this post was submitted on 31 Dec 2023
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The COVID-19 pandemic took a brutal toll on Danielle Miele’s family, but after two exorbitant ambulance bills she’s afraid to call 911.

Her teenage son attempted suicide in 2022, Miele said. His mental health deteriorated during the pandemic, and he needed an ambulance transfer from the Roseville emergency room where Miele took him to a treatment center in San Mateo. The ambulance company hit Miele with a $9,000 out-of-network charge, which was sent to collections “almost immediately,” she said.

The virus also left Miele with seizures that mimic the symptoms of a heart attack, she said. Miele called 911 the first time a seizure happened. The 15-minute ride to the hospital cost $4,000 without help from insurance.

A new California law taking effect Jan. 1 targets the kind of “surprise” ambulance bills that put Miele’s family in debt even though they had medical insurance. These bills take the form of out-of-network charges for commercially insured patients who have no control over which ambulance company responds to a call for help.

Under the new law, patients will only have to pay the equivalent of what they would have paid for an in-network service. Health insurance and ambulance companies will have to settle the bill directly even if they don’t have an existing contract.

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[–] [email protected] 29 points 10 months ago (2 children)

TIL ambulance companies are a thing.

[–] [email protected] 17 points 10 months ago (1 children)

Yeah, they provide a ton of transport services that are not emergency-related. If a person is completely bedbound, then any and all trips to the doctor need to be handled by an ambulance service that can provide a transport stretcher (a heavy duty collapsible stretcher with straps on it like a seatbelt) and personnel to transfer the person between their bed and the stretcher.

And we call the ambulance service when we discharge any patient from our hospital to a short term rehab facility, even if the person can move themselves from the bed to the stretcher. Just because it's transfer between medical facilities.

And if we transfer someone to another hospital with a higher level of care, we have to specifically request an emergency ambulance instead of a transport ambulance.

So those services are a lot more complicated than people realize. But in any of these situations, the patient shouldn't get an exorbitant bill because of some insurance company shenanigans, which is all in- vs. out-network stuff is.

[–] [email protected] 7 points 10 months ago

It’s bizarre because they solved this with ERs/hospitals forever ago - there used to be in network and out of network ERs/hospitals. Even worse, even if the hospital was in-network, some of the Drs working in the hospital would be out of network - so your surgeon would be in network but the anesthesiologist wouldn’t be somehow.

I don’t know why it’s taken them so long to solve ambulances too.

When you don’t have a choice in providers, it seems bizarre they can pull the in/out of network shit.

[–] [email protected] 7 points 10 months ago* (last edited 10 months ago)

Tbh I am on a free healthcare country and I also learned this was a thing, I naive of me thought this was like part of the hospital or something like that but nah or at least not all of them, they are subcontracted companies that handle the vehicles and drivers and medical stuff on those ambulances.

[–] [email protected] 28 points 10 months ago (6 children)

Do Americans also get billed for calling the police or the fire department?

[–] [email protected] 29 points 10 months ago (1 children)

Not anymore, at least with fire. Fire departments used to essentially sell insurance and would let your house burn if you hadn't paid.

[–] [email protected] 12 points 10 months ago (1 children)
[–] [email protected] 5 points 10 months ago (1 children)
[–] [email protected] 4 points 10 months ago* (last edited 10 months ago) (1 children)

This was the libertarian utopia they wanted I would bet.

Right up until it affects them.

[–] [email protected] 4 points 10 months ago (1 children)

This one has been bouncing around in my mind since I read about it a few hours back.

Imagine picking up the phone to a fire call and saying "nah, sorry, your house has to burn" and thinking that's OK over seventy five fucking dollars.

I'm really having trouble wrapping my head around it.

[–] [email protected] 2 points 10 months ago* (last edited 10 months ago)

It’s kinda the way taxes and insurance works. It wasn’t $75 - if you divide the annual costs of a fire station by the fires put out it’s probably $100-500k/fire. Or $75 from everyone whether they have a fire or not.

Which is also why the fire department kinda has to let it burn - because no one would actually be ok getting a $100k bill to put out their fire.

Can you imagine not paying the $75 for fire coverage? Surely the county could have just added it as a tax…… and actually provided fire coverage.

But this guy wouldn’t have voted for it almost certainly….

[–] [email protected] 17 points 10 months ago (1 children)

Not yet but I'm sure they fix that

[–] [email protected] 4 points 10 months ago

AFAIK in South Africa you can call the police, but they're pretty much useless. If you actually need help you call one of the private companies doing police business, but naturally it's going to cost you.

[–] [email protected] 3 points 10 months ago

There might be extra fees if your house alarm has multiple false alarms and the police show up each time.

[–] eclectic_electron 2 points 10 months ago

I think businesses get bills from the fire department, but not individuals.

[–] [email protected] 2 points 10 months ago

We just get shot by the police when we call them.

[–] [email protected] 1 points 10 months ago

I wanna say no, but I think there are some situations where, say a bar or tavern regularly has to bring the police in for fights, etc. in certain areas the owner might start getting billed for not handling security properly. That's probably not a direct PD bill, but some sort of permit violation.

But in general, no.

[–] [email protected] 18 points 10 months ago (1 children)

They keep patching around the problem without actually doing what they should to tackle it once and for all

[–] [email protected] 3 points 10 months ago* (last edited 10 months ago)

Came here to say pretty much this.. Tip of the iceberg, will surely help some people, but absolutely and categorically not an actual solution to the problem. Which will never happen until people are willing to confront the actual reality - the system isn't broken, it is working exactly as intended, it just doesn't work for you, and the only way to be rid of it is to tear the whole thing down.

[–] [email protected] 14 points 10 months ago

We teach children about Rumpelstiltskin and why that is evil, but don't outlaw the commercial practice fully.

[–] [email protected] 13 points 10 months ago

An obvious step forward, but sooooo much more to do.

[–] [email protected] 6 points 10 months ago

One of many problems that can be solved just by copying one of the happy G7 peer nations, because none of them are that cruel.

[–] [email protected] 3 points 10 months ago

Ambulance calls should give a fixed fee or handled by local taxes or cost plus. I’m all for free enterprise but emergency services shouldn’t be large expenses.