Americans are safeguarded against surprise medical bills under the No Surprises Act, which became effective last year. However, ambulance rides were excluded from this legislation. A recent study discovered that over half of insured patients faced surprise bills for ambulance rides, amounting to approximately $130 million annually, according to the U.S. Public Interest Research Group (PIRG).
David Feng and Christy Shum are currently disputing a bill of more than $7,000 for an ambulance ride their 1-year-old son, Theo, took from home as a newborn. He required the transfer to a children’s hospital with specialized care due to breathing difficulties and a need for additional oxygen. The cost of the ride was never considered during the process.
A few weeks later, the couple received a bill totaling over $7,000 for the ambulance transfer. UnitedHealthcare, Christy’s insurance company, only covered around $1,000, leaving them responsible for the remaining amount due to the service being labeled as an “out-of-network provider or facility.” This unexpected bill was shocking and unjust according to Feng.
While the No Surprises Act eliminated many surprise medical bills, including those for emergency services, such as life-saving helicopter flights, it failed to address surprise bills from ground ambulances. Patricia Kelmar, a member of the federal committee established to examine this issue, highlights the need for establishing fixed costs tied to ambulance treatment to ensure fair payment from insurance companies and protect individuals from excessively high out-of-network bills.
Unfortunately, there is no clear timeline for implementing a new system, leaving families like David Feng and Christy Shum struggling to deal with their $6,000 ambulance bill. Shum appealed the bill but received a denial from UnitedHealthcare. Furthermore, the insurance company took back the $1,000 payment they initially made, stating that Blue Cross Blue Shield of California, Feng’s insurance company, should have covered all the expenses for the baby’s first month.
Despite spending hours on the phone with both insurance companies, seeking answers, the bill remains unpaid over a year later. Shum expresses frustration at the lack of resolution and the immense amount of time spent on this matter.
The ambulance provider claims that the bill has been submitted multiple times but is stuck in the system. Additionally, they argue that operating specialized critical care transport around the clock is costly and relies on timely and fair reimbursement from insurance companies.
Blue Cross Blue Shield of California, respecting federal privacy laws, cannot provide specific answers regarding the couple’s bill. However, they have assured the family that they are actively working to resolve the issue. UnitedHealthcare, Shum’s insurer, emphasized that primary coverage for Theo falls under Feng’s insurer and has reached out to the ambulance company and Blue Cross Blue Shield of California to assist in resolving the bill.
Despite the stress caused by the bills, David Feng and Christy Shum find solace in the fact that their son, Theo, eventually came home from the hospital after two and a half months and is now in good health.
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