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$100 cap on ambulance rides – new recommendation would end surprise billing for patients

$100 cap on ambulance rides – new recommendation would end surprise billing for patients
$100 cap on ambulance rides – new recommendation would end surprise billing for patients 04:36

NORTH TEXAS - One-hundred dollars may soon be the most patients would ever have to pay for an emergency ambulance ride.

A committee of government advisors endorsed the idea for Congress to solve the problem of surprise ambulance bills.  Congress now must decide whether to put the committee's recommendation into law.

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"This is a tremendous win for the consumers," said PIRG Senior Director of Health Care Patricia Kelmar, who was on the committee along with insurance companies and ambulance providers. "The recommendations came down strongly for patients to make a decision whether they need emergency care based solely on their medical condition and not on the fear that they are going to get a big balance bill."

Every year, more than 3 million Americans are rushed to a hospital by an ambulance. For many, this unexpected ride can cost hundreds, if not thousands of dollars, out of pocket.

According to a U.S. PIRG Education Fund study, more than 50% of insured patients are at risk of receiving an out-of-network bill for an ambulance ride. In Texas, the risk is 70%.

Out-of-network ground ambulance rides cost insured Americans $129 million, according to a 2020 study published on Health Affairs. 

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The proposal by the federal committee would do away with out-of-network ambulance bills – a gap left in the 2020 No Surprises Act that was supposed to do away with all surprise medical bills.

The CBS News Texas I-Team has been shining a light on the problem of surprise ambulance bills for more than two years.

"It's frustrating," said Rachel Metzger, whose 5-year-old daughter was rushed to the hospital by an ambulance after a fall. "You expect when you have insurance, when you pay for insurance, that they will be there for you when you need it." 

The five-mile ambulance ride from the Metzger home in Austin to the hospital cost the family $1,082 out-of-pocket. Austin-Travis County EMS, the only emergency ambulance provider in the area, does not contract with any private insurance companies – meaning all its ambulance rides for patients with private insurance are billed out-of-network.

"It feels bad to feel like you are getting ripped off by these people that are supposed to be proving you lifesaving services," Metzger said.

CBS News Texas

For the past six months, the federal committee has been meeting to come up with a payment system that would take patients out of the middle of billing disputes between insurance companies and ambulance providers.

The committee is recommending patients be charged the lesser of a $100 or 10% of what insurance companies must pay for an ambulance ride. The insurance company would be responsible for the rest.

Under the recommendations, ambulance providers and insurers would enter a rate-setting arrangement that would provide more predicable rates for both parties.

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