How To Resolve A Surprise Ambulance Bill

If you've ever dialed 911 in an emergency for an ambulance, you probably were not thinking about how much that phone call would wind up costing. All that mattered was getting help. That's all I thought about when my daughter went into anaphylactic shock last year. But what ensued changed my entire perspective on ambulances forever. One phone call launched me into an 11-month insurance nightmare. Fortunately, I learned how to resolve a surprise ambulance bill.

I was lucky things worked out fairly in the end. But it took a lot of my time and patience. I ended up writing three articles about my experience and what I learned because it affected me so much. I hope my experience can help you get a resolution if you ever get stuck with a surprise ambulance bill too.

Let's all try and raise awareness of our broken EMS system in hopes we can get federal oversight, better legislation to protect patients, and more government funding for ambulance crews.

More And More People Need To Resolve Surprise Ambulance Bills

Unfortunately, more and more people with health insurance are being faced with huge balance bills from ambulance companies. And ironically, The No Surprises Act provides out-of-network surprise billing protections for all types of situations except ground ambulances.

If you haven't read my first article already, please check out The Cost Of Calling An Ambulance And The Nightmare That Ensued. It goes into the background of my story, explains what a surprise ambulance bill is, covers some insights on San Francisco ambulance providers, and a few positives from my experience.

Please also take a look at the article I wrote on why our EMS system is broken and why so many people are getting stuck with these expensive surprise ambulance bills. You'll learn why there are gaps in legislation specifically for ground ambulances and some possible solutions.

Below, I provide a detailed look at all of the steps I took over the course of 11 months to resolve my surprise ambulance bill. This is followed by a summary of tips you can use to help resolve a surprise bill of your own.

The Detailed Steps I Took To Resolve My Surprise Billing Nightmare

Resolving a surprise ambulance bill is not easy, but it can be done. Everyone's situation is different depending on location, state ambulance laws (if any), the emergency's circumstances, the ambulance provider, whether or not you have insurance, the actual terms of your insurance, and more.

Nothing moves fast with insurance companies or ambulance provider administration, so that's the main reason my experience took so long to resolve. I wrote everything down as best as I could remember so I never forget. My memory isn't what it used to be. But it sure was an overwhelming experience. Here goes…

Month 1

I get a letter from DataiSight (a 3rd party negotiator for my insurance company) that said they were in contact with AMR (ambulance company) on behalf of my insurance to help resolve my ambulance bill. The letter said it was unlikely AMR would bill me more than contracted rates. I had hoped I wouldn't owe that much money when I got this letter. But unfortunately, their belief about AMR ended up being completely false).
I get a letter from AMR saying they received a partial payment from my insurance that didn't satisfy the balance. At the time I thought perhaps my insurance just hadn't finished processing the claim. I decided to wait things out.
A new letter comes from DataiSight saying they were unable to negotiate with AMR and that I should contact my insurance.
Meanwhile, my insurance posts my EOB saying I only owe $180 to AMR.
Now I'm really confused and starting to worry.

Month 2

Stared in disbelief when I received a $3532 bill from AMR for the ambulance ride. How in the world could the bill be that high? I foolishly put it aside and waited for a revised bill to come. Surely my insurance would get this resolved.
I have a bad feeling in my stomach and decide to call DataiSight to try and figure out what's going on. DataiSight said AMR was unable to negotiate the balance. I request they try again and jot down a reference number. More waiting. They tell me to call back in a week or so.
I follow up with DataiSight and they said they were unsuccessful and to contact my insurance. Augh!
Over the next several weeks I have multiple calls with my insurance asking them to review and reprocess the claim. I get several letters in the mail saying the claim was reviewed and everything was processed correctly. How could this be?!
Why is my EOB saying I only owe $180 but AMR is asking me for $3532? Turns out it all has to do with AMR being out of network and my insurance applying contracted rates to the claim that AMR doesn't accept. Basically, my insurance believes AMR should accept contracted rates and my claim can't be processed any other way. And AMR says nope and sticks me with the difference in cost.

