Pennsylvania mom's $4,500 ambulance bill exposes loophole in surprise billing law

A Montgomery County, Pennsylvania, mother says she was stunned to receive a $4,576 ambulance bill after her young son was transferred between hospitals during a medical emergency.

Maria Pfeiffer says the bill reveals a gap in the federal No Surprises Act, which protects patients from many unexpected medical bills but does not apply to ground ambulance transports.

A surprise bill after an emergency transfer

Last fall, Pfeiffer's son developed breathing complications from croup and was taken to Jefferson Abington Hospital.

But later, Pfeiffer said doctors determined he needed a higher level of care and arranged for him to be transported by ambulance to Children's Hospital of Philadelphia's King of Prussia campus.

Months after her son recovered, Pfeiffer opened a bill she never expected.

"It was $4,500," she said.

Pfeiffer said she assumed the ambulance transport would be covered by insurance, or that she would have been told if the provider was out of network.

"I just thought it was something that would get covered by insurance," she said. "Or if this was a situation where it was going to be an out-of-network provider, we would have at least been informed about that and been able to give consent."

A loophole in the No Surprises Act

Pfeiffer said she spent weeks communicating with CHOP, the ambulance provider, VMSC Emergency Medical Services, and her insurer, Aetna, trying to resolve the bill.

During that process, she learned that the federal No Surprises Act, passed in 2020 to shield consumers from many unexpected medical bills, does not cover ground ambulance services.

"To me, I would imagine that ground ambulances are the majority of emergency transports," Pfeiffer said.

According to the U.S. Public Interest Research Group, roughly three million privately insured Americans use ground ambulances each year, and many receive surprise bills after those rides.

The Commonwealth Fund has similarly reported that millions of privately insured Americans rely on ground ambulances each year and that more than one in four trips may result in a surprise bill.

Insurer and ambulance provider disagree on the cause

The insurer and ambulance company offered different explanations for why patients can end up with these bills.

VMSC said insurers often reimburse ambulance services at rates below the actual cost of care, leaving patients caught in the middle. VMSC has argued Pennsylvania lacks some of the protections and reimbursement systems that other states have adopted to address the issue.

A spokesperson for CVS Health, which owns Aetna, said the patient's responsibility was lower than what VMSC originally billed and criticized the provider's handling of the claim.

"What happened to the Pfeiffer family is outrageous and deeply troubling," CVS Health Executive Director of External Affairs Phil Blando said in a statement. "When providers agree to reimbursement terms, we expect them to honor the contract and not frighten patients with large bills they don't owe in the first place."

Blando also said "a clear gap remains with ground ambulance services" under the No Surprises Act and that the law "needs to be changed."

CHOP says bill was waived

CHOP did not respond to CBS News Philadelphia's specific questions about the case.

However, in a letter provided by Pfeiffer, the hospital said it coordinated with VMSC to waive the bill. The hospital also said it revised language in its consent forms for future patient transfers to provide greater clarity for families. 

When Pfeiffer learned the bill had been resolved, she said she became emotional.

"I cried immediately," she said.

She hopes sharing her experience helps other families avoid a similar situation.

"I don't want other people to fall into this situation," Pfeiffer said.

Pennsylvania has not adopted additional protections

Nearly two dozen states have adopted their own laws aimed at protecting consumers from surprise ambulance bills. Pennsylvania is not among them.

Even where state protections exist, experts note that many workers get health coverage through self-funded employer plans that are generally exempt from state insurance regulations, meaning some consumers can still fall through the cracks.

What to do if you receive a surprise ambulance bill

Consumer advocates and healthcare experts recommend:

• Ask for an itemized bill
• Confirm the claim was submitted to your insurance company
• Carefully review your explanation of benefits
• File an appeal if you believe the claim was processed incorrectly
• Contact the provider to discuss payment options or negotiate the bill
• Keep records of all communications with insurers and medical providers

Experts say patients should never assume the first bill they receive is the final amount they owe.

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