessary emergency care.
- Surprise Billing Protections: Although the "No Surprises Act" primarily covers air ambulances, some states have their own laws that address surprise billing for ground ambulance services. It's worth checking if Tennessee has any specific regulations that might apply.
- Contractual Obligations: If the ambulance service was not clearly identified as out-of-network at the time of transport, there may be an argument that you were not adequately informed, which could be considered a breach of contract or misleading practice.
- Negotiation and Payment Plans: Many healthcare providers, including ambulance services, are open to negotiating bills or setting up payment plans, especially if the charges are significantly higher than expected.
Let me know if you have any questions or clarifications.
The Patient Transport Form says it was medically necessary, and it does say that I gave verbal consent. I was given the option of ambulance or life-flight helicopter, so I chose ambulance thinking it would save money for the insurance company and be cheaper for me, but I was not given the option of declining the ride, even though I wouldn't have due to it being life-threatening.
Here's how you can approach this situation:
- Review Your Insurance Policy: Double-check your insurance policy to understand the coverage details, especially regarding out-of-network services. Look for any clauses that might support your case for coverage of the ambulance ride.
- Contact Your Insurance Provider: Reach out to your insurance company to discuss the situation. Explain the emergency nature of the transport and ask if they can reconsider the coverage decision. Sometimes, insurance companies can make exceptions or provide additional support. If your coverage is through an employer-sponsored plan, federal rules require the plan to offer a full and fair review of denied or underpaid claims under 29 C.F.R. § 2560.503-1.
- Negotiate with the Ambulance Service: Contact the ambulance service directly to negotiate the bill. Explain your situation, including the emergency nature of the transport and your inability to choose a different provider. You can request a reduction in the bill or propose a lump sum payment that is more manageable for you.
- Explore State Laws: Investigate if Tennessee has any specific laws regarding surprise billing for ground ambulance services, such as proposed legislation like House Bill 1061. Some states have protections that might apply to your situation.
- Seek Legal Advice: If negotiations don't lead to a satisfactory outcome, consider consulting with a lawyer who specializes in healthcare billing disputes. They can provide personalized advice and help you explore legal options.
- Consider Payment Plans: If a reduction isn't possible, ask the ambulance service about setting up a payment plan. This can help you manage the financial burden without depleting your emergency fund.
I called the hotline for the Surprise Billing Protection Act, USA, and they said it did not qualify, unfortunately. I was NOT informed of the ambulance being out of network at the time of service, or I would have declined at that point and asked for another route to take.
Should I ask them about Tennessee "No Surprise" Legislation HB 1061 that may go into effect July 1st?
Yes, it's definitely worth asking about Tennessee's "No Surprise" Legislation HB 1061. If it goes into effect on July 1st, it might provide additional protections or avenues for addressing your situation. It's always a good idea to stay informed about any new laws that could impact your case. If you have any more questions or need further assistance, feel free to reach out!
Should I pay the balance and hope to be reimbursed by insurance via an appeal to the insurance claim, or wait to pay the bill until insurance reviews the active appeal that is pending?
It's generally advisable to wait for the insurance appeal process to conclude before paying the full balance, especially if there's a chance the insurance might cover more of the cost. Paying the bill in full might complicate the reimbursement process later.
However, if you're concerned about potential late fees or credit impacts, you could contact the ambulance service to inform them of the pending appeal and see if they can hold off on collection efforts until the appeal is resolved.
Ultimately, the decision depends on your financial situation and comfort level with potential risks. If you have any more questions or need further assistance, feel free to reach out!
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