Charleston, S.C. (WCBD) – A COVID-19 relief bill passed by Congress in December will clamp down on various forms of ‘surprise’ medical billing.
The new legislation limits the amount patients can be billed for out-of-network services but the regulations that go into effect in 2022 do not include ground ambulances.
According to a Health Affairs report, 71% of all ambulance trips involve potential surprise bills.
Summerville resident Maria Beck learned about surprise billing the hard way.
In September, Beck went to an Express Care for what she thought was an ear issue. When she arrived, the doctor noticed she was having trouble walking and speaking.
“The doctor came in and immediately noticed something was off,” she said.
The doctor called a Dorchester County ambulance to make the trip, which was less than half a mile.
Beck said she was in the back of the ambulance alone and did not receive treatment on the way to the hospital.
“It was scary to be back there alone with all of the equipment. I was surprised they did not give me oxygen because I was clearly having trouble breathing,” she said.
A Dorchester County representative disputed Beck’s claim.
“The patient was not alone in the ambulance. The paramedic was in the seat behind the patient communicating with the hospital via radio,” said a Dorchester County Representative.
Beck’s thyroid level was dangerously low. She spent a few days in the hospitals and received bills for the urgent care, hospital, and ambulance a few weeks later.
“I received the hospital bill which was a crazy amount of money but my insurance covered it and I had zero amount due which is exactly what I expected because I have good quality insurance and I had met my out of pocket deductible for the year,” she said.
Insurance had covered all her bills except the $734 ambulance ride, which was out of network.
“[I thought,] Wow I was in that ambulance for three minutes. They didn’t ride in the back they actually performed no activity other than pushing my cart? How do they get $734? How do they possibly charge that?” she said.
She called Dorchester County and her insurance company to dispute the charge and learned a claim had never been filed. A couple weeks later she received an amended $306 bill.
“[I thought} well it should have been zero that’s how insurance works,” she said.
Beck was a victim of balance billing.
Balance billing occurs when an out of network provider takes what insurance offered them and then comes after patient for the remainder of the bill.
“Each year I hear about balance billing more than the previous year because every year patients are being forced into more narrow networks and having to pay a greater share of their healthcare,” said Caitlin Donavan the Senior Director with the National Patient Advocate Foundation
Patients can only be balance billed for out of network providers. News 2’s investigation revealed Dorchester and Charleston Counties are not in network for any private insurers which leaves patients little choice but to hike big costs in the case of an emergency.
“There are very dangerous consequences of people being too scared to call an ambulance,” said Donavan.
Berkeley County EMS is in- network with Blue Cross Blue Shield.
Forms of balance billing are currently illegal in states like California, Florida, and New York. New federal protections passed in December fall short to include ground ambulances.
“The problem with ambulances is that you can’t request a certain ambulance company. I would love to find one patient in any town who can name their ambulance company or whether or not they are in network,” she said. ” The other problem is that ambulances are very complex mobile emergency rooms and they charge like them,” she added.
Donovan encourages patients to do their research
“We think you should pay a bill if you have a service but it doesn’t mean you should pay what you have been charged. You can always call and negotiate either by asking for a payment schedule or offer a lesser amount by looking up comparable pricing on a site like Healthcare Bluebook,” said Donovan.
Beck said she hopes more is done to protect patients.
“My hope is that somebody else doesn’t have to pay out of pocket for something they can’t afford or loosing credit over money they just don’t have,” she said.
How do ambulance bills compare across the Tri-county?
News 2’s investigation revealed Dorchester county has the highest EMS rates in the tri-county. Rates are broken down by different levels of service and are approved by county council.
“The general philosophy is that tax dollars make the service available and then those that use the service pay when they use the service. This year the budget for the department is $9,108,963 with projected revenue of $5.3 million,” wrote a Dorchester County representative.
According to Dorchester County, Basic Life Support (BLS) includes basic assessment, vital signs, bandaging, splinting and oxygen administration.
Advanced Life Support Call I (ALS I) includes paramedic level assessment, diagnostic 12 lead EKG, IV initiation and fluids, any two medications or two doses of the same medication excluding nitroglycerine and aspirin, if pain medication is administered, end tidal CO2 monitoring.
Advanced Life Support Call II (ALS II) Includes: All ALS I plus defibrillation, synchronized cardioversion, transdermal cardiac pacing, endotracheal intubation including video laryngoscopy, more than 2 does of the same medication or administration of more than two medications, CPAP. BiPAP, cardiac arrest resuscitation
|Charleston County||Berkeley County||Dorchester County|
|Base BLS: $375.00||BLS (non-emergent): $275.00
|Base ALS I: $425.00||ALS I (non-emergent): $325.00
|ALS I: $725.00|
|Base ALS II: $550.00||ALS II: $689.17||ALS II: $1,285.00|
|Mileage: (Urban) $8.50
|Mileage: $7.00||Mileage: $9.00|
User fees make up only a portion EMS departments’ budget. Charleston County EMS covers 56% of its cost from fees. Berkeley County estimates 50.7% of their EMS budget will be funded by revenue. According to a representative with Dorchester County, 58.2% of its EMS department’s budget is covered by user fees.