Kaiser Health News
New California Law Offers Fresh Protection From Steep Ambulance Bills
Bernard J. Wolfson
Tue, 07 Nov 2023 10:00:00 +0000
Last year, Jennifer Reisz’s college-age daughter, Megan, was kicked in the chest multiple times by the family’s horse. Megan fell to the ground, unable to move or speak. Though she was alone, her Apple Watch detected her distress and called 911.
She was taken to a hospital in Clovis, a city in Fresno County, near where the Reisz family lives. But the severity of Megan’s injuries โ four broken ribs and a partially collapsed lung โ prompted doctors to transport her 12 miles by ambulance to the Level I trauma center at Community Regional Medical Center in Fresno.
While Megan was still recovering at home from her injuries, she received a $2,400 bill from the ambulance company โ after the family’s health plan had paid nearly $2,200.
“When we received the bill, I thought our insurance company was processing the claim incorrectly,” says Jennifer Reisz. An attorney, Reisz says she then spent hours on the phone with the health plan, the ambulance company, and a few consumer advocates. She learned that the ambulance company was not in the health plan’s network and was permitted to bill patients for any uncovered portion of its charges โ a practice known as balance billing.
Starting Jan. 1, ground ambulance operators will be barred from doing that because of a new law signed by Democratic Gov. Gavin Newsom. California is the 14th state to provide some protection against balance billing for ground ambulance rides.
At the federal level, an advisory committee established under the No Surprises Act is working on a plan to address the problem nationally.
Both the federal law, which took effect in 2022, and a California law that predates it largely banned balance billing for hospital care and air ambulance services, but not ground ambulance services.
And that is hardly fair, since patients have zero control in a medical emergency over which ambulance company responds, whether it is in network, or how much it will charge.
In California, nearly three-quarters of emergency ground ambulance rides result in out-of-network bills. The average surprise bill for a ground ambulance ride in California is $1,209, the highest in the nation, according to a December study.
The new law, which applies to about 14 million Californians enrolled in state-regulated commercial health plans, limits how much a non-network ambulance operator can charge patients to the amount they would pay for an in-network ambulance.
The law also caps bills for uninsured people, stipulating they can’t be charged more than the Medi-Cal or Medicare rate, whichever is greater. (Medi-Cal is California’s Medicaid program, providing coverage to people with low incomes or disabilities.) And it prohibits ambulance operators and debt collectors from reporting patients to a credit rating agency or taking legal action against them for at least 12 months after the initial bill.
Under current law, people in distress sometimes decline to call an ambulance for fear of a huge bill, putting themselves or a loved one at risk, says Katie Van Deynze, policy and legislative advocate for Health Access California, which sponsored the legislation. With the new law, she says, “they will have peace of mind.”
Existing laws already protect Medicare and Medi-Cal beneficiaries from surprise ground ambulance bills. The new law does not cover the nearly 6 million Californians enrolled in the subset of employer-sponsored health plans that are federally regulated.
The advisory committee working on a federal fix agreed last week on nonbinding proposals that would, among other things, prohibit balance billing for the vast majority of ambulance rides and cap patients’ financial liability at $100. The committee plans to formally report its recommendations to Congress early next year for potential legislation.
Under California’s new law, patients can expect to save an average of nearly $1,100 per emergency ambulance ride and over $800 per nonemergency ride in the first year, according to a legislative analysis conducted this year.
Health plans will be required to pay ambulance operators the rates set by county authorities, which the study said would increase the average amount insurers pay per ride by around $2,000.
Since ambulance rides account for a tiny percentage of overall health plan spending, those increases should not raise premiums by much.
But local authorities might be tempted to hike ambulance rates over time to increase revenue for publicly run ambulance operators, such as fire departments, says Loren Adler, associate director of the Brookings Schaeffer Initiative on Health Policy. That could prompt health plans to raise ambulance copays, offsetting some of the consumer savings from the new law, Adler says.
Jenn Engstrom, director of CalPIRG, an advocacy group that helped shepherd the law through the legislature, notes there will be built-in accountability, since the legislation requires public reporting of ambulance rates. “If we notice that things start to skyrocket, there will be a need for legislative action or local action,” Engstrom says.
Reisz says the ambulance company that transported her daughter wrote off the bill after she made it clear she had no intention of paying it โ and after her health plan ponied up a little more. But as she notes, not everyone is a lawyer adept at arguing their cause.
Even if you are no rhetorical wizard, you can take simple steps to protect yourself against errors or ambulance operators that disregard the new law.
