By U.S. lawmakers have been working on protecting consumers and patients from surprise medical bills for years. Earlier this year, both parties were close to passing legislation that would mandate protections for patients, but the effort was stalled after private-equity firms started flooding the country with ads opposing the policy. As the bill got held up in deliberation, the coronavirus pandemic hit, further stalling the process.
With no law in the books, patients have become more vulnerable to surprise medical bills than ever. Congress set aside $175 billion for hospitals, doctors, and providers working on the front lines of the pandemic, but to receive this money, they had to agree not to send surprise medical bills to their patients. However, the protections are littered with gaps that can put patients at risk.
Short Rides and Steep Bills
Around 450,000 Americans have been hospitalized with coronavirus thus far, with more being admitted every day. Having a robust health insurance plan may not be enough to shield patients from surprise medical bills, which usually stem from ambulance rides, out-of-network providers, and medical laboratories. In many cases, the patient didn’t choose the provider(s) or the care they received. It was after they left the hospital when they realized how much they were being charged.
That’s what happened to a 60-year-old woman from Pennsylvania who wishes to remain anonymous for personal reasons. She was being treated at a hospital in Philadelphia for COVID-19 when the medical team decided to take her off her ventilator, so they could move her by helicopter to another local hospital with better care equipment nearly 20 miles away. After spending six weeks in the hospital, she later recovered from her illness, but she continues to suffer from symptoms to this day.
Now house-bound, she’s gotten hit with a bill for $52,112 from the air ambulance company. “How am I going to pay this all off?” she worries.
She was unconscious when providers decided to move her to another hospital, so she didn’t have any control over the process. Both hospitals are also in-network. It was the air ambulance company that wasn’t covered by her insurance. Blue Cross initially offered to cover $7,539, but the company later reneged its offer.
She isn’t alone.
Studies show around 71% of ambulance rides result in surprise medical bills. Around 20% of emergency room patients are also at risk of getting hit with these charges.
Dealing with all this financial stress can be overwhelming when these patients are still recovering from the illness that put them in the hospital in the first place. Around a third of hospitalized coronavirus patients say they’ve experienced an altered state of mind after contracting the disease. This often includes fatigue, confusion, and mental fog.
For the woman from Pennsylvania, she’s still having trouble completing basic tasks like cooking, bathing, and eating.
Filling the Gaps
While Congress tried to get providers and health networks on board with these protections, many companies have the freedom to charge however they please. Emergency relief funds distributed by Congress didn’t go to ambulance firms and medical laboratories when they were released to providers and hospitals.
Many states are hesitant to regulate ambulance fees, considering service providers are often run by state or local governments. States and districts depend on ambulance rides as a source of revenue, but this usually puts older and less healthy residents at a disadvantage.
Some health plans offered by insurance companies do not cover follow-up care or ambulance rides, and the government doesn’t have the authority to restrict or regulate air ambulance fees. To do so, lawmakers would have to amend the Airline Deregulation Act.
Several air ambulance firms have been hit with multiple lawsuits from patients, giving them a chance to fight these charges in court. One firm, Air Methods, is currently facing six separate class-action lawsuits in federal court where patients describe expensive charges and aggressive debt collection tactics.
In one case, the company tried to garnish over $53,000 from a patient’s bank account. Air Methods says these bills are several years old and the company has since updated its billing practices. However, records show Air Methods has already transported 3,300 coronavirus patients over the course of the pandemic. The company says it had a “special process” for handling their billing.
It’s often up to facility administrators to contract with third-parties that use more sound billing tactics.
Unable to pay the exorbitant bill, the Pennsylvania woman ended up calling her state’s insurance commissioner, Jessica Altman. While Altman doesn’t have the authority to force the air ambulance firm to cancel the bill, she was able to talk to someone from the woman’s insurance company, Independence Blue Cross. She got the company to reprocess the claim, and now the woman doesn’t have to pay $52,000 for an ambulance ride that she never asked for in the first place.
Do your best to help your patients make sense of these fees. Getting treated for the coronavirus can result in a range of medical expenses, but we can try to work together to limit the number of surprise medical bills.