Month 3

Around this time I get a precollections notice from AMR. They have no sympathy for what I'm dealing with and want to be paid. I finally speak with a rep who seems to know what he's doing. He says he will put my account “on hold” for 30 days to give me more time to sort things out with my insurance and avoid my account from getting sent into collections.
Meanwhile, I try again with my insurance company this time filing an official appeal on the handling of my claim.
More phone calls, more paperwork, more stress, more frustration. But I still have hope that an insurance appeal will help me get this sorted out.
I finally break down and tell Sam what's going on. I'd been trying to shield him from this stressful debacle because I wanted to resolve everything on my own. I hoped to be able to surprise him and say “Hey guess what I sorted out over the past x months!” He had stresses of his own and I didn't want to pile on more worries. But he could tell something was up with me and I spilled the beans. Fortunately, Sam was surprisingly calm about it and encouraged me to keep up the fight.

Month 4

Out of the blue, I get a call from a collections agency saying my account is delinquent and I need to arrange payment for my AMR bill. WTF! AMR said they had put my account on hold so this wouldn't happen. The collections agency is absolutely awful to deal with. They say they have no knowledge of the hold and have no way to contact AMR. What a crock of sh–.
I call AMR and explain they screwed up and sent my account to collections by mistake. I speak to multiple people and get nowhere. “We're unable to contact the credit agency” etc. I'm about to explode when I finally get another supervisor on the phone and re-explain everything. I start to break down and cry because I'm at wit's end. She seems to feel a sliver of empathy and says she'll put in a request to have my account pulled out of collections but that it could take weeks.
More endless waiting.

Month 5

I get a letter from my insurance company that my appeal was denied. I am in shock. Seriously?! I'm too far in to give up. I just can't shake how outrageous this whole thing is.
Next, I start to brainstorm other options. I do a lot of research on the internet, and even reach out to a NY Times reporter who covers these types of cases. She responded and collected some info from me but ultimately wasn't able to help.
Then in desperation, I reach out to my insurance agent to see if what I'm going through is normal and if they have any suggestions. He tells me it's actually quite common and there are cases much worse than mine. He says I could contact the Dept of Insurance and write to our state representatives. And lastly, he says he could have his assistant try and talk to the insurance company on my behalf but they may not get any results. I graciously take him up on the offer. More waiting.
I keep following up with the collections agency and AMR. I need them to fix their mistake and put my account back on hold in good standing while I wait for an update from my insurance.
Finally, AMR says they have successfully pulled my account out of collections. I get a 30-day extension for my balance due to work things out with my insurance.
My agent's assistant says my claim is being looked at but there's still no update. More waiting.

I Reach The Half Way Mark In Resolving My Surprise Ambulance Bill

Month 6

My 30-day extension with AMR is running out. I manage to speak to the same supervisor from the last month and get another courtesy extension. She said my account will remain on hold until I receive a bill in the mail.
I request my case get escalated with my insurance. I just want this to be over.

Month 7

I get a bill from AMR for the full $3532 again. Augh! Now the clock is ticking again.
More phone calls, more painful waiting. But I find out my case has been sent to my insurance company's Egregious Billing Department. This sounds promising, but I don't get my hopes up.
I call AMR back with a new reference number from my insurance company. I get another extension for my balance due. Phew. Fingers crossed!

Month 8

I finally speak with someone nice in the Egregious Billing Department. I send a bunch of paperwork and wait.
A few weeks later, my insurance says they will take over communications with AMR and attempt negotiations again. They tell me to sit back and wait some more.
Per an insurance rep's unofficial recommendation, I send AMR a check for $180. This is the amount from my original insurance EOB.
I have a small glimmer of hope.
I get another bill from AMR for the $3532 again. Augh. I send a copy to my insurance to update my case records and wait.
A week later, my insurance company send me a letter. It says more or less that negotiations with AMR failed again. However, it vaguely says as a good customer I shouldn't have to pay excessive costs for medical services. I'm confused about what this means but am hopeful.

