I’m generally of the opinion that most health care can be shopped for if a person is willing to put in a little time to use the available tools. As I try to bring to my readers’ attention on a regular basis, with a little planning and a little understanding of what is out there, it’s often possible to save thousands or even tens of thousands of dollars on needed medical services. For example, a while back I featured a story about a man who went to Thailand for shoulder surgery, saving more than $120,000 in the process!
But in some cases it just isn’t feasible to shop for a provider. Ambulance services come immediately to mind. I recently had forwarded to me by a friend a story about how the cost of ambulance services can get out of hand. Below are a few excerpts.
Let’s say you get into an accident and an ambulance arrives to take you to the hospital. It could be for a life threatening injury, or more of a precaution. A few weeks later, a bill arrives for ambulance services. How much should you expect to pay?
The correct answer is that you never really know. Charges for ambulance transportation vary dramatically across the U.S. and from provider to provider. In Monterey County, California, the average minimum charge for basic life support (BLS) ambulance transportation is $2,206. A few hours away in Mendocino County, the average is just $575… health insurance may only cover a fraction of the charge if the provider is out-of-network. In an emergency situation, patients are unlikely to compare ambulance prices or find an in-network provider, which leaves many suffering from sticker shock.
That’s exactly what happened to Robin Spring of Corralitos, California. Spring called 911 after becoming short of breath and was taken to the hospital in an ambulance. She later received a bill for $2,288. Citing the fact that the ambulance was out-of-network, her insurance covered just $750, leaving Spring with a balance of $1,538. But there were no in-network ambulance companies in Santa Cruz county, where Spring lived…
The article goes on to explain a root cause of the wild variation: Medicare.
A major factor behind high charges is that insurance reimbursements often do not reflect provider costs, leaving a small margin for ambulance companies. In 2010, the average Medicare payment was just 2% more than the average provider cost per transport. For many providers, the payment was less than the average cost per transport, meaning that the provider actually lost money transporting Medicare patients to the hospital. Insurance reimbursements, which are often based on Medicare fee schedules, may be even less…
Since margins are thin for Medicare and in-network patients, ambulance providers often avoid negotiating contracts with insurance companies or charge out-of-network individuals significantly higher rates in order to compensate…
While the uninsured and those with high-deductible insurance are usually the type of self-pay patients hit with high charges, in the case of ambulance services they can also hit people with more conventional health insurance.
Patients who have insurance and means, but use an out-of-network provider, face the highest out-of-pocket costs. When the ambulance arrives, they have unknowingly entered into an arrangement in which their insurance will likely cover only a fraction of the charge, if any of the bill, leaving them on the hook for the balance…
Other patients may lack insurance coverage and be unable to pay their bill. “50 percent of the calls we go on we don’t get any reimbursement for,” says chief paramedic Josh Nultemeier of King American Ambulance in San Francisco. One estimate put the collection rate (the percentage of ambulance charges that are actually paid) in San Diego county at just 33%…
When people need an ambulance, they’re usually not thinking about in-network benefits. In emergencies, the decision may be out of the patient’s control if a bystander calls 911 or if he or she is unconscious. And even when a patient is cost-conscious, there may be only one local provider or the decision may be made by the dispatch system. As the costs of America’s patchwork system vary dramatically, whether a patient receives a manageable bill or a crippling one is ultimately a matter of chance.
So, are there things self-pay patients (which includes a lot of people with conventional health insurance too, in this case) can do to protect themselves from high ambulance charges? Here are a couple of suggestions:
- If at all possible, find alternate transportation. Some injuries or conditions require a first responder immediately, and whatever the closest ambulance is to the patient is the right one, regardless of charge. But in other instances, just having someone drive you to the emergency room is the better option (and here’s how to save money on care in the emergency room).
- If you have insurance, know ahead of time which ambulance services are in your network, and if possible try to get the ambulance dispatcher to send an ambulance from that service. Again, in some cases the nearest ambulance is the right one, but in other cases a few minutes delay isn’t going to result in loss of life, limb, or bodily function.
- If you don’t have conventional health insurance, know ahead of time what your options are and what they charge. This will probably be harder in rural areas where choices tend to be fewer, but if you have choices find out which one will be best for you and your wallet before you need an ambulance.
- If you wind up in an ambulance not of your choosing (and that’s probably going to be pretty typical), you might be able to negotiate the bill down after the service is provided, just like other medical services.
