Austin saddles consumers with big ambulance bills

In late 2022, Rachel Carnahan-Metzger of Austin, TX rushed her young daughter to the hospital via ambulance due to a fall. She expected her insurance to cover the ambulance bill but was surprised to find a whopping $1,082 out-of-pocket bill they were required to pay. 

The reason? According to an article from the Austin American-Statesman, “EMS does not have contracts with private insurers” and “Austin-Travis County does not negotiate payment amounts with customers.” Thus, individuals are often left with no choice but to pay these surprise ambulance bills. CBS Texas news article, noted that Austin-Travis County EMS “does not contract with any private insurance companies – meaning all its ambulance rides for patients with private insurance are billed out-of-network.” According to Carlos Ledesma of Austin-Travis County EMS, “we encourage patients to request claims be reprocessed as in-network, then balance bill(s) the patient.” So there’s really no way of telling or anticipating how high your surprise bill might be, adding to the frustration of it all. The discrepancy and confusion among individuals receiving surprise ambulance bills continue to grow. Although Austin-Travis County EMS offers interest-free payment plans to individuals who are facing these surprise bills, it’s not enough.

Time after time individuals who call 911 for an ambulance are hit with a considerably high bill, even if they’re insured. As detailed in a U.S. PIRG Education Fund study, for the 3 million privately insured individuals who are transported to emergency rooms via ambulance every year, 51% are at risk of being exposed to a possible surprise out-of-network bill. These surprise bills can be shocking and detrimental to the lives of individuals who rely on these transportation services to save their lives. No one wants to worry about the financial implications of an ambulance surprise bill on top of the stress of a health-related emergency. 

The federal No Surprises Act protects patients from most other surprise out-of-network bills such as emergency room care, most health care providers at in-network hospitals and air ambulances. But the patient billing protections don’t extend to ground ambulance transportation. Texas enacted ambulance surprise billing protections which went into effect in January 2024. It’s a big step and helps some Texans. But that state law only covers people who have state-regulated insurance. (To find out if that’s the kind of insurance you have, your insurance card will have TDI or DOI imprinted on it, or you have insurance through the Employees or Teachers Retirement System of Texas (ERS or TRS).) But most other insurance doesn’t offer Texans any ambulance surprise billing protections. 

That’s why we need a federal law to make sure everyone can be protected from the extra hundreds or thousands of dollars in ambulance surprise bills.

PIRG’s senior director of health care campaigns, Patricia Kelmar, served as the consumer representative of a federally appointed Advisory Committee on Ground Ambulance and Patient Billing (GAPB) to work with interested stakeholders on finding a federal solution. The Committee’s recommendations will be sent to Congress soon and make recommendations to remedy this situation. They are as follows:

• Ban on balance billing for both 911 and interfacility emergency transportation
• Patients would only pay whatever cost-sharing they would, as if the ambulance had been in-network.
• Ambulances would be prohibited from sending any bill to a patient until after they run it through the patient’s insurance 
• Patients co-pay amount would be capped to an amount that doesn’t deter them from calling the ambulance when they need one
• The No Surprises Help Desk would handle consumer questions and complaints. 

With both sides working hand in hand to propose legislative solutions and ideas like these, future families just like the Carnahan-Metzgers won’t be burdened by a bill that they never saw coming.  But while we wait for federal protections, people should keep an eye on the rates the County sets for emergency services. And Austin EMS should start contracting with our insurers to protect us from ambulance surprise bills.  

And if you’ve experienced an ambulance surprise bill, we want to know. Tell us here:  Have you ever received an ambulance surprise bill?