MARY LOUISE KELLY, HOST:
How much does it cost for an ambulance ride to the hospital? Will your insurance cover it? If you're in an accident and an ambulance pulls up, there may be a big price just for getting in. That's the subject of our medical bill of the month. Dr. Elisabeth Rosenthal is the editor-in-chief of our partner, Kaiser Health News. Hey there.
ELISABETH ROSENTHAL: Hi. Good to be here again.
KELLY: All right. So who are we meeting today?
ROSENTHAL: Today we're meeting Peggy Dula, who lives in suburban Chicago. She had a car accident a few months ago. Her sister and brother were with her in the car. But she ended up with a very surprising bill.
KELLY: All right. And I know that KHN reporter Bram Sable-Smith spoke to Peggy. So I want you to hang on. We're going to listen, and then you and I will discuss.
BRAM SABLE-SMITH, BYLINE: The crash happened while Peggy Dula was driving her brother and sister out to a barn near her home in Saint Charles, about 45 miles west of Chicago. Peggy's daughter trains horses out there and invited them to come see. Peggy had never driven those roads before. She pulled into an intersection, mistakenly thinking it was a four-way stop, and her car was hit by a pickup truck.
PEGGY DULA: I don't remember which direction I spun, but I ended up facing back around the other way, the way I was coming from.
SABLE-SMITH: They each took separate ambulances to the same hospital. Her sister, Cynthia, was the most injured, spending five days in the hospital with a brain bleed, cracked rib and a bruised lung. Her brother Jim also cracked his ribs. Peggy just had bruising on her chest. And in hindsight, she says she probably didn't need an ambulance.
DULA: But of course, you don't know that at the time. And you're at their mercy because it's an accident. It's an unforeseen event. You're not calling the ambulance yourself and checking what they're going to charge you. You're at their mercy.
SABLE-SMITH: The ambulances each came from a different nearby emergency service, and all three billed for the exact same things - advanced life support plus a mileage fee. So Peggy was shocked when she got a bill for about $3,600, 2 1/2 times higher than Jim's and nearly three times higher than Cynthia's.
DULA: And it's so patently obvious that they're gouging me that I'm really irate about it.
SABLE-SMITH: Peggy says her insurer paid about $900, then the ambulance service billed her for the remainder.
So have you paid the $2,710.94 that they charged?
SABLE-SMITH: Peggy has paid about $40 as a sign of good faith, but she wants the district to adjust their charges down, more in line with her sister's bill. The only problem is the district doesn't have to do that.
DULA: It's not that I'm unwilling to pay for an ambulance. It's that it should be equitable. It should be fair. There's just this complete lack of fairness.
SABLE-SMITH: And she's resolute about not paying until those charges come down. But in June, her bill got sent to collections. For Kaiser Health News and NPR, I'm Bram Sable-Smith.
KELLY: OK. So Elisabeth Rosenthal, let me sum up. Peggy, it sounds like she's on the hook for something like $2,700. She's being sent to collection agency. This is exorbitant. She was the least hurt in the accident, and yet she got the biggest bill.
ROSENTHAL: Yeah. First, good for her for fighting it. And her daughter even offered to pick her up and take her to a doctor. She wasn't really that badly hurt.
KELLY: Yeah. And so since she was the least badly hurt, why does she get the biggest bill?
ROSENTHAL: Well, the problem is every ambulance company can set its own prices and decide whether to join insurance networks. That includes fire departments, which today often run local ambulance services. In fact, the three that responded to this accident were from three different fire departments. They put out fires for free but can charge basically whatever they like for the ambulance service. Researchers who study bills say they have very little connection to reality.
KELLY: Very little indeed. And I'm thinking about - isn't there something called the No Surprises Act, which is supposed to protect consumers from surprise bills like this ambulance bills of Peggy? I mean, doesn't it say that if you don't consent to out-of-network care, the provider has to give you the in-network rate?
ROSENTHAL: Yeah, it's pretty outrageous. But the federal law somehow made an exception for the new policy for ground ambulances. So it offers patients some protection against surprise bills from air ambulances and some other out-of-network medical bills. But ground ambulances were left out.
KELLY: So what are you supposed to do here? If the ambulance pulls up to your car crash, your bike crash, whatever it is, you're supposed to - what? - Google whether the ambulance is in-network?
ROSENTHAL: Yeah. Pretty unreasonable. It's a good idea to know if your local fire department and hospital ambulance services participate in your health insurance network. But frankly, the reality is you have no control over which ambulance company turns up in response to the 911 dispatcher. And many, many ambulance companies today don't participate in any networks at all. So all three of the fire department ambulances that turned up at this accident, for example, were out of network for all three siblings.
KELLY: And to the point Peggy made, if you're in a situation where an ambulance has been summoned, you may not be in the best state to self-assess whether you actually need one or whether you can wait and have, you know, somebody else drive you to the hospital. So what are people supposed to do?
ROSENTHAL: Well, it's tough, but I think it's important for people to know just because an ambulance pulls up, it doesn't mean you have to get in. The crew, of course, will likely advise you it's best to get checked out. Many people like Peggy think, well, sure, I don't feel that bad, but why not? Well, if you're just a bit banged up, you may save a lot of aggravation and money calling an Uber or asking a friend to come take you to a doctor or an urgent care. But don't be a hero. If you have something like a head injury, just get in the ambulance and worry about the bill later.
KELLY: Advice there from Dr. Elisabeth Rosenthal. Thank you.
ROSENTHAL: Thanks for having me.
KELLY: And if you have an outrageous or confusing medical bill, you can go to NPR's Shots blog and send it to us.
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