|By Mary Ann Roser, Austin American-Statesman|
|McClatchy-Tribune Information Services|
By industry standards, her
Even the savviest consumers are often unaware that they might have to shoulder a large share of their ambulance bill.
That practice of balance billing is widely criticized by consumer advocates who say it's unfair because emergency patients have no way to seek a lower-cost ambulance service when they call 911.
While the federal government forbids ambulance companies from balance billing patients covered by government payers, such as
"When you call 911, you get no say in who shows up," said
"Balance billing can be crippling for families."
Few states provide consumer protections for emergency ambulance billing,
After a four-year process,
In the emergency room last fall at
Bayne, who is 35 and the married mother of two other children, called EMS and her insurer to object. She discovered that, at the time of her emergency,
'Caught in the middle'
Insurance payments vary widely based on individual policies and the amount of service a patient receives on the ride to the hospital.
Negotiated rates for medical care generally entitle private insurance companies to a substantial cut in cost. But EMS providers have no incentive to negotiate discounted rates with insurers, said
The money to cover the service "has got to come from somewhere," he said.
Newly insured people under the Affordable Care Act represent a whole new group of people poised to confront balance billing for ambulance services, Pogue and others said.
"I think people who have insurance very comfortably think, 'Because I have insurance, I will be covered,'" said Bayne, who has since paid her bill in full.
So that consumers don't get "caught in the middle," EMS providers and insurance companies should get together and negotiate a fair cost for ambulance service, said
"Balance billing is really an issue between the provider and the insurer, and the consumer is used as a pawn," Lucia said. "Consumers go to hospitals that are in network and they don't expect to be balance billed. The person having an emergency is not in the position of asking whether the doctor or ambulance is in network."
Even if an emergency patient were to ask about the cost of an ambulance ride before getting in, Travis County EMS personnel are not likely to have answers. They don't have insurance information nor are they in any position to discuss costs, EMS Chief of Staff James Shamard said.
"We're dealing with folks at one of the worst times in their lives," he said. "It's about taking care of patients."
People with insurance are advised to find out before they need an ambulance how much of the cost is covered. They are likely to face far steeper charges once they get to the hospital. Emergency care is among the costliest of medical services.
Paying for the rest
Austin-Travis EMS collects about
At the same time, however,
If not for that taxpayer money,
"Private insurance has a vested interest in increasing the company profit line regardless of the impact on the cost of readiness," having the service available, 24/7, officials said in a statement. "If the city entered into contracts with private insurance companies, the cost of use would shift to the general taxpayers by increasing the cost of readiness."
"Like all of health care, there is a lot of cost-shifting," Hooten said. "Our bills would be about
Said Bayne: "I can afford this bill, but for people who are struggling or a single mom, she may be looking at a
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