What You Need to Know Before Calling an Ambulance
If you’ve ever ridden an ambulance before, you know that the bill can hurt just as much as the injury. The process of getting transportation to a hospital in a medical emergency in the U.S. is one that is complicated, worrisome, and expensive. In this blog we’ll explore the different factors that affect the cost and level of care you can receive from an ambulance, so that next time you or someone you know needs one, you’ll be able to make the best decision possible.
Medicare and Medicaid
If you are on Medicare or Medicaid, then you’re in luck, the pricing of an ambulance is usually not going to be complicated. Medicare will pay for your ambulance given that it’s a medical necessity. An ambulance is defined as a medical necessity by Medicare if it is the only safe mode of transportation to get you to the hospital. Generally, if you’re well enough to not need the medical support of an ambulance, it won’t be considered a medical necessity. If you’re on Medicare check here for the specific details. Medicare pays the ambulance company a flat fee plus a mileage fee that is predetermined in their annual CMS report. On average this cost is $300-500, which is less than most ambulance companies want, but we’ll get into that later.
For the rest of us, the first thing to know about ambulances is that they aren’t cheap. The average cost of an ambulance ride if you have Health Insurance is $432 out of pocket, and without Health Insurance, you’ll be looking at an average bill between $400-$1200. That cost can skyrocket depending on your situation (more on that later). All major Health Insurance companies cover ambulance rides if they’re deemed necessary, but it usually includes a $20-$150 copayment, not to mention your annual deductible if you haven’t met that yet.
Classification of Ambulances
Ambulances can be publicly-owned, private-owned, or charity-run. Depending on where you live and what your situation is, it can make a difference which ambulance picks you up. However, it is typically chosen at the whim of the 9-11 dispatcher. In any case, we’ll go through each type of ambulance and then give you tips on what you can do to get the best and most affordable ambulance ride.
According to the National Association of Emergency Medical Technicians (NAEMT), 63.5% of ambulatory services nationwide are provided by public entities, the majority being local Fire Departments. There are certain cities, like Hammond and East Chicago, Indiana, where ambulatory services are paid for by the city through taxpayer dollars. For the rest of us, public ambulances cost generally the same as private ones, the only difference is who owns and operates them.
When you dial 9-11, most of the time a public ambulance from a nearby municipality will transport you to the hospital. On the other hand, private ambulances tend to be used for inter-facility, non-emergency transport. The main difference with a private ambulance is that you need to be extra careful that it’s covered by your insurance. That non-insured ambulance ride bill will hit you when you least expect it. Be familiar with what your insurance company defines as “medically necessary,” as not all interfacility transports may meet the criteria.
In the past, ambulance rides were typically completely free, with public fire departments and charity organizations paying the bill. That was before healthcare costs in the U.S. exploded in the 80s and 90s, and regulations made it more expensive for regular civilians to handle ambulatory care. There are still remnant charity ambulatory services, but they are rarely free. The rising cost of healthcare made funding ambulances by local organizations nearly impossible. However, the exorbitant cost has lead charitable businesses and individuals to fund air ambulances for those without health insurance. If deemed medically necessary, air ambulances are usually covered by Health Insurance.
When things get Tricky
A not-so-uncommon problem with ambulatory services is being sent to an out-of-network hospital, or the ambulance itself is out-of-network. Many times the ambulance company, whether public or private, will send patients to the nearest hospital regardless of patient-preference. 21 states (as of this posting) have passed some sort of legislation protecting patients from emergency services transporting them to out-of-network, or charging extra out-of-network fees. There are no federal protections. These laws, however, are rarely enforced. An extra ambulance ride to another hospital will often result in a higher price for you, regardless of whether you have health insurance or not.
Unfortunately, there’s no quick or easy solution to solving these two problems. If an ambulance will not drive you to your hospital of choice, you can always refuse medical treatment (as long as your life is not in danger) and call another township or municipality for another ambulance. Similarly, if the ambulance company picking you up is out-of-network (more likely with private ambulances), you can do the same thing.
Why do ambulances cost so much anyway?
Why does riding in an ambulance cost hundreds, sometimes thousands of dollars? The answer is more complicated than you think.
If a person calls for an ambulance and is in life-threatening need of medical transportation to a hospital, the ambulance company is legally obligated to take the person once they’ve arrived. Furthermore, lawsuits can be and have been raised against ambulance companies that leave injured people at the scene of an incident. The patient will be billed days after the transportation date. In these types of scenarios, it’s not uncommon for people to put off or not pay their ambulance bills on time or at all. In fact, it’s so common that ambulatory services will often offer large discounts to customers who pay their bills within 30 days of the incident.
This common behavior would suggest that ambulance companies should only take patients who are definitely in need of immediate medical care, however ambulance companies will always push to transport patients. That’s because it’s the only possible way they can make money. If a paramedic comes out of the ambulance and performs the Heimlich maneuver on a choking person, and that person no longer needs an ambulance, the ambulance company will make no money. It’s quite the Catch-22 for the ambulance company.
The ambulance companies are also usually operating at a loss with Medicare and Medicaid patients. The fixed amount that the government pays for an ambulance, currently around $400, is usually below what it costs the ambulances to operate. Compound those losses with the losses mentioned above, and the ambulance needs to overcharge “regular” customers to make up for the losses.
Regardless of bad business, operating an ambulance is still not cheap. EMS/EMTs make an average of $32,500 salary, which comes out to around $16 an hour, and paramedics make $41,000 a year, or around $20 an hour. Add the cost of the driver, the vehicle, maintenance on the vehicle, medical supplies & equipment, and gasoline, and it’s a surprise that ambulances are not more expensive.
The Unit Hour Utilization (UHU) is defined as the number of hours on average that the ambulance is in service divided by the number of hours that the ambulance is not in service. A UHU of 0.3 is average. The ambulance staff needs to be ready for a call at any time, which means they need to be paid at all times, which drives up the cost of the ambulance.
Quick Tips to Pay the Least for an Ambulance:
Don’t Ride in an Ambulance
If you need to get to a hospital quickly and are not in need of the medical services of an ambulance, try calling an Uber instead. You’ll save a fortune. In fact, in cities with Uber, the usage of ambulances is on average 7% lower than in cities without Uber. If you’re unsure as to whether you need an ambulance or not, you should probably get the ambulance just to be safe.
Know your Health Insurance Plan
Make sure you know your Healthcare Plan inside and out. If you don’t, you can always call your insurance company in the case of an accident to check if an ambulance or hospital is in-network, and if your illness is deemed medically worthy for the insurance company to pay for it.
Triple Check the Bill
Medical bills are well-known for being erroneous. Stephen Parente, professor of Health Finance at the University of Minnesota estimates that 30-40% of medical bills contain errors. There are professional companies that will audit your medical bills for errors, these include Copatient, and Medliminal.
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