Surprise ambulance bills can leave families deep in debt after a medical emergency. A new state law that forces insurance companies to negotiate payments is expected to save Californians tens of millions of dollars a year.
The COVID-19 pandemic has taken a cruel toll on Danielle Mieles’ family, but after two ambulance overcharges she’s afraid to call 911.
Her teenage son attempted suicide in 2022, Miele said. 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 hit Miele with a $9,000 out-of-network charge, which was immediately sent to collections, he said.
The virus also left Miele with seizures that mimic the symptoms of a heart attack, he said. Miele called 911 the first time she had a seizure. A 15-minute trip to the hospital costs $4,000 without insurance coverage.
The last time I had one of my seizures, I said, I’m going to die here at home, I’m not getting another ambulance, Miele said. I would rather die at home than incur more medical debt.
A new California law that takes effect Jan. 1 targets the kind of surprise ambulance bills that put the Mieles family in debt even though 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 have to pay only the equivalent of what they would have paid for an in-network service. Health insurance companies and ambulances have to pay the bill directly even if they don’t have an existing contract.
Supporters of the new law argue it will make a big difference for thousands of families like the Mieles. The second time the Mieles’ son needed an emergency psychiatric hold, the ambulance company that arrived was part of the family’s insurance network. Their co-pay: $83.
Ambulance companies did not run afoul of the law, which includes assurances that health insurance plans reimburse them for services.
Californians hit with millions in surprise bills
The California Association of Health Plans, which represents insurers, opposed the bill before it became law because of its potential to increase premiums by $67.3 million statewide. In contrast, people with commercial health insurance stood to save about $44.5 million in out-of-pocket charges for ambulance rides, according to a legislative analysis.
Katie Van Dynze, a legislative advocate for Health Access California, said the law closes a long-standing gap in California’s consumer protections against surprise medical bills for those with commercial insurance. Health Access California, a consumer advocacy group, sponsored the new law.
It’s the last remaining gap, but it’s really big, Van Dynze said. You can be insured but it doesn’t matter.
About 14 million Californians with state-regulated commercial health plans will benefit from the laws’ protections. According to a Kaiser Family Foundation analysis, 73% of all ground ambulance calls in California resulted in an out-of-network charge in 2018 among people with large employer insurance. California also has the highest median surprise ambulance bill in the country at $1,209, according to a study published last year by the US Public Interest Research Group.
In a statement during the legislation’s passage, Assemblymember Tasha Boerner, the Democrat from Carlsbad who authored the measure, said people have no control over which ambulance company takes them during a crisis. .
The last thing anyone should be thinking about when they call 911 is whether they can afford an ambulance ride, Boerner said in his statement.
Learn more about the lawmakers mentioned in this story
State Assembly, District 77 (Solana Beach)
State Assembly, District 77 (Solana Beach)
City Council Member / Businessman
How he voted in 2021-2022
District 77 Demographics
No occasion 25%
The Asm. Tasha Boerner took no less $1.4 million from Party sector since he was elected to the legislature. That represents 31% of his total campaign contribution.
The law also protects uninsured people from receiving expensive ambulance bills by capping their out-of-pocket costs at the Medi-Cal or Medicare rate, whichever is greater. Medi-Cal is the state’s health insurance program for very low-income residents and protects its enrollees from these types of fees.
About 6 million Californians enrolled in federally regulated health plans are not protected by the law, but a national committee is working on a solution to the US No Surprises Act, which protects Americans from many type of surprise fee, including air ambulances, but not covering ground ambulance rides. Generally, those 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 the newborn’s ambulance ride
Lainey Arebalo and her family are thankful that future emergencies will be covered in California. Her health insurance company does not contract with any ambulance companies in San Luis Obispo County where they live, leaving them with no choice but to pay out of pocket.
In September, minutes after Arebalo gave birth to her son Brady, doctors decided to transfer her to a larger hospital about 20 miles away. Brady was not breathing properly and had to be admitted to a neonatal intensive care unit. The ambulance came and took him away.
The next month, letters from the ambulance company started arriving: Arebalo owed $4,400 for the move, he said.
Here I am, you know, less than two months after giving birth I was told that I would be sent to the collections, said Arebalo.
Insurance covered most of Brady’s five-day hospital stay, which totaled $109,000, Arebalo said, but would not pay for the out-of-network ambulance ride. Insurance eventually paid about a third of the bill after Arebalo filed a complaint, but the remaining unexpected costs still cut 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. He is on a payment plan of $200 per month.
That was a real surprise bill, and one I’m still paying, Arebalo said.
Supported by the California Health Care Foundation (CHCF), which works to ensure thatpeople have access to the care they need, when they need it, at a price they can afford. Visitwww.chcf.orgto learn more.
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