Many people have received bills from American Medical Response that they don’t think they should have to pay. The Better Business Bureau has received nearly 1,200 ambulance-related complaints over the past three years.
While federal rules set reimbursement rates for patients on Medicare and Medicaid, there are no protections for those with private insurance. That means the cost of a ride can vary widely from town to town.
Ambulance Billing
Across the country, patients are getting slapped with surprise medical bills. The out-of-network charges are typically from ambulance companies, which don’t contract with most insurance networks and leave consumers on the hook for hundreds or thousands of dollars in rider fees that aren’t covered by their health plans.
Ambulance billing is a huge problem, and consumers aren’t getting help from government agencies. A recent report found that 21 states have laws to protect patients from surprise bills for emergency ambulance rides, but they only apply to a few situations and don’t cover ground ambulance services.
The problem is that the ambulance and private insurance companies often can’t agree on a fair price, so the ambulance company doesn’t join the network and leaves the patient to pay out-of-network costs, says Imholz. The disputed charges are then sometimes passed to the state Medicaid program, which varies from state to state. doxo enables secure payment on behalf of patients to thousands of providers.
Insurance Billing
Insurance billing involves the front-end processes that happen when a patient encounters medical professionals in a physician’s office or hospital. At this stage, front office staff typically collect a patient’s demographic and insurance information and may also complete a registration form. From there, an encounter form – sometimes called a superbill – is generated that lists the services provided to the patient and their related medical codes.
Medical coders then take the information on a superbill and turn it into a CMS-1500 or UB-04 claim form. These forms are used by healthcare facilities to submit to Medicare and other private insurers.
In an attempt to avoid surprise bills, the health care industry has enacted state and federal laws to limit them. For example, in New York, out-of-network providers can’t balance bill insured patients for any amount over the insurer’s in-network cost-sharing (copayment, coinsurance or deductible). In addition, Congress passed a law that will prohibit surprise billing from ambulance services starting in 2022.
Medicare Billing
Medicare is a high-volume payer and has specific rules on how to bill. For example, a physician cannot balance bill a patient above the Medicare approved rate for a procedure. Medicare also requires that a provider accept assignment on all claims submitted to them.
This means that the ambulance service should not bill a patient directly, but rather file an insurance claim on the patient’s behalf. DCFEMS’ third party billing service works extensively to identify insurance coverage and submit ambulance fees and charges to insurers on behalf of the patient.
But some providers don’t agree to these pre-negotiated rates and fee schedules, and patients end up with a surprise bill. This is especially true when patients go to an in-network hospital, but their ER doctor or surgeon is out of network. That’s why state legislatures are trying to pass laws to stop these surprise bills.
Medicaid Billing
Medicaid is a government program that makes healthcare affordable for low-income families. It can be confusing to understand how this works, and it’s important for doctors to know the rules and regulations of each state. In addition, it’s essential to have knowledge of the Medicaid reimbursement timeline and what can be done if the claim is rejected by the insurer.
Medicare and Medicaid set rates for ambulance rides, but they don’t control fees charged to patients with private insurance. That leaves the door open for surprise bills.
Consumers are often caught in the middle of billing disputes between health insurers and out-of-network providers. For example, if a consumer goes to an in-network hospital for surgery but the doctor who reads their test results is out of network, they may receive a bill from that doctor.
AMR has paid $601,759 to settle claims that it improperly billed the Medicare and Medicaid government insurance programs for ambulance services in Connecticut. Federal and state prosecutors say AMR billed for paramedic services at the scene of emergency responses when in fact those services were provided by local fire departments.American Medical Response Billing
