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Sha'Ron James


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Fear calling 911 because of an ambulance charge? Tell the state now

 

Date: February 24, 2017
Source: Palm Beach Post
Author:  Charles Elmore

 

A state working group meets Tuesday to consider whether legislators need to set some new ground rules for ambulance charges — like the bill for more than $800 that caught Edward and Bonny Fishman of Boynton Beach by surprise.

Then came this: Boca Raton Fire Rescue Services threatened to turn the Fishmans over to a collection agency if they did not pay, the couple said.

“I was shocked,” Edward Fishman, 64, said. “What is this? We pay taxes for fire and rescue. Why is there a charge? How do they determine how much they charge?”

The Fishmans were eating at a restaurant in Boca Raton when Edward fainted. Paramedics arrived. Edward regained consciousness and seemed to be OK, as the the couple tells it. They wondered if they should drive themselves to the hospital, which was a couple of miles away, or let paramedics take him. There seemed to be no harm in the latter, the Fishmans said they concluded.

Doctors checked Edwardout and he went home feeling better — until the bill for the ride to the hospital arrived.

While grateful for emergency aid, consumers like the Fishmans feel something is wrong with the system. As they see it, they are effectively paying three times for ambulance service. The first is through local taxes to support city or county ambulances. Then they pay premiums for health insurance. Then come mystery charges after the ride.

These can vary from several hundred dollars to more than $1,000 for a ground trip, according to complaints to state agencies. For air ambulances, consumers report being hit with charges of $25,000, $35,000 or more.

There’s no state-set legal limit on what ambulance services can charge consumers beyond the price their insurers are willing to pay. In effect, the cost to consumers can be whatever the ambulance providers say it is.

Such unpredictable charges can force consumers in a terrifying and risky moment to consider the financial consequences of calling 911 rather than just focusing on getting medical help.

“If God forbid we were in an emergency in the future, I would think twice about calling an ambulance,” Bonny Fishman, 62, said.

Consumers say it is absurd to think they can shop around for the best deal with an ambulance. Typically, calls go to the nearest city or county ambulance service. Yet most municipal services decline to join insurer networks, seeing no financial reason to do so. Otherwise, taxes might have to go up or services could have to be cut, they say.

After considerable lobbying, ambulances were removed from groundbreaking Florida legislation last year to protect consumers in situations where they have no realistic chance to choose medical providers in their insurance network. That can be in emergencies, or other cases where consumers cannot easily shop around. Example: A consumer schedules a procedure at a hospital in her insurer’s network, thinking she is covered, only to have an out-of-network anesthesiologist there hand her a surprise bill for thousands of dollars after the treatment.

The new law caps such out-of-pocket charges at the equivalent of in-network costs, providing an incentive for medical providers to negotiate with insurers and join networks.

Ambulances, though, remain an unresolved issue.

Florida insurance consumer advocate Sha’Ron James convened a panel of industry and government representatives to look for possible solutions. They next meet Tuesday in Tallahassee with a focus on ground ambulance charges.

Boca Raton officials did not respond to a request for comment for this story, but other ambulance providers have argued insurers want to impose reimbursement rates that are too low. Sometimes the consumer’s portion reflects rising deductibles or co-pays under various health plans, they point out.

Most ambulances are operated by counties and cities, and any solutions that force them to join insurer networks or cap out-of-pocket consumer costs could leave local governments forced to raise taxes or cut services, they say.

Maybe the first thought for patients should be “did they survive to complain about the bill in the first place?” Mac Kemp said at a meeting last fall. He is deputy chief of clinical affairs for Leon County Emergency Medical Services, representing the Florida Association of Counties.

But consumer advocates said this should not be dismissed as some trivial, secondary matter.

Surprise ambulance bills can be a big problem for families, threatening their good credit or pushing them into debt or toward bankruptcy when they may already be struggling with other medical bills, said Sean Dugan, a health policy analyst for the National Association of Insurance Commissioners. He cited the case of a Montana man who said he would rather have bled to death rather than incur so much debt from emergency transportation that it threatened his ability to pass on his farm to his family.

The Fishmans said they were down to one income at the time and did not have a lot of money to cover a bill they were not expecting.

“We just assumed as taxpayers we were covered for that,” Bonny Fishman said. “Then we got a huge bill.”

 

Get involved

The Florida Insurance Consumer Advocate’s Emergency Medical Transportation Working Group meets Tuesday, Feb. 28 in Tallahassee’s Hermitage Building, First Floor Conference Room, from 9 a.m. to 1 p.m.

Got a story about ambulance charges they need to hear? You can email them here:

http://www.myfloridacfo.com/Division/ICA/EmergencyMedicalTransportation.htm

To call in to Tuesday’s meeting : (712) 770-4035

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