By Diana Stewart, Executive Account Manager
Surprise billing happens when a patient with health insurance is treated at an out-of-network hospital or when an out-of-network doctor assists with the procedure at an in-network hospital. Bills for such services can range from hundreds to tens of thousands of dollars.
“Surprise” out-of-network bills have come under close scrutiny, mostly focused on Emergency Room instances where a participant my seek services at an in-network hospital, but the attending physician could be out-of-network. Ambulance transportation is known to be a large component of the problem as well, although its impact is poorly understood.
For members of large national insurance plans, from 2013–17, 71% of all ambulance rides involved surprise bills. For both ground and air ambulances, out-of-network charges were substantially greater than in-network prices, resulting in an average potential surprise bill of $450 for ground transportation and $21,698 for air transportation. Though out-of-network air ambulance bills were larger, out-of-network ground ambulance bills were more common, with an aggregate impact of $129 million per year. Out-of-network air ambulance bills had an aggregate impact of $41 million in 2013 increasing to $143 million in 2017.
As the Federal Government seeks to implement legislation limiting surprise billings for emergency services at in-network levels, federal proposals to limit surprise out-of-network billing should incorporate protections for patients undergoing ground or air ambulance transportation as well as hospital services.
Eliminating surprise billing would save people with employer-provided health insurance as much as $40 billion annually. However, surprise billing lets hospitals extract more money from patients and demand higher payments from insurers.