One thing people should also remember is that ambulances are expensive to operate, and are typically on-call 24-hours a day. I read a recent blog post elsewhere complaining about an $800 charge for 5 mile ambulance ride.
Jim Mathes took one bad step out of his apartment in early September and wrenched his back. The pain was so intense he had to crawl back inside on all fours. He needed medical care, but there was no chance he could get himself down three flights of stairs to his car. So he did what anyone would do; he called for an ambulance.
That turned out to be an even bigger misstep, sending him into the demanding arms of a multibillion dollar global industry, and leaving him with a nearly $800 bill for a 5-mile ride.
The ambulance crew helped him downstairs, but once there, he felt well enough to drive himself to Parkwest Medical Center hospital, only five miles away in Knoxville, Tenn. The technicians urged him to ride in the ambulance, however.
“It’s no big deal,” Mathes recalls one technician saying, repeatedly. So Mathes got in.
Maybe the ride wasn’t a big deal, but it was an $800 deal…
Two weeks after the back incident, Mathes was stunned by another pain — a $798 bill he received from Rural/Metro of Tennessee. By Mathes’ math, the cost was more than $150 per mile.
“If I’d have known it would cost that much, I would have crawled to the hospital,” he said. His insurance won’t cover the ride, so Mathes is stuck paying the bill.
As if to add insult to back injury, the ambulance ride costs are itemized on a copy of the bill Mathes provided. It says the per mile cost was really only $8.73. The flat rate for sending the rig anywhere was $755.
“I feel like I was duped,” Mathes said. “I’m glad we’re not paying the amount for gas per mile that they do. Oh wait, that’s what they are asking me to do. Unbelievable.”
This story was pretty interesting, mostly for the obvious missteps by the patient and misunderstanding of what ambulance service is for. Two quick points:
- Severe back pain is probably something that deserves a call to a friend or family member to have them take them to the hospital, or better yet perhaps an urgent care center or doctor.
- Ambulances are expensive to operate.
I’d actually found a version of this story posted on another site, and the comments there from several people were fairly instructive:
Dave: People forget you’re also paying for this service to be available 24/7. You have to pay the staff for being on call, the lights, the room, etc. It’s always there for you. If you need it at 2 in the morning on a holiday it will be there for you. People need to think about these things before complaining about using a service like this and then seeing a large bill.
Chris: I am a paramedic in a very large and busy 911 system. The gentleman complaining about his bill should have thought twice before calling 911 for back pain. In my professional opinion, back pain is not a true medical emergency requiring immediate transport to the hospital via ambulance. Because he chose to call 911, he now has to pay for the services he used. Ambulances carry a load of expensive drugs and equipment and are staffed by highly trained EMTs and Paramedics who need to be paid. As another poster commented, it is expensive to run a 24/7/365 operation. A new ambulance (without any equipment…just the vehicle) costs over $100,000. A heart monitor is about $10,000 and the stretcher around $4,000. Many publicly run EMS systems that get taxpayer funds receive FAR less than police or fire depts. To make up for that lack of funding, EMS has to bill. Next time save the ambulance for true life threatening emergencies and take a cab.
Jason: What people don’t seem to get is that ambulances haven’t been just “throw the patient in the back and take off” type transports since about 1960. You are getting a mobile hospital room with all the tools/equipment and skills needed to keep you alive. That costs money. Just one piece – the LifePak heart monitor/defibrillator – is close to $12,000 to purchase new from the manufacturer. If you don’t need all the fancy gear that an ambulance has, you probably don’t need to be taking an ambulance to the hospital. A back injury.. I’d want to transport that guy in case of spinal injury.
Rick: Actually, a new ambulance unstocked costs at least $180,000. A new Lifepak 15 (don’t make 12s anymore) costs $33,000. How do I know? I am a director at an EMS service and just bought 3 of each this year. ALS ambulance care costs a lot money because the equipment and personnel are not cheap.
I’m certainly no stranger to the idea that the charges for medical services can be wildly inflated and abusive to those without insurance or who are out-of-network (I probably wouldn’t have anything to write about on this blog if it weren’t the case). But medical services do cost money, emergency services tend to be the most expensive form of treatment because they’re expected to be available 24 hours a day/7 days a week, and assuming the ambulance ride was necessary, it’s probably worth remembering that the ambulance service has likely saved your life, limb, or other major bodily function.
Remember, the point of being a self-pay patient isn’t to just save money, it’s to get the best value for your money. In that light, an $800 ambulance bill to transport a heart attack victim to the hospital is probably a pretty good value.