02 Mar If You Need an Ambulance, You May Be Surprised by the Bill
The federal No Surprises Act took effect on January 1, 2022 to help protect insured Americans from surprise medical bills for out-of-network medical providers. Essentially, the law was passed by Congress to help shield consumers from the financial hardships caused by unreasonably high healthcare expenses.
The law specifically addresses the long-standing practice in which out-of-network medical providers – ranging from doctors to air ambulance companies – bill patients for the amounts their insurer did not cover. While balance billing was already prohibited in both Medicare and Medicaid, the federal No Surprises Act extended similar protections to individuals insured through employer-sponsored and commercial health plans.
Notably, the law protects consumers from receiving a balance bill when they are transported by air ambulance. However, ground ambulances were left out of the no Surprises Act because many are operated by public agencies that feared the law would limit their ability to continue offering services.
In emergencies and urgent situations, most patients do not have the ability to specifically request an ambulance provider within their health plan’s network – potentially exposing them to surprise medical bills. In an analysis of commercial insurance claims reported by Health Affairs, about 28% of emergency trips in a ground ambulance resulted in a potential surprise bill for consumers.
The analysis found that public ambulances, such as those operated by a local fire department, are more likely to be out-of-network and to have their charges paid in full by the insurer compared with ambulances operated by a private-sector ambulance. Additionally, allowed amounts and cost-sharing tended to be higher for private equity- or publicly traded company-owned ambulances than other private-sector ambulances.
These findings illustrate that being transported by a private-sector ambulance in an emergency comes with substantially higher allowed amounts, patient cost sharing, and potential surprise bills. It is up to lawmakers whether additional legislation can be crafted to address this issue.
Pacific Federal is a Zenith American company and subsidiary of Harbour Benefit Holdings, Inc.