Congress Banned Surprise Medical Bills, But Not for Ambulances

After years of debate, Congress has banned surprise medical bills as part of its $900 billion stimulus package passed on Dec. 21 that provides aid to those suffering the adverse economic effects of the coronavirus pandemic.

However, while patients are now offered protection from unexpectedly incurring high costs due to out-of-network medical treatment, ground ambulances are not included in the surprise billing ban. Rather, the measure focuses on protecting patients who believe they’re covered by their insurance but end up receiving bills from out-of-network doctors and specialists who were involved with their treatment.

What Does the Surprise Medical Bill Legislation Do?

The congressional measure, which takes effect in 2022, helps ensure patients won’t be held responsible in both emergency and non-emergency situations if they receive surprise medical bills. Patients will still have to pay for their in-network deductibles or cost-sharing amounts, but they cannot be held accountable if they are unable to choose to be treated by a provider within their insurance network.

The new law specifically bans out-of-network providers from balance billing patients unless they have received prior notice and an estimate of the costs they will incur 72 hours before medical treatment is rendered. Additionally, the law creates a framework for arbitration that allows insurers and doctors the means to resolve any payment disputes without the involvement of the patient.

What Are Surprise Medical Bills?

A surprise medical bill is one that a patient receives when they’ve gone to a facility within their insurance network, only to unknowingly and unexpectedly be treated by providers who are out of their insurance network. This practice often results in unexpected — and significantly high — bills which can create considerable financial burdens for patients.

Scenarios giving rise to surprise medical bills typically occur when a patient goes to the emergency room and is treated by a number of specialists, such as anesthesiologists or cardiologists, who have contracted with the hospital, but are not part of the same insurance network. A patient might also receive a surprise medical bill associated with out-of-network laboratories or scheduled surgical procedures.

Many insurance companies won’t cover their policyholders for bills they’ve incurred by treating with out-of-network doctors — even if the patient had no knowledge concerning whether the provider was in or out of network. This means that patients end up being billed directly by these providers, sometimes incurring thousands of dollars in medical bills.

Studies show that one out of every five trips to the emergency room results in a patient receiving a surprise medical bill. Significantly, according to The Balance, almost two-thirds of bankruptcies are related to medical debt.

Ambulances and Surprise Medical Billing

Since a trip to the emergency room often requires transportation by ambulance, patients may still incur surprise bills in certain cases. While surprise medical bills associated with air ambulance travel are banned by the legislation —which are reported to exceed $20,000 on average — ground ambulance travel is not. This means that patients may still incur a surprise medical bill if they call an ambulance.

In fact, an estimated 71% of ambulance rides result in a surprise bill. Ambulances also have some of the highest out-of-network billing rates out of all the medical specialties. According to a study referenced by Health Affairs, the average amount of a surprise medical bill for ground ambulance transportation is $450.

Additionally, patients often have no control over what ambulance arrives if they require emergency transportation, making it impossible to determine whether it’s in-network or otherwise covered. Ambulances can also be both privately and publicly owned — regardless of which entity owns an ambulance, patients can still incur a surprise bill.

Among the states that have passed surprise medical bill laws, many of them have also excluded ambulances.