Month 9

I speak to my insurance again and it turns out they are going to reprocess my claim using AMRs rates. I'm not told how much I will owe, but this sounds like good news. I'm told to wait 2 weeks for the claim to reprocess.
After a very long wait, I get an updated claim from my insurance. It says I will owe $850 for the ambulance. That's still a lot of money, but so much less than $3532.
I wait for the insurance payment to get to AMR and for a revised bill to come.

Month 10

A revised bill from AMR never comes.
I'm busy with life and getting our son ready for back to school. Why are there so many apps to sign up for? And oh the labeling of everything takes forever!

A Curveball In The Final Month Of Resolving My Surprise Bill

Month 11

I get a precollections notice from AMR in the mail on a Saturday saying I'm past due. What?! Not this all over again. The notice was dated 2 weeks prior and said my account would be turned over in four days. Oh jeez. Why did they never send me a bill?!
I debate if I should wait until Monday to speak with someone on the phone at AMR or try to pay it online. Every other time I tried to use their online portal to view my account in the past it didn't work.
Fortunately, I'm able to pull up my account on AMR's website. It shows they received the new payment from my insurance. The balance due has been also adjusted to $670 ($850 minus the $180 check I sent in Month 8).
For some stupid administrative reason, my AMR account does not update to zero balance even though my credit card is charged within 24 hours.
I am so close to the end yet this monkey wrench has me wanting to scream my head off. WTH can't AMR update my account to zero balance?! I do NOT want to get sent into collections again because of this administrative hiccup.
I make several more phone calls. Finally, I speak with someone who says the billing department hasn't processed it yet and it could take up to two weeks to clear. Really?! He puts my account on hold again to avoid my account going into collections. I don't believe him but pray he's right.
Every day I keep checking to see if my AMR account updates to zero balance. Still nothing. WTF folks?
Finally, ten days later, my AMR account is updated and shows my payment processed and there is zero balance due.
I call AMR the next day to verbally get confirmation and ask them to make a note that I called to confirm.
I take a long deep breath, tell Sam it's finally over, and spend six hours writing this page and another article on some of my research.

How To Resolve A Surprise Medical Bill Of Your Own

If you ever find yourself facing a surprise medical bill, here's a summary of steps you can take to try and fight back. Resolving a surprise bill isn't a quick or guaranteed process, but it can be done.

Document everything! Retain all copies of invoices, notices, explanation of benefits, letters you send, reference numbers, check numbers, receipts.
Also, keep track of all the when's and who's – for ex. the date and time of the calls you make and the names and employee ID numbers of the people you speak to.
If your bill does not have a written due date, don't assume you have months to sort things out. Find out exactly how long you have. Ask for extensions and get your account placed on hold if possible and get proof. Getting a new reference number from your insurance company that you can give to the ambulance co may help with getting extensions.
Be aware that an ambulance company or hospital can send your account to collections if you fail to respond or send payment. Avoid the huge headaches and terrible customer service that come with collection agencies.
Ask your insurance to review the claim again, file an appeal, file a grievance and be prepared to be on the phone a lot and fill out paperwork.
Request an advocate at the ambulance company to review all the charges for any errors. This can help buy you some time to resolve your surprise bill. Review them yourself as well.
Do your best to stay calm when on the phone. If a representative you're speaking with doesn't seem experienced, ask for a supervisor, or call back and try again with someone else.
Research your state's laws to see if there are any protections you can leverage. Check for any new federal legislation as well.
Let your HR manager know what's going on. They can contact the company's insurance agent for suggestions or potentially pull some strings with your insurance company. If you are self-insured, contact your own insurance agent for advice and support.
File a complaint with your local Department of Insurance and contact your state's representative. It might be a long shot, but some people have had success going this route to resolve a surprise ambulance bill when nothing else worked.

Thanks for reading this far and following along with how I was able to resolve my surprise ambulance bill. Hopefully, you never have to go through a crazy ordeal like this. But if you do, perhaps learning from my experience can help you get it sorted out one way or another. Stay safe everyone!