Shocking ambulance bills put these families in debt. A new California law bans the practice


Summary

Surprising ambulance bills after a medical emergency can plunge families deep into debt. A new state law that forces insurance companies to negotiate payments is expected to save Californians millions of dollars a year.

The COVID-19 pandemic took a brutal toll on Danielle Miles’ family, but she’s afraid to call 911 after two exorbitant ambulance bills.

Milley said his teenage son attempted suicide in 2022. His mental health deteriorated during the pandemic, and he required an ambulance transfer from the Roseville emergency room, where Miele took him to a treatment center in San Mateo. The ambulance company charged Miele a $9,000 out-of-network charge, which was almost immediately sent to collections, he said.

He said that due to the virus, Miley also started having seizures which were similar to the symptoms of a heart attack. Milley called 911 the first time she had a seizure. Without insurance, the 15-minute trip to the hospital cost $4,000.

“The last time I had a stroke I basically said, I’m going to die right here at home, I’m not going to get another ambulance,” Milley said. I would probably rather die at home than incur more medical debt.

A new California law taking effect Jan. 1 aims to target the surprise ambulance bills that leave Miles families in debt, even if they have medical insurance. These bills take the form of out-of-network charges for commercially insured patients who have no control over which ambulance company responds to a call for help.

Under the new law, patients will only have to pay what they would have paid for in-network service. Health insurance and ambulance companies must pay the bill directly, even if they do not have an existing contract.

Supporters of the new law argue it will make a big difference for thousands of families like Miles’. The second time the Miles’ son needed an emergency psychiatrist, the ambulance company that came was part of the family’s insurance network. Their co-payment: $83.

Ambulance companies did not oppose the legislation, which includes assurances that health insurance plans will reimburse them for services.

Californians lose millions in surprise bills

The California Association of Health Plans, which represents insurers, had opposed the bill before it became law because it had the potential to increase statewide premiums by $67.3 million. In contrast, people with commercial health insurance save about $44.5 million in direct charges for ambulance rides, according to a legislative analysis.

Katie Van Dienz, legislative counsel for Health Access California, said the legislation closes a long-standing gap in California’s consumer protections against surprise medical billing for people with commercial insurance. Health Access California, a consumer advocacy group, sponsored the new legislation.

It’s the last remaining gap, but it’s really big, Van Dienz said. You may be insured but it doesn’t matter.

About 14 million Californians with state-regulated commercial health plans will benefit from the law’s protections. According to an analysis by the Kaiser Family Foundation, 73% of all ground ambulance transports in California resulted in out-of-network charges in 2018 among people with large employer insurance. California has the highest average surprise ambulance bill in the country at $1,209, according to a study published last year by the U.S. Public Interest Research Group.

In a statement at the time of the legislation’s passage, Assemblywoman Tasha Boerner, a Democrat from Carlsbad who wrote the measure, said people have no control over which ambulance company picks them up in times of crisis.

The last thing anyone should be thinking about when calling 911 is whether they can afford an ambulance ride, Boerner said in his statement.

Learn more about the MLAs mentioned in this story

tasha borner

State Assembly, District 77 (Solana Beach)

tasha borner

State Assembly, District 77 (Solana Beach)

How they voted in 2021-2022

Generous conservative

District 77 Demographics

Vote Registration

Dame 43%

GOP 26%

no party 25%

campaign contribution

ASM. Tasha Boerner has taken at least $1.4 million From team area since being elected to the legislature. he represents 31% Of his total campaign contributions.

The law protects uninsured people from getting expensive ambulance bills by limiting their out-of-pocket costs to the Medi-Cal or Medicare rate, whichever is higher. Medi-Cal is the state health insurance program for very low-income residents and already protects its enrollees from these types of bills.

Nearly 6 million Californians enrolled in federally regulated health plans would not be protected by the law, but a national committee is working on a solution to the U.S. No Surprises Act, which would protect Americans from a variety of surprise bills, including air-ambulance transportation. Covers rescues, but does not cover ground ambulance rides. Typically, they are Californians who work for large multi-state or multinational private companies with self-funded health plans. Californians can ask their employer what type of health plan they offer.

$4,400 bill for newborn’s ambulance trip

Lanny Areballo and his family are grateful that future emergencies will be covered in California. Their health insurance company does not contract with any ambulance companies in San Luis Obispo County, where they live, leaving them no choice but to pay out of pocket.

In September, minutes after Areballo gave birth to her son Brady, doctors decided to transfer her to a larger hospital about 20 miles away. Brady was unable to breathe properly and needed to be admitted to the neonatal intensive care unit. The ambulance came and took him away.

Over the next month letters started arriving from the ambulance company: Areballo was owed $4,400 for the transfer, she said.

“You know, here I am, less than two months after giving birth I was told I was going to be sent to collections,” Areballo said.

Brady Areballo plays in his grandparents' living room in Templeton on Dec. 19, 2023.  Photo by Larry Valenzuela, CalMatters/Catchlight Local
Brady Areballo plays in his grandparents’ living room in Templeton on Dec. 19, 2023. Photo by Larry Valenzuela, CalMatters/Catchlight Local

Areballo said the insurance covered almost the entire cost of Brady’s five-day hospital stay, which totaled $109,000, but it would not pay for the out-of-network ambulance ride. Eventually, insurance paid about a third of the bill after Areballo filed a complaint, but the remaining unexpected expense is still cutting into the family’s finances. She ended her maternity leave early to return to work as a special education teacher to help pay the bills. She is on a payment plan of $200 per month.

It was definitely a surprise bill and I’m still paying it, Areballo said.

Supported by the California Health Care Foundation (CHCF), which works to ensurePeople need the care they need, at a price they can afford. visitwww.chcf.orgto find out more.


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