The Cost Of Calling An Ambulance And The Nightmare That Ensued

There is nothing scarier than being in a situation where you have to call 911 in fear of losing someone’s life. I’ve dialed those digits two times in my life. Both times I was scared sh-tless. Little did I know that the second call would lead me to a 10-month-long surprise ambulance bill nightmare.

The first time I dialed 911 was when I was in middle school. I was home alone with my mom when she fainted and wouldn’t respond. If you’re a parent, don’t underestimate the importance of teaching your kids about 911 emergency services. You just never know what could happen.

The second time I dialed 911 was this past winter when our daughter unexpectedly went into anaphylactic shock. She was only 9-months-old at the time. Too young to speak, all she could do was cry and beg for “HELP!” through her eyes.

Fortunately, both my mother and daughter fully recovered. But unfortunately, I never expected that calling for an ambulance that second time would be the most expensive phone call of my life.

A Shocking Surprise Ambulance Bill Arrives

After we got past the chaos and waiting at the hospital, our follow up visit, and dietary adjustments, life got back to normal.

I didn’t think much about how much we would owe in medical bills. I was just focused on making sure we didn’t have another scare like that and counting our blessings.

We had a platinum PPO plan at the time with a top three insurance carrier that cost $2,300 a month. Thus, I figured we’d owe a reasonable amount of money in co-insurance.

I guesstimated $200-$300 for the ambulance ride and $400-$800 for the ER.

But I found myself caught in a surprise ambulance bill nightmare about a month later. The horror story started when I got an envelope in the mail from AMR, American Medical Response, the ambulance company.

Unsuspecting, I ripped it open only to instantly feel my stomach knot up and my pulse shoot through the roof. It said I owed them $3,539 for our daughter’s 25-minute ride to the hospital. What?!

I started to panic. Surely that’s not right. We have insurance. There must be a timing issue. We can’t owe that much with our plan.

Boy was I dead wrong. In actuality, I had just become another victim of surprise ambulance billing.

Related: How To Compare Health Insurance Plans And Save Money

What Is A Surprise Ambulance Bill Anyway?

If this is the first time you’ve heard of surprise ambulance billing, I’m glad you’re reading! One of my goals this year is to educate more people about this horrible, convoluted dilemma that few people outside of the medical and insurance arena know about.

A surprise ambulance bill is an unexpected invoice of considerable size sent to a patient for out-of-network emergency transport. In other words, a giant balance bill from an ambulance provider.

Even though some insurance plans like mine say that ambulance transport for out-of-network providers is covered the same as in-network providers, there is a catch. And that catch is what screws a lot of people like me.

The catch is that if an out-of-network provider does not have contracted rates with your insurance carrier, they can charge you 5x, 10x, 20x, or more if they want.

Your insurance company will likely process the claim using in-network contracted rates. But since the ambulance company doesn’t accept contracted pricing, they stick you with a balance bill.

Your chances of getting a surprise ambulance bill depend a lot on where you’re located, your insurance, and if there are ambulance providers with contracted rates in the area. Some states and locals have laws to prevent surprise ambulance bills, but not many.

How An Ambulance Ride Cost 10x More Than Expectations

To further clarify how someone like me with top-tier PPO health care insurance got screwed, here’s how things happened.

  1. AMR charges me ~$4,250 for our daughter’s ALS1 Emergency transport, mileage, testing, medications, and monitoring services.
  2. My insurance company processes the claim as if it were in-network. They apply a plan discount of $3,360 bringing the “amount allowed” down to $898.
  3. Then my insurance company calculates my 20% co-insurance owed, which equals $180.
  4. My insurance company sends AMR a check for 80% of $898, which is $718.
  5. AMR records the $718 payment and sticks me with the $3532 balance.
  6. I get very PO’d, stressed out, and lose sleep over this BS situation.
  7. Screaming in my head, I decide to fight tooth and nail to get the charges reduced somehow.

Getting The Runaround By The Insurance Company And Ambulance Provider

When I first saw my EOB (explanation of benefits) from my insurance carrier saying I would only owe $180, I was thrilled. The way I interpreted the claim, things looked good. Obviously, I didn’t yet understand what was really going on.

I wait several weeks after getting the initial surprise ambulance bill. Then, I start to sweat the AMR balance isn’t updating from $3532 to $180.

I call their customer service many times to try and get an update. But, all I get are impatient reps from an overseas call center saying “$3532 is how much you owe ma’am. There is nothing we can do. How would you like to send payment?”

Grrrrrr. My normal calm demeanor turned red with anger.

After multiple calls to AMR, my insurance company, and a contracted third-party negotiator, I began to boil.

AMR wouldn’t back down and said they couldn’t negotiate rates “by law.” The third-party negotiator said they tried but couldn’t do anything else to help me.

Finally, my insurance company said they reviewed my claim twice and that it was processed correctly. Ugh.

Determined To Fight A Messed Up System

Tired of talking to unsympathetic overseas reps for hours and not getting anywhere, I decided to turn my fire into fuel. I didn’t want to pay such an outrageous bill without a proper fight. So, I decided that I would only bite the bullet and pay if I pursued all possible avenues.

I encourage you to also put strong emotions to good use. For example, you can use rejection as motivation to do more with your life. And you can use perpetual failures as an incentive to save money and plan for a better future.

I started to research other surprise ambulance bill stories and learn more about the system.

Even though I felt a $3,532 balance bill was excessive, I was shocked to hear some people have been slapped with surprise ambulance bills in the tens of thousands.

As part of my research, I wanted to find out if things could have turned out differently if we had taken a different ambulance.

