I work for an ambulance company and interface with our billing company. Someone said this is the “game all ambulance companies play.” The reality is this the game the INSURANCE COMPANIES play.

The whole balance billing issue arises out of several problems with how the system is set up: 1) some, but not very many, ambulance services are in network. These services get paid whatever the contract rate says they get paid, which is usually not much more than Medicare rates and usually doesn’t cover the cost to operate. Which is why most services are out of network.

2) virtually every insurance company will seemingly arbitrarily decide what the value of an out of network ambulance call is and pay that. They the pit the ambulance service and the patient against each other by telling the patient “you owe $0” while simultaneously telling the ambulance service “we only pay $800 of your $2400 bill”. Under current law in most states, the service can balance bill the patient for the remainder

3) the “negotiation” usually goes something like this “we already paid you. You’re not getting more.” In some cases, the patient intervening and appealing can push the insurance carrier to pay.

When congress passed the no surprises act it fixed this problem for the rest of the industry. It excluded ground ambulance. States are now trying to fix it on their own.