The federal No Surprises Act, which limits the circumstances where patients can receive a bill for a larger amount than their insurance covers, doesn’t apply to ground ambulances.
Most ambulance providers haven’t reached agreements with insurance companies on in-network rates, and since they have the option to bill patients for whatever their insurance didn’t cover, it doesn’t create a strong incentive to get into their networks, said Adam Fox, deputy director of the Colorado Consumer Health Initiative.
American Medical Response said that its records showed Blue Cross and Blue Shield of Illinois sent a check to the Sassano family instead of paying the ambulance service directly, which is confusing for patients. Colorado could reduce the odds of that happening by requiring insurance companies to pay ambulance providers correctly, it said in a statement.
Sassano said, as far as she can tell, whether a bill is covered may come down to whether someone at the emergency room checked the right box. While not every time her daughter was transported may have been an emergency by their insurance’s definition, she also wasn’t given the option to just call a cab, she said.
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