Houston – When you’re sick or in pain and you need a doctor quickly you probably don’t stop to check rates for how much an ambulance ride to the nearest hospital will cost you. But did you know one out of every four ambulance rides results in a surprise bill for thousands of dollars? It’s why a new law bans surprise ambulance bills in Texas. Investigative reporter Amy Davis explains who is protected and what you should do anytime you get a bill from an ambulance service.
Family surprised to learn insurance only covered a small part of a short ambulance ride
It was 3 a.m. on a Friday night when Lorenzo Del Carlo fell on the stairs in his home fracturing his ankle. He says the pain was so severe he couldn’t drive himself to the emergency room.
“The pain was so strong that I preferred not to take a risk,” said Del Carlo.
The trip to the emergency room from his house is 1.8 miles. That trip caused him a different kind of pain when he received a city Houston EMS bill for $2,600.
“The amount was ridiculous for an ambulance, absolutely,” he said.
Del Carlo’s insurance company paid $680 leaving him to pay the rest: more than $1,300. His Blue Cross Blue Shield of Texas statement reads “the amount billed is more than what is allowed for this service. The provider is out of network.”
We discovered the city of Houston’s EMS service is not in any insurance company’s network.
“I think the real problem in this situation is that you can’t shop for an ambulance. Whichever one that 911 sends you is the one you’re going end up with,” Jamie Dudensing, Texas Association of Health Plans.
New law helps protect people from being stuck with big ambulance bills
Jamie Dudensing is the CEO of Texas Association of Health Plans, a trade group that lobbied lawmakers to pass senate bill 2476 to ban surprise ambulance bills.
“The state of Texas has come in and said, ‘here is a reasonable amount that ambulance companies should be paid.’”
The new law that took effect January 1st requires your insurance carrier to cover all ambulance charges outside of your co-pay and deductible even when the ambulance company is out of network. This would eliminate those surprise bills.
“If you receive an extra bill, you should not pay it. And you should definitely call your insurance company,” Dudensing explains.
But the new surprise ambulance bill law doesn’t cover everyone
Since this is a state law it can only protect people with state-regulated health plans. Think retired teachers and state employees. That is about 1/3 of Texans.
Del Carlo, who works for a large oil and gas company, still would not be protected but Dudensing said Texas is now putting pressure on U.S. lawmakers to include ambulance billing to the federal “No Surprises Medical Billing Act” that took effect in 2019.
“We need congress to step up and pass a final protection to also include ambulances in the full no surprises act,” said Dudensing.
Until that happens, here’s how you can check to find out if this state law protects you from surprise ambulance bills.
Look at your insurance card.
If you see “TDI” for Texas Department of Insurance printed on your card id DOI for department of insurance. That means your plan is regulated by the state of Texas and you are protected.
If you have a question for Investigator Amy Davis to look into, email AskAmy@kprc.com.