Ambulance Charge

So I open my mail this afternoon & find a bill from Monmouth Ocean Hospital Service Corp. in the amount of $2,908. Last month, in the days before his death, I called 911 because my husband collapsed in our home & was unresponsive. Maplewood EMT's arrives, revived him & took him to St. B. The bill I received states that the ambulance service was non-contracted Aetna, my insurance provider. I'm sorry, but when one calls for emergency service, do they expect people to request an in-network ambulance service? Has this happened to anyone else & is so, how did you deal with it? Pay the bill, negotiate with the ambulance company...?

Mrs. GB

From the amount charged it looks like it is a bill for paramedics, not EMTs or an ambulance.  You cannot request one paramedic service over another.

The same story from the Star Ledgerhttp://www.nj.com/business/ind...

MONOC will send a paramedic unit in addition to the FD or Rescue Squad unit in situations that appear immediately life threatening.  Patient collapsed and unresponsive would clearly fit that circumstance.  Unlike the Fire Department and Rescue Squad, MONOC will bill you directly and they can be quite expensive.  

I don't think there is such a thing as in network ambulance service but your husband's insurance policy might have a flat rate benefit for private ambulance transport in an emergency situation. Call the insurance company for additional information.  In my case, I received an ambulance bill because the ambulance staff got my husband's name wrong.  I was able to resolve the problem over the phone.  

Unfortunately, you should be prepared for additional medical bills covering your husband's care.  I received bills from in network and out of network doctors and other medical personnel who provided uncovered services in the hospital and from private ambulance services called by one medical facility to transport him home or to another facility.  The bills continued to arrive for a year after his death.

If your husband had medicare coverage, you should check with them as well.  They are likely the primary provider with your husband's insurance policy providing secondary coverage.

They send medical bills to dead people?

joan_crystal said: The bills continued to arrive for a year after his death.

Dead people have estates.

Welcome to our crazy fee-for-service health care system.  Works great until you actually need it.

They send bills until they are paid by someone .

Yes, settling the medical bills (or making them go away if the deceased had no remaining assets) is part of managing the estate. 

RobB said:

They send medical bills to dead people?

joan_crystal said: The bills continued to arrive for a year after his death.

One doctor's office told me that they could legally bill for up to a year after service was rendered.

I called our insurer on Joan's always sound advice & they will try to negotiate a lower charge with the ambulance service. 

So glad the insurance company is working with you on this.  

RobB said:

They send medical bills to dead people?

The Republican health car plan is much simpler and therefore better. It has two parts.

1. Don't get sick.

2. If you do get sick, die fast.

We had a similar experience more than once. My husband appealed and eventually won. But it takes dogged persistence. This is hideous.

so the real issue here is the actual cost.  Healthcare isn't a mess because of insurance.  Healthcare is a mess because an Ambulance costs $3000 and a day in an emergency room costs $50,000.   Why does a knee replacement cost 8x in the US vs Canada?  

Woot said:

so the real issue here is the actual cost.  Healthcare isn't a mess because of insurance.  Healthcare is a mess because an Ambulance costs $3000 and a day in an emergency room costs $50,000.   Why does a knee replacement cost 8x in the US vs Canada?  

BINGO

If this is not addressed it is all just rearranging the deck chairs on the Titanic.

I agree, to a point.  Bills are insane, but insurance companies are also posting huge profits.  They certainly are not the whole problem but they are a part of it.

INSURANCE COMPANIES ARE NOT THE PROBLEM. INSURANCE COMPANIES ARE NOT THE PROBLEM. 

It is total BS to say they are and it just serves to cover the truth that Woot posted.

If anything insurance company at least bring some control to the out of control cost of health care provisioning.

Cost is THE issue. As an example my Dad was recently hospitalized for 12 days, with pneumonia. No surgeries, nothing invasive. Seen by multiple pulmonologists and infectious disease docs, but on no antibiotics that I couldn't get at CVS.  The bill was $147,000.

Oh, and I too am getting ambulance and EMT bills like OP, however his supplement plan is covering most of it 

The day before my husband passed away, I called for an ambulance. Two showed up, both MONOC. I received a bill for both, and paid them, because there were two. I was fortunate that they were covered by my insurance, at least mostly. This is one of the few instances where I did not challenge a bill that did not look right. A number of months later, I received a refund check from MONOC for one of the ambulances.