Check your insurance policy to know your deductible and any copay or coinsurance should you ever need an ambulance. If you get an ambulance bill, don’t pay it right away. Check your insurer’s explanation of benefits to make sure what it says you owe matches what you think your cost-sharing amount should be. If the bill is higher, the ambulance company may be trying to pull a fast one. Call the ambulance company and tell them they need to knock the bill down. If they don’t, file a complaint with your health plan and include a copy of the bill.
If you disagree with your plan’s decision, or it takes more than 30 days for the plan to respond, take your complaint to the regulator.
The new law requires your insurer to tell you if your health plan is regulated by the state and thus subject to the statute. If it is, the regulator is likely to be the Department of Managed Health Care. You can contact that agency online (www.healthhelp.ca.gov) or by phone at 1-888-466-2219. If your health plan is regulated by the Department of Insurance, you can file a complaint online (www.insurance.ca.gov) or call 1-800-927-4357.
Another good resource is the Health Consumer Alliance, which offers free legal assistance in multiple languages. Call 1-888-804-3536.
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.ย
——————————
By: Bernard J. Wolfson
Title: New California Law Offers Fresh Protection From Steep Ambulance Bills
Sourced From: kffhealthnews.org/news/article/new-california-law-caps-ambulance-costs/
Published Date: Tue, 07 Nov 2023 10:00:00 +0000
Did you miss our previous article…
https://www.biloxinewsevents.com/epidemic-the-scars-of-smallpox/
Kaiser Health News
Election Outcome Could Bring Big Changes to Medicare
SUMMARY: During the campaign, both Donald Trump and Kamala Harris are positioning themselves as defenders of Medicare, each blaming the other for potential cuts to the program. The election could significantly impact Medicare’s future, especially with more beneficiaries opting for Medicare Advantage plans run by private insurers, a trend that could escalate under a Trump administration. Critics warn that increased privatization would limit care options and raise costs, while supporters argue these plans provide better benefits. Polls indicate that a candidate’s stance on Medicare heavily influences voter decisions, highlighting the program’s importance in the upcoming election.
The post Election Outcome Could Bring Big Changes to Medicare appeared first on kffhealthnews.org
Kaiser Health News
Whatโs at Stake: A Pivotal Election for Six Big Health Issues
SUMMARY: In the election campaign’s final days, Vice President Kamala Harris and former President Donald Trump clash over health care, including issues of abortion access and the Affordable Care Act (ACA). Harris aims to preserve ACA subsidies and protect health care rights, while Trump’s campaign lacks clarity on health plans, suggesting significant cuts. The future of Medicaid, drug prices, and transgender health care also hinges on the election outcome. Trump’s proposals could roll back protections for these groups, contrasting with Harris’ promises to uphold existing health care rights and enhance drug pricing negotiations, setting stark differences for voters.
The post What’s at Stake: A Pivotal Election for Six Big Health Issues appeared first on kffhealthnews.org
Kaiser Health News
Trump quiere que Harris pague un precio polรญtico por ofrecer salud a inmigrantes sin papeles
SUMMARY: Marรญa Sรกnchez, una inmigrante de 87 aรฑos de Mรฉxico, vive sin papeles en Illinois y carecรญa de seguro mรฉdico durante aรฑos, a pesar de haber trabajado y pagado impuestos. A los 65, no pudo inscribirse en Medicare y evitรณ atenciรณn hasta caer enferma. En 2020, Illinois lanzรณ un programa que cubre a mayores indocumentados, permitiendo a Marรญa acceder a atenciรณn mรฉdica que le salvรณ la vida. Esta iniciativa se enmarca en un movimiento mรกs amplio en estados demรณcratas para proporcionar seguro a inmigrantes. Sin embargo, enfrenta crรญticas republicanas y desafรญos econรณmicos, dado el creciente costo del programa en Illinois.
The post Trump quiere que Harris pague un precio polรญtico por ofrecer salud a inmigrantes sin papeles appeared first on kffhealthnews.org
-
Kaiser Health News7 days ago
Vance Wrongly Blames Rural Hospital Closures on Immigrants in the Country Illegally
-
News from the South - Georgia News Feed6 days ago
Co-defendant takes plea deal in YSL RICO trial | FOX 5 News
-
Mississippi News Video6 days ago
Free Clinic of Meridian Celebrates 10 Years
-
News from the South - Arkansas News Feed6 days ago
Buc-eeโs set to open second Arkansas location
-
News from the South - North Carolina News Feed6 days ago
FBI arrests NC man known as 'AK Guru' who is accused of selling hundreds of machine guns
-
Our Mississippi Home6 days ago
A New Deep Sea Remotely Operated Vehicle Coming to USM
-
News from the South - Alabama News Feed3 days ago
“There is a man here trying to use your ID” Suspect caught in Elberta using stolen ID at victims wor
-
Mississippi News Video6 days ago
Macon enacts Halloween curfew