How an Apple Watch Saved a Student’s Life and Exposed a Billing Nightmare
Last year, Jennifer Reisz’s daughter Megan was kicked multiple times in the chest by the family horse. The college student fell to the ground, unable to move or speak. But even though she was alone, her Apple Watch sensed her distress and called 911.
A Costly Ambulance Ride
Megan was taken to a hospital in Clovis, a city in Fresno County near where the Reisz family lives. However, due to the severity of her injuries (four broken ribs and a partially collapsed lung), the doctors decided to transfer her 12 miles by ambulance to the Level I trauma center at Community Regional Medical Center in Fresno.
While Megan was still recovering from her injuries at home, she received a $2,400 bill from the ambulance company, after her family health plan had already paid nearly $2,200.
“When we received the bill, I thought our insurance company was processing the claim incorrectly,” said Jennifer Reisz. Reisz, who is a lawyer, spent hours on the phone with the health plan, the ambulance company, and consumer advocates.
She learned that the ambulance company was not in-network with her health plan, and they were allowed to bill patients for any uncovered portion of their charges, a practice known as balance billing.
A New Law to Protect Patients
Starting January 1, 2024, ground ambulance operators will no longer be able to engage in this practice, thanks to a new law signed by Democratic Governor Gavin Newsom. California is the fourteenth state to provide some protection against balance billing for ground ambulance rides.
At the federal level, an advisory committee established by the No Surprises Act is working on a plan to address the issue nationwide.
Both the federal law, which went into effect in 2022, and a previous California law largely banned balance billing for hospital care and air ambulance services, but not for ground ambulances.
An Unfair Situation
And that’s not fair, because in a medical emergency, patients have no control over which ambulance company responds, whether it’s in-network, or how much they will charge.
In California, nearly three-quarters of emergency ground ambulance transports result in out-of-network bills. The average surprise bill for a ground ambulance ride in California is $1,209, the highest in the country, according to a December study.
Protecting Californians
The new law, which applies to around 14 million Californians enrolled in state-regulated commercial health plans, limits how much an out-of-network ambulance operator can charge patients compared to what they would pay for an in-network ambulance.
The law also limits bills for uninsured individuals, stipulating that they cannot be charged more than the Medi-Cal or Medicare fee, whichever is higher. (Medi-Cal is California’s Medicaid program, which provides coverage for low-income individuals or those with certain disabilities). And it prohibits ambulance operators and debt collectors from reporting patients to a credit rating agency or taking legal action against them for at least 12 months after the initial bill.
Under the current law, people in danger sometimes refuse to call an ambulance out of fear of a massive bill, which could put themselves or a loved one at risk, said Katie Van Deynze, legislative and policy advocate for Health Access California, which sponsored the legislation.
Conclusion
The unsettling tale of Megan’s accident sheds light on the precarious situation many face after receiving life-saving emergency care. Despite her Apple Watch triggering a crucial 911 call, the subsequent ambulance journey led to a hefty bill for the already-injured student. Jennifer Reisz’s tireless efforts to navigate the complex web of insurance, health plan, and ambulance company conversations only highlighted the disparity in patient protection. California’s newly signed law brings hope, introducing vital safeguards against exorbitant billing practices for ground ambulance services. With 14 million Californians set to benefit from this legislation, it’s a crucial step toward shielding individuals from overwhelming medical expenses during emergencies. Yet, the fight continues for nationwide fairness in healthcare billing.
Photo: Freepik.com