But do pay attention to bills received. The company that was providing oxygen continued to bill for providing the service for several months, even though they had picked up the equipment two days after he died. I might have thought it was a clerical error, but they had done the same thing the first time he had oxygen from them after an operation. It took several calls over the course of a couple of months to rectify the matter and when I called Horizon to file a complaint, Horizon tried to talk me out of it. I was not to be deterred.

It is far more than doubly difficult to deal with the emotional impact of a loved one's serious illness/death and to have to manage all of the resulting medical bills at the same time.  Medical care is far too expensive in this country.  Insurance companies, health maintenance organizations, pharmaceutical monopolies, and the like contribute to the problem with the add on of administrative and third party costs plus the price fixing that can accompany monopolies.  Your insurance policy may help control prices for you; but, the uninsured pay the difference in even higher medical costs than the insured are paying.  If you are insured, take a look at your EOB next time. Comparing the billed amount with the negotiated cost billed to your insurance company can be an eye opener.

Woot said:

so the real issue here is the actual cost.  Healthcare isn't a mess because of insurance.  Healthcare is a mess because an Ambulance costs $3000 and a day in an emergency room costs $50,000.   Why does a knee replacement cost 8x in the US vs Canada?  

peteglider said:

Cost is THE issue. As an example my Dad was recently hospitalized for 12 days, with pneumonia. No surgeries, nothing invasive. Seen by multiple pulmonologists and infectious disease docs, but on no antibiotics that I couldn't get at CVS.  The bill was $147,000.

Oh, and I too am getting ambulance and EMT bills like OP, however his supplement plan is covering most of it 

Just to clarify, the bill the OP is referencing looks like it is for paramedics, not EMTs.  Paramedics have gone through two years of school (one year classroom time, and one year clinical hours) to get that certification, and are able to provide a much wider range of assessments and treatments. In New Jersey they are known as Mobile Intensive Care Paramedics, MICP for short.  EMTs are able to provide many basic and needed medical services, but for more life threatening conditions, paramedics are needed.  I can't speak of the bill in question, but in general paramedics are legitimately associated with higher costs due to the training, equipment, supplies, and drugs needed.  

As far as being billed, for the most part private companies provide a lot of the coverage for New Jersey, both BLS and ALS.  Some places have volunteers for BLS, some provide it through the town paid via property taxes, but for places that aren't able to provide 24/7 coverage that way the choices are to either provide no coverage, or to pay a private company to come in.  Getting a bill for an ambulance is much preferable to not getting an ambulance at all. 

Most EMTs I know make somewhere between $10-$15 an hour.  That's roughly $20,000 to $31,000 a year, and that doesn't include the additional costs associated with providing benefits.  There are two EMTs on any ambulance by law, and they need to be paid.  For paramedics the average is around $25 an hour, so you have two employees making about $52,000 a year, plus benefits, who also need to be paid.  Then there is the cost of the ambulance, around $130,000 without equipment, then add the cost of the equipment (stretcher, oxygen, defibrillator, etc).  For medics you then have added, and costly equipment (portable EKG, drug box, intubation tools and supplies, IV, etc).  Then there is wear and tear, ambulances don't last forever and need to be repaired or replaced on a somewhat regular basis. Plus everything needs insurance up the wahoo.

When you get a volunteer, or taxpayer funded EMT, and don't get a bill, don't think that the ride was free.  The costs associated with it were covered by property taxes, or by fundraising, and the EMTs were either paid hourly by the town through property taxes, or volunteered their time for free, usually on a very part time basis.  They have the same costs, they are just funded differently.  Companies like Atlantic or MONOC don't receive tax money or donations, and people aren't willing to ride their ambulances for 40 hours a week, including nights, weekends, and holidays, for free, so billing is their only choice.

I can't comment on the bill the OP received, since I don't know what assessments and treatments were done, but in general ambulances and paramedics cost money and those costs need to be covered.

This was my main problem with Obamacare.  It did nothing to fix the underlying healthcare system.

Woot said:

so the real issue here is the actual cost.  Healthcare isn't a mess because of insurance.  Healthcare is a mess because an Ambulance costs $3000 and a day in an emergency room costs $50,000.   Why does a knee replacement cost 8x in the US vs Canada?  

There are two really good things due to Obamacare. The elimination of refusals due to pre-existing conditions and the Medicaid expansion to those in need.

