Expensive bills for using an ambulance put these families in debt but a new California law bans the practice

The COVID-19 pandemic has taken its toll on Danielle Milley’s family, but after two exorbitant ambulance bills, she’s afraid to call 911.

Milley said his teenage son attempted suicide in 2022. His mental health deteriorated during the pandemic and he required an ambulance transfer from the Roseville emergency room, where Miele took him to a treatment center in San Mateo. The ambulance company charged Miele a $9,000 out-of-network charge, which was sent to collections “almost immediately,” he said.

He said the virus also gave Milley seizures that were similar to heart attack symptoms. Milley called 911 the first time she had a seizure. Without health insurance, a 15-minute trip to the hospital cost $4,000.

“The last time I had a stroke I basically said, ‘I’m going to die right here at home… I’m never going to get another ambulance,'” Milley said. “Maybe I’d rather die at home than incur more medical debt.”

A new California law taking effect Jan. 1 targets the type of “surprise” ambulance bills that leave Milley’s family in debt despite having health insurance. These bills take the form of out-of-network charges for commercially insured patients who have no control over which ambulance company responds to a call for help.

Under the new law, patients will only have to pay what they would have paid for in-network service. Medical and ambulance insurance companies must pay the bill directly, even if they do not have a contract.

Supporters of the new law argue that it will make a big difference for thousands of families like Miley’s. The second time Milley’s son needed an emergency psychiatric admission, the ambulance company that came was part of the family’s insurance network. Your copayment: $83.

Ambulance companies did not oppose the legislation, which includes assurances that health insurance plans will reimburse them for services.

Californians get millions in surprise bills

The California Health Plans Association, which represents insurers, had opposed the bill before it became law because it had the potential to increase statewide premiums by $67.3 million. By contrast, people with commercial health insurance could save about $44.5 million out of pocket for ambulance rides, according to a legislative analysis.

Katie Van Dienz, legislative counsel for Health Access California, said the law addresses a long-standing shortcoming in California’s consumer protections against surprise medical billing for people with commercial insurance. Health Access California, a consumer advocacy group, sponsored the new legislation.

“That’s the last gap left, but it’s really big,” Van Dienz said. “You may have insurance but it doesn’t matter.”

Nearly 14 million Californians with state-regulated commercial health plans will benefit from the law’s protections. According to an analysis by the Kaiser Family Foundation, 73% of all ground ambulance transports in California resulted in out-of-network charges in 2018 among people with large employer-provided insurance. California also has the highest average surprise ambulance bill in the country: $1,209, according to a study published last year by the U.S. Public Interest Research Group.

In a statement at the time of the bill’s passage, Assemblywoman Tasha Boerner, the Carlsbad Democrat who authored the measure, said people have no control over which ambulance company picks them up in times of crisis.

“The last thing anyone should be thinking about when calling 911 is whether they can afford an ambulance ride,” Boerner said in his statement.

The law protects uninsured people from getting expensive ambulance bills by limiting their out-of-pocket costs to the Medi-Cal or Medicare rate, whichever is higher. Medi-Cal is the state’s health insurance program for very low-income residents and protects its members from these types of bills.

Nearly 6 million Californians enrolled in federally regulated health plans would not be protected by the law, but a national committee is working on a solution to the U.S. No Surprise Act, which would protect Americans from a variety of surprise bills, including for air ambulance transportation. is, but does not include ground ambulance trips. These are usually Californians who work for large private multinational or multistate companies with self-funded health plans. Californians can ask their employers what type of health plan they offer.

$4,400 bill for newborn’s ambulance trip

Lanny Areballo and his family are grateful that future emergencies in California will be covered. His health insurance company does not contract with any ambulance companies in San Luis Obispo County, where he lives, so he has no choice but to pay out of pocket.

In September, minutes after Areballo gave birth to her son Brady, doctors decided to transfer her to a larger hospital about 20 miles away. Brady was unable to breathe properly and had to be admitted to the neonatal intensive care unit. The ambulance came and took him away.

Over the next month, letters started arriving from the ambulance company: Areballo owed $4,400 for the transfer, he said.

“Here I am, you know, less than two months after giving birth and they told me they were sending me to collections,” Areballo said.

Insurance covered almost the entire cost of Brady’s five-day hospital stay, which totaled $109,000, Areballo said, but would not pay for the out-of-network ambulance ride. Insurance eventually paid about a third of the bill after Areballo filed a complaint, but the remaining unexpected expense still affected the family’s financial situation. She ended her maternity leave early to return to work as a special education teacher and help pay the bills. It has a paid plan of $200 per month.

“It was definitely a surprise bill and I’m still paying it,” Areballo said.

This note was prepared in collaboration with the California Health Care Foundation (CHCF), which works to ensure People get access to the care they need, when they need it, and at a price they can afford. Visited www.chcf.org for more information.