Emergencies that lead to ambulance rides are nerve-racking enough, but sometimes the bill that follows can be almost as stressful.
Although ambulance and rescue-vehicle services are accountable to the R.I. Department of Health for licensing, policies, equipment requirements and unexpected incidents leading to a patient’s serious injury or death, the DOH has no say over prices charged for services.
That’s left up to local authorities, who set rescue-vehicle rates for cities’ and towns’ emergency medical divisions, and, in the case of private ambulance services, the companies themselves.
The federal government sets Medicare and Medicaid rates for rescue vehicles and ambulances, with the stipulation that patients not be charged for the balance, but that’s not the case with private insurers, which often don’t agree with ambulance services on prices.
According to state law, insurers may not charge a patient more than $50 for a copay for emergency ambulance rides. Other than that, the companies are not bound by other requirements.
“That’s if they apply a copayment, and all plans are different,” said John Garrett, director of operations at the R.I. Office of the Health Insurance Commissioner. “There’s no other limitation.”
‘Cranston bills out about $12 million annually. We get back about $2.5 million.’
PAUL A. CASEY, Cranston Fire Department deputy chief
There is no oversight on how much insurers have to cover for ambulance rides, and no requirement that patients be warned by the transport service if such a trip will not be covered by their insurance plan. That creates situations in which patients are shocked when they receive a large bill for the portion of ambulance fees not covered by insurance, in many cases a balance that amounts to thousands of dollars.
Blue Cross & Blue Shield of Rhode Island, one of the state’s major private insurers, did not respond to requests for comment.
Billing procedures begin with the rescue or ambulance service, which bills patients’ insurance for the ride and any other services administered. Insurers pay for the portion of the bill covered under a patient’s plan, and the patient is responsible for the balance, Garrett said.
Typically, though, that process applies only to emergency ambulance rides.
If someone chooses to use an ambulance for a reason other than an emergency, such as a more comfortable trip to the hospital for someone with a chronic illness, or a ride from one medical facility to another, they will likely be billed the entire cost.
“If it was nonmedically necessary transportation, it would be denied [by insurance],” Garrett said.
In 2017, a Kaiser Health News study of 350 consumer complaints about ambulance charges nationally found a common scenario was when a patient in an emergency was transported by an ambulance service that was “out of network” for the patient. In some cases, insurance companies paid some of the bill and left the patient to pay the rest. And because the ride was out of network, the balance was typically much higher.
Sometimes ambulance services drop contracts with insurers because the two sides can’t agree on fair rates, KHN reported.
Cranston’s rescue-vehicle service operates like most other cities and towns in Rhode Island, said Deputy Chief Paul Casey, director of the emergency medical division of the Cranston Fire Department.
City residents in need of emergency transport within Cranston’s limits are not billed for ambulance rides, but their insurers are.
“The hospital supplies our third-party biller with your insurance information and we accept what your insurer pays us,” Casey said. “There is no copay because you pay taxes in Cranston. There is no financial burden on the taxpayers.”
It’s different for a nonresident, who may see a bill of between $50 and $200 for an emergency transport, Casey said.
A person with no health insurance will receive the entire bill, but the city has a procedure that allows people to claim hardship and get the costs reduced or eliminated.
In Cranston, basic life support transport costs $1,700 plus mileage, and advanced life support is more than $2,000 in addition to mileage. Those rates are set by city councilors, Casey said. Insurers then pay what they deem the services are worth.
“In the end, Cranston bills out about $12 million annually and we get back about $2.5 million,” Casey said.
According to the Department of Health, there are 84 ambulance services operating in Rhode Island.Garrett, who’s been reviewing carrier coverage at OHIC for five years, said he doesn’t recall any challenges to unexpectedly large ambulance bills in the recent past.
“We haven’t had a lot of complaints around that issue,” he said.
The Better Business Bureau office in Marlborough, Mass., which serves Rhode Island, has received 12 complaints about ambulance services in the region over the past two years, said Paula Fleming, the agency’s chief marketing and sales officer.
According to the BBB website, most complaints are about duplicate billing or mistakes during the billing process.
Elizabeth Graham is a PBN staff writer. Contact her at Graham@PBN.com.