The rest is a band aid that may instead hurt future healthcare reforms. The nation has been talking about and worrying over Obamacare and not resolving medical prices, ripoffs and the lack of coverage even for those who are insured. Its been a multi-year diversion from issues that are serious.

Obamacare placed many in Medicaid. They are helped. However, 12 million signed up for Obamacare did not get Medicaid coverage. Another 19 million who did not sign up are mandate penalized or have one of the numerous exemptions from the mandate.

Very few of the non-Medicare 12 million will collect. They will have paid in over the years, paying their premiums with usually government (that is we, the taxpayers) also paying the private insurers. Finally, if they have a claim its almost always denied due to the high deductibles.

I know someone who is pretty liberal, having voted Obama twice. She paid in over the years about $400 monthly with government paying $350. Last year she had a real medical issue with a multi-thousand dollar claim. She collected zip after years of paying about $8000 a year. What she said of Obama and Obamacare can't be printed here.

Some of you have agonized and cried over the working poor losing coverage. Seems paternalistic and condescending to me. I'm sure the working poor can open their own mouths. And if they don't care, so be it. Or many of the working poor who are not in Medicaid maybe feel like my friend, they pay in but do not collect.

Instead of crying over the working poor and over the Obamacare band aid we should be crying over the ridiculous cost of medical care and the latest ripoffs where you are uncovered because the ambulance or something else is not in network. We should instead work to get single payer so that all medical services are covered with no deductibles while voting politicians who do not support this out.

Here's a perspective on Obamacare:

Doctors like me look at health insurance very differently than Obama does. To us, insurance often presents a cumbersome roadblock to actual health care.
When a patient comes to me smiling with their new Obamacare coverage, it is difficult for me to smile back. That’s because I immediately envision a test or a referral that may not be covered by their plan or an essential service they will have to reluctantly pay for out of pocket because of their deductible.

http://www.nydailynews.com/opinion/dr-marc-siegel-doctor-hates-obamacare-article-1.2846378

Insured but not covered:

https://www.nytimes.com/2015/02/08/sunday-review/insured-but-not-covered.html

Many Say High Deductibles Make Their Health Law Insurance All but Useless:

https://www.nytimes.com/2015/02/08/sunday-review/insured-but-not-covered.html

To those of you who think rescinding Obamacare will doom the Republican party - DON'T BE SO SURE.

Since this thread has veered into discussion of Obamacare, I will just throw in here the benefits a family member derived from the ACA: 

1.  Able to obtain insurance despite pre-existing condition.  Big big big.

2.  Able to access insurer-negotiated rates for services, which means the insurance did provide a benefit even while we were paying down the deductible.  Eg, one medicine that was $2,700 a month without insurance was $1,100 with the insurance.

3.  Able to cap our out-of-pocket expenses.  This was tremendous for peace of mind.  We knew that whatever happened (eg, I think peteglider recently mentioned a 12-day, $147,000 hospital stay for a family member), we would only be paying premiums, deductible, and specified copays/coinsurance, up to a specified amount per year.

These were huge benefits to our family, even though we didn't always go beyond the deductible.  Due to circumstances, there was no federal subsidy.

I will always be deeply grateful for Obamacare, while recognizing that like any big project it has needed tweaking all along.  Frankly terrified about the future.

mjc said:

I will always be deeply grateful for Obamacare, while recognizing that like any big project it has needed tweaking all along.  Frankly terrified about the future.

So sad you're terrified. Before Obamacare, where you constantly terrified?

peteglider's comment shows the real issues. A $147,000 bill for 12 days of pneumonia. Its become a racket. A parasitic racket between medical providers and insurance. Where the medical billing is so ridiculously high that many people are terrified into buying overpriced insurance.

My father had pneumonia, many, many, years ago. I don't think the billing was over $500 (based on that he was making 12,000 a year and we had less than 1,000 in the bank and we had no problem or complaint over paying).

Which is why we need to work on fixing the real problems. Not be diverted with endless discussions on Obamacare.

I've lived 15 years without insurance. I had assets but I was healthy  and took my chances. I was not terrified and it paid off. We saved, I guess, about 100,000 in insurance. I figured if I went bankrupt I could always rebuild.

BG9 said:



So sad you're terrified. Before Obamacare, where you constantly terrified?

