The No Surprises Act, which went into effect last year, protects Americans from most surprise medical bills. But there's one important point the legislation misses: ambulance rides.
A recent report found that more than half of insured patients' ambulance trips result in a surprise bill. According to the US Public Interest Research Group (PIRG), these trips cost patients about $130 million annually.
David Feng and Christy Shum are currently struggling with their bill, which totals more than $7,000. The bill relates to an ambulance ride taken from home by their one-year-old son Theo, a week after his premature birth as a newborn.
“He was breathing, but very heavily,” Feng said. “So he wasn't getting the oxygen he needed.”
Doctors told the couple that the baby would have to be taken by ambulance to a children's hospital with a special team and life support. At no point during this process did they consider the cost of the trip.
But a few weeks later, with Theo still in the hospital with two holes in his heart, the couple received an ambulance bill. It totaled over $7,000.
Christy's insurance company UnitedHealthcare paid nearly $1,000 of that, but owed them the rest — more than $6,000 because UnitedHealthcare said the service was an “off-network provider or facility.”
“It's totally shocking when you see the draft law, and to me it's really unfair,” Feng said.
Many surprise medical bills like the ones they received were eliminated by the No Surprises Act, a law passed by Congress in 2020 that protects consumers from most surprise bills for emergency services, including life-saving helicopter flights.
What wasn't eliminated, however, were surprise bills from regular ambulances on the ground.
PIRG's Patricia Kelmar said Congress “dodged the issue” and “decided to acknowledge the issue by establishing a federal committee to look more deeply into the issue.” Kelmar is on that committee.
“There are fixed costs associated with outpatient treatment,” she said. “We should set a price that is linked to costs and helps ensure that our insurance companies pay those costs at a real price and protects people from these really big off-network bills.”
However, there is no set timeline for developing a new system, leaving some families struggling.
Shum appealed the $6,000 ambulance bill, but received a letter from UnitedHealthcare stating, “Payment for this service is being declined.” The insurance company also withdrew the $1,000 that they paid – on the grounds that Feng's insurance company, Blue Cross Blue Shield of California, should have paid all the costs for the baby's first month.
More than a year later, the ambulance bill — totaling over $7,000 — remains unpaid, despite spending hours on the phone with both companies trying to get answers.
“It's frustrating,” Shum said. “The fact that it's taking so much time and it's still not resolved and we still don't know anything.”
The company that provided the ambulance told CBS News that the bill had been submitted multiple times but was “stuck” in the system. It goes on to say that operating 24/7 specialized critical care transport is expensive and relies on insurance companies to reimburse costs in a timely manner and at a fair price.
California's Blue Cross Blue Shield told CBS News that federal privacy laws prevent it from answering questions about issues with the couple's bill.
The family say Blue Cross Blue Shield called and promised to work on a solution to the problem, but the family say there has not been a solution yet.
UnitedHealthcare, Shum's insurer, said the primary insurance for Theo is with his father's insurance company and not UnitedHealthcare, but they have now “contacted both the ambulance company and (Blue Cross Blue Shield of California) to help resolve this bill.” .”
Still, Feng and Shum say the stress of the bills couldn't spoil a magical moment – the day Theo finally came home from the hospital after two and a half months. He is healthy now.
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