Should I appeal this? If so, what would you say in an appeal letter?

I had a serious medical problem a couple of months ago that resulted in two incidences of EMS transporting me to the hospital after I called 911. (I was admitted for multiple-day stays after each transportation.) I found out later that our local ambulance/EMS service is out-of-network with my health plan and I now owe about $2800 for EMS transportation after my insurance, Anthem BCBS, paid its out-of-network fee.

This to me seems incredibly unfair and unreasonable - as a citizen who needed emergency treatment and called 911, I had zero input into who responded to my calls. This is especially the case here, because our local ambulance/EMS service has FIRST RIGHT OF REFUSAL for calls so I couldn’t call anyone else even if I wanted to unless EMS was unable to respond due to lack of capacity.

Is it worth the time and effort to appeal this? If so, how should I frame the appeal? Apparently ambulance authorities are exempt from state and federal balance billing laws as well. What a freaking racket.

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Most ambulance services don’t have contracts with insurance companies. Even if you could choose your provider, it likely wouldn’t make a difference because most aren’t contracted. Unfortunately, appealing may not help much since your claim wasn’