I can't speak for mjc, but I am and was.  Back in 2004 the business I was working for wasn't doing well.  Then, with one month's notice, our health insurance was dropped because my boss (owner of the company) decided to no longer provide health insurance to save money.  I was uninsured for a few months until I got married in late 2004.  In 2005 I was diagnosed with thyroid cancer, luckily I had insurance through my husband, so it was covered.  The cancer had made it to my lymph system before it was caught, so I will never be cancer free, and will have testing for the rest of my life, with the possibility of future treatments if it starts growing again.  Even with being covered by my husband's policy, I am constantly terrified because I recognize that coverage offered through an employer is no guarantee, all it takes is a layoff and that coverage is gone.  With the preexisting condition I have, finding a policy without the protection of ACA would be impossible. 

I admit that over billing is an issue, due partly to try to cover costs of uninsured patients with no assets which means the hospitals/doctors will never recoup their losses.  It is also due in part to the insurance companies playing games, each company has a different rate of what they consider a fair price for each visit, procedure, etc.  By making sure that each and every bill is well above and beyond the amount the insurance company is willing to pay, they guarantee that they will get the fullest reimbursement that the insurance company is willing to pay.  If your insurance company was willing to pay $1,200 for a procedure, but the hospital only bills them $800, they have left money on the table.  By billing $10,000 for the procedure, they guarantee they will get the highest amount the insurance company was willing to pay.  The problem comes in when they start aggressively going after out of network patients for the balance, or going after uninsured patients for the padded bill vs asking the patient to pay the more reasonable cost.  Single payer would solve this, as the government would set rates of reimbursement, the same as they do now with Medicare. 

BG9 said:



I've lived 15 years without insurance. I had assets but I was healthy  and took my chances. I was not terrified and it paid off. We saved, I guess, about 100,000 in insurance. I figured if I went bankrupt I could always rebuild.

I was healthy until I wasn't.  And since I'll need continuing care for my cancer for the rest of my life, going uninsured and counting on filing for bankruptcy just is not an option.

BG9 asks:  "So sad you're terrified. Before Obamacare, where you constantly terrified?"

In the interim between leaving "guaranteed issue" NJ and the passage of the ACA, pretty much yes.

I absolutely agree with you that working on cost is a central and necessary part of the solution.  What's currently being charged is, technically, nuts.  But it's also a long-term solution, while medical needs are immediate.

I'm glad you have been healthy and saved all that money.  Had you or a family member experienced a serious medical problem, you might not only have been bankrupted (not an option for us, nearing retirement) but ultimately imo would have to choose between forgoing care and receiving care at the public expense, whether hospital "charity care" billed to other patients or Medicaid.  Heads you win, tails someone else pays.

BG9 said:

I've lived 15 years without insurance. I had assets but I was healthy  and took my chances. I was not terrified and it paid off. We saved, I guess, about 100,000 in insurance. I figured if I went bankrupt I could always rebuild.

 So if something terrible happened while you were uninsured, you would declare bankruptcy to avoid paying your medical bills. Who would be responsible for your unpaid expenses? The physicians and facilities who provided the services. How would they recoup this money? By charging other patients more. 

See how having a large uninsured population contributes to increased medical costs?

mjc said:

I'm glad you have been healthy and saved all that money.  Had you or a family member experienced a serious medical problem, you might not only have been bankrupted (not an option for us, nearing retirement) but ultimately imo would have to choose between forgoing care and receiving care at the public expense, whether hospital "charity care" billed to other patients or Medicaid.  Heads you win, tails someone else pays.

And someone else doesn't pay with Obamacare? Heads those who get sick enough to collect win, whereas the healthy young pay.

Whether, it be charity care or insurance, someone always pays, usually someone else. With any health insurance you can pay premiums for dozens of years without needing any care. That makes you the someone else who pays.

kthnry said:

 So if something terrible happened while you were uninsured, you would declare bankruptcy to avoid paying your medical bills. Who would be responsible for your unpaid expenses? The physicians and facilities who provided the services. How would they recoup this money? By charging other patients more. 

See how having a large uninsured population contributes to increased medical costs?

Trust me, the ridiculous costs we have here in America are not due to the uninsured.

Look at something simple like drug prices for Medicare. We have our Democratic senators from NJ voting against a bill to enable the purchase of drugs from Canada. We have a federal law prohibiting Medicare from negotiating drug prices.

Effectively, we have laws to keep prices high for the seniors and the retired.