In July 2023, Jagdish Whitten, a 25-year-old runner, had a harrowing encounter with a car that struck him while crossing a busy street in San Francisco. He described the moment as doing a “little flip” over the vehicle before landing on the pavement and managing to crawl to safety on the curb. Despite fearing the cost of an ambulance, he resolved to seek treatment, believing he was not in mortal danger.
Whitten sustained a mild concussion, a broken toe, and various bruises, all of which required medical attention at two hospitals. Initially, doctors stabilised him and determined it necessary to transfer him via ambulance to Zuckerberg San Francisco General Hospital, the city’s only trauma facility. After a brief ambulance ride, he was released with instructions for follow-up care but was unprepared for the staggering bill that would soon arrive.
The ambulance ride cost an astounding $12,872.99 for a mere six miles. This included an exorbitant base rate, mileage charges, EKG monitoring, and fees for infection control. The convoluted billing system for ambulance services often results in unexpected costs due to the lack of regulation and the fact that many operate outside insurance networks.
Whitten attempted to have his ambulance expenses covered through his father’s Anthem Blue Cross insurance plan, but the insurer denied the claim, citing that the service was out of network without prior authorisation. His father, Brian Whitten, was bewildered, arguing that a doctor had dictated the need for the ambulance. Although WHitten’s case raised questions about emergency care protocols, it also illuminated the difficulties faced by patients when navigating insurance claims.
Despite mounting pressure on insurance companies to improve coverage transparency, ambulances largely remain outside of standard competitive practices. An alarming 80% of ground ambulance rides result in out-of-network billing, leading to “surprise” bills, which unfairly burden patients financially. Eighteen states have taken steps to regulate surprise ambulance billing, and California soon followed suit, although these laws won’t apply universally, especially to those with employer-sponsored insurance.
Eventually, after appealing the denial, Anthem agreed to cover a portion of the cost, amounting to $9,966.60, yet Whitten was still liable for $2,906.39. Brian Whitten faced frustration while trying to negotiate with AMR, the ambulance provider, unable to bypass their automated phone system to discuss the bill. Constrained by circumstance, he reluctantly paid up, fearing damage to his son’s credit from potential collections.
In a surprising turn of events, AMR later fully refunded Brian’s payment due to their internal audit discovering the original billing did not meet critical care criteria. This rare refund highlighted the potential for error within the large-scale medical billing system, which reportedly sees discrepancies in less than 1% of its encounters.
While AMR advised patients contesting bills to contact them directly, the overarching sense of unpredictability looms large for those requiring emergency ambulatory services. The grave concern persists regarding patients potentially refusing essential medical transport due to fear of exorbitant charges, emphasising the pressing need for systemic reform in the ambulance service billing process. The Bill of the Month initiative, established by KFF Health News and The Washington Post’s Well+Being, has strived to illuminate such billing complexities, assisting patients in tackling their medical charges effectively.
In July 2023, runner Jagdish Whitten suffered injuries after being hit by a car. Despite the need for immediate medical treatment, he was shocked to receive a nearly $13,000 ambulance bill. His insurance denied the claim, leading to frustration and confusion. Eventually, after a lengthy appeal, partial payment was made, but he was still left with considerable costs. AMR later refunded part of the charge after discovering an error, highlighting issues in ambulance billing practices.
Jagdish Whitten’s experience reveals the complexities and unexpected challenges associated with ambulance billing, illuminating how patients can find themselves financially strained after emergencies. With the rise of surprise medical bills and lack of regulatory oversight, there’s an urgent need for reforms to safeguard patients from such unpredictable costs. His story underscores a larger issue within healthcare, urging for a more transparent system to prevent burdensome debts and ensure patients receive necessary care without fear of financial repercussions.
Original Source: www.washingtonpost.com