Emergency Medical Services (EMS) Ambulance Providers In San Francisco

I was surprised to learn there are only 3 ambulance providers permitted to respond to ALS 911 emergencies in San Francisco. ALS stands for Advanced Life Support. BLS stands for Basic Life Support. EMS is the catchall term.

As it turned out, two of the 3 ALS providers showed up to our house almost simultaneously. The San Francisco Fire Department (SFFD) and American Medical Response (AMR). SFFD seemed to be there as backup and didn’t charge us anything thankfully.

Here’s a matrix of the current list of ambulance providers in San Francisco if you’re curious.

List Of San Francisco Ambulance Providers

The kicker – none of them are in-network with our insurance with United Healthcare! Turns out there are zero in-network ambulance providers within 30 miles of our zip code. AMR used to be in-network in San Jose, but terminated back in 2016.

So, I would have been screwed no matter who showed up at our house. I guess that makes me feel better.

Not really.

It’s shocking the only in-network ambulance companies we have within a 60 mile radius are WestMed Ambulance in San Leandro and Hayward, and Baystar Medical Services in Burlingame.

The Positives Of A Surprise Ambulance Bill

Admittedly, I’m not always the best at seeing the bright side of a bad situation. I have a reflex tendency to panic and think the worst. But, there’s always a silver lining if you look hard enough.

Even though this whole ordeal has been incredibly stressful, here are the positives of our surprise ambulance bill.

  • Our daughter is alive and well, hallelujah!
  • Saving her life is worth WAY more than $3,532
  • 911 dispatch answered my call immediately
  • And they dispatched the EMS team while I was still on the phone
  • Both the SF Fire Department and AMR paramedics showed up crazy fast
  • 6 EMS first responders were on site to help save our daughter’s life
  • The paramedics were SO calm, kind, and attentive
  • We did not get COVID-19 on the ambulance ride or the hospital
  • This ordeal motivated me to raise awareness of surprise ambulance bills and hopefully get us one step closer to more protective legislation
  • Our ability to pay the ambulance balance bill can help keep AMR in business so they can save others’ lives, including those who can’t afford to pay
  • The ~$3,300 in savings we got this year for switching from a Platinum to a Gold insurance plan covers most of the balance bill.
  • I’m not done fighting yet!

The Health Insurance Saga Continues

Wondering if I caved in and paid the balance bill? Not yet! Even though the original surprise ambulance bill arrived in the mail over eight months ago, I haven’t given up yet.

It’s been a roller coaster of a journey so far. Certainly more than I can fit into one post. Thus, I’ll be publishing a follow-up post to provide an update.

I’ll go over important legislation and gaps to be aware about. And I’ll include a detailed list of all the things I’ve done to fight my $3,532 bill.

In addition, I’ll cover some important lessons I’ve learned through this process. Plus, I’ll summarize what you should do if you’re ever faced with a similar situation. And, hopefully, I’ll be able to provide a final resolution to this unfortunate situation.


Sam’s Perspective About This Ambulance Bill Fiasco

My dear wife shielded me from this saga for several months because she knew I would get pissed off as well. We have this running joke in our house for difficult situations: There’s no need for both of us to suffer!

That afternoon, I decided to follow the ambulance to the Emergency Room while my wife accompanied our then 9-month-old daughter in the ambulance.

Due to COVID-19 protocols, I wasn’t allowed inside the hospital. Only one parent or guardian was. Therefore, I waited in my parked car for five hours, praying everything would be alright. Not being able to help your child in need is one of the most difficult things a parent can experience.

During this time, it really got me thinking about how people and companies take advantage of others during their most vulnerable times. Although I’m thankful for the medical attention we received, I’m also surprised there isn’t legislation in California to better protect its citizens from medical price gouging.

The surprise $3,532 ambulance bill makes me question the need for having a gold or platinum PPO health insurance plan that costs over $2,200/month. If our health insurance isn’t going to cover such emergencies, we might as well get the cheapest health insurance policy possible.

Price for medical care versus inflation

Maximum Motivation To Build More Wealth

Costly medical bills is another reason why we need to stay focused on our finances. With no stable job with benefits and no government health care subsidies, we’re on our own.

After reading my wife’s post, I’m now motivated more than ever to build more wealth and boost our passive income streams. I thought we had enough money, hence my current sabbatical and desire to re-retire. But perhaps not if medical costs continue to skyrocket.

The system has a way of keeping us trapped in a never-ending cycle to make more money. Ideally, I would like to get to a level of wealth where we don’t have to stress about what a 25-minute ambulance ride costs. Is that so much to ask?

There’s nothing like a health scare to make you appreciate life and all that you have more!

Please think twice before retiring early with kids or becoming an entrepreneur. Having one parent work a traditional day job may be the best combination if the other parent wants to take more risks.

Have A Pre-Mortem Checklist

Finally, the best thing we can all do is have a pre-mortem checklist for various types of potential emergencies. List out the potential emergencies and list out the steps you would take in case of such emergencies. This way, you can think more calmly and rationally when bad things happen.

We now have antihistamines and epipens in case of future allergic reactions. We’ll administer the medicine and we’ll take our daughter to the ER room ourselves if necessary. Of course, if things seem really bad, then we’ll dial 911 and pay whatever medical bills that come our way.

Readers, have you ever had to call 911 for an ambulance? Did you receive a surprise ambulance bill afterwards? If so, how much was it, what type of insurance did you have, and was the ambulance in-network? What city/state were you in?

The Cost Of Calling An Ambulance And The Nightmare That Ensued is written by Samurai Sydney for

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