A DOTING mom was left reeling after receiving a surprise ambulance bill topping $3,000.
Her newborn suffered a suspected skull fracture and had to be transported 35 miles to hospital in Utah.
Robyne and Michael Gallacher told Fox 13 News that – as cautious parents – they called emergency services after their baby boy Alden, hit his head.
They were concerned about the bump which led to “a pretty big goose egg.”
Michael said, “We’d already hit our max out of pocket. We figured we’ll just play it safe. Get him checked out.”
However, the doctors were equally as cautious, and decided little Alden needed to remain in hospital overnight, to monitor his condition.
The mother was extremely anxious after the doctors emphasized the urgency of the situation regarding her son’s health. Her mind was in disarray, grappling with thoughts about the duration of his stay in Primary Children’s Hospital and what the future held in store.
However, Alden was much better the following day, and was discharged from the hospital.
But the couple’s relief over their son’s health was soon replaced with financial concerns, when they received their ambulance bill a few weeks later.
Upon arrival at Primary Children’s Hospital in Salt Lake City, the couple was shocked to learn from the ambulance service provider that their insurance had covered only a fraction of the expenses incurred during the 35-mile journey from Tooele.
They billed the Gallachers a further $2,900.
Michael recalled today, “First thing we thought is like, ‘insurance made a mistake.
“‘Like, they didn’t process it right. No, we hit our max out-of-pocket.
“Something’s wrong – there’s some kind of miscommunication between the provider and our insurance.’”
They were told that the ambulance which had transported their baby was out-of-network.
There were no in-network providers available in Tooele County at the time of the call-out.
The good news was that their insurance firm paid $13,000 in costs for their son’s medical care and overnight monitoring.
But the bad news was that the Gallachers were out-of-pocket as were expected to cover the ride between hospitals.
The broadcaster pointed out that the federal No Surprises Act, protects patients from most out-of-network emergency medical costs.
This includes air ambulances – but not ground-based vehicles.
According to Patricia Kelmar, the senior director of health care campaigns at the health research organization PIRG, roughly half of all cases involve the use of an out-of-network ambulance for transportation.
“And what that means is your insurer will pay some amount towards that bill.
“But that ambulance has then the ability to send you a balance bill. We often call it a ‘surprise bill.”
In 2022, the PIRG Education Fund published a document that said patients ended up spending around $129 million on surprise ground ambulance costs.
CONGRESS FAILURE
Unfortunately, Congress didn’t include ground ambulances from the No Surprises Act, which has complicated matters for the likes of the Gallachers.
PIRG reported: “Ten states have enacted laws to protect patients against out-of-network bills from ambulance companies.
“However these state laws are limited to protecting only patients who are insured by a state-regulated health plan.
“That means that 60% of Americans who get their insurance coverage through a self-funded plan offered by their employer are left unprotected because these types of plans are exempt from state laws.
“Insured patients need a federal solution, modeled after these state laws, to ensure protection across all 50 states.”
Michael agreed, warning, “It sets people up to have to choose between physical suffering or financial suffering.
“And that should not be a choice on the table… you need help.”
What is the No Suprises Act?
The federal No Surprises Act was enacted in 2022 to provide protections against surprise medical bills and to reduce healthcare costs.
In general, you are protected from surprise billing for:
- Most emergency services (including emergency mental health services),
- Non-emergency services from out-of-network providers at certain in-network healthcare facilities (hospitals, hospital outpatient departments, or ambulatory surgical centers)
- Services from out-of-network air ambulance service providers
- You are also protected from disputes over payment for these services between plans/insurers and providers/facilities, so that you’re not in the middle
But:
- It does not cover every unexpected or high medical bill
- You can still be billed for services and treatments that are not covered by your plan
- Its surprise billing protections do not apply to non-emergency services provided by an out-of-network provider at an out-of-network facility
Source: U.S. Department of Labor
Kelmar suggested that consumers contact their insurer to ask if the firm can pay more towards their bill.
If that approach fails, patients could go directly to the ambulance provider, and request a discount.
“It takes a lot of courage to call up the company that saved your life or got you the care that you needed when you needed it and fight a bill,” she said.
The story hit a nerve with Fox viewers, with one commenting on the broadcaster’s social media, “I had the same issue. It was the Pleasant Grove Fire Dept that took me a few miles to my in-network hospital.
“I was unconscious. I had no say which hospital they took me to.”
He added that he ended up being “charged $2,234. My insurance company assured me that they would deal with it and to definitely not pay them.
“I didn’t, and it took two years for it to be settled.
“The [fire department] was wrongly balance billing me.
“I was sent collection notices every month for multiple months. I couldn’t do anything on my end. Only my insurance company’s legal arm could resolve it.”
In general, you are protected from surprise billing for most emergency services, including emergency mental health services, per the No Surprises Act.
