DENVER — If you ever have to call 911 and take an ambulance, the last thing you want to worry about is the cost. That's why Colorado lawmakers and the U.S. Congress are taking steps to stop surprise ambulance bills.
The No Surprises Act, a federal law passed two years ago, was supposed to end surprise medical bills. But there was a loophole: ground ambulances weren’t included. As a result, if you ride in an ambulance, you may still get hit with surprise bills through a process known as “balance billing.”
While in many cases, balance billing is illegal in Colorado and across the country, there are some gaps in the protections. When an ambulance provider charges more than your health insurance coverage, you’re left to pay the difference.
“It's making people really fearful to call an ambulance when they think they might need it because they're worried about getting hit by an unexpected bill that they cannot afford,” said Adam Fox, who directs the Colorado Consumer Health Initiative.
Fox explained that although “people have zero control over what ambulance picks them up” and “whether it’s part of their insurance network,” the existing gap in protections means costs fall on them.
“We see consumers get hit, oftentimes, with bills that are in the $1,000 to $2,500 range that they're not expecting,” he said.
That's exactly what happened to Alvin and Mary Gordy, a Denver family charged almost $2,000 for an ambulance ride from one building to another within the same hospital complex. After getting help from Denver7, the couple was able to negotiate with the ambulance provider and their insurance to reduce their out-of-pocket costs to zero.
Colorado lawmakers are trying to reduce surprise bills by capping consumer costs at the coinsurance, deductible, or copayment required under their insurance plan. Legislators in Colorado’s House will review the bill on March 19.
Colorado is one of 14 states trying to strengthen protections against surprise bills. But Fox said, “We still need federal-level action to address the gap in its entirety.” That’s because state protections only apply to state-regulated insurance plans, not private employer plans or other plans regulated out of state.
Given the complexity of the ambulance billing system, the No Surprises Act created a committee to develop recommendations for a follow-up law on ambulance bills.
Almost half of the time when people need an ambulance, they end up in one that isn’t covered by their insurance network. “And that means that the ambulance can charge whatever it wants to your insurance, and then you will have to owe whatever your insurance doesn't pay,” said Patricia Kelmar, a consumer advocate with the U.S. Public Interest Research Group who served on the committee.
To protect people from balance billing like that, Kelmar said the committee recommends that the U.S. Congress "cap the out-of-pocket cost for an ambulance ride for insured Americans to $100 so that people know it would never be more than $100.”
The committee hopes Congress will apply that cap to both situations where people encounter ambulances: being rushed to a hospital during an emergency or being transferred between medical facilities.
Shawn Baird, a former president of the American Ambulance Association who also served on the committee, said Congress must strike a balance between protecting consumers from surprise bills and ensuring ambulance services are paid enough to cover their costs.
“You have to have quite a number of ambulances out there, all stocked up, ready to go, not busy doing anything else, always ready to take the next call,” Baird said.
The committee suggests Congress should establish a tiered pay structure for insurance providers to cover out-of-network costs based on ambulance rates set by state and federal laws. Insurers would then need to pay the ambulance companies directly.
“Let's get the patient out of the middle and let's get the insurance companies to recognize that they need to pay a fair rate for the service,” Baird said.
The committee also asks Congress to create a “No Surprises Help Desk” for ambulance billing questions.
However, these solutions could take months to implement. The committee’s report will be finalized this week, then it could take up to three months for the recommendations to go to Congress. Then, lawmakers would need to take up the recommendations, draft a bill and introduce it.
In the meantime, “if you do think you're having a medical emergency, it is important to call an ambulance. And if you have a billing issue after the fact, there are resources in our state to help you,” Fox said.
Fox suggested Coloradans dealing with surprise ambulance bills can contact their insurance provider, Colorado’s Division of Insurance or consumer advocacy groups like the Colorado Consumer Health Initiative for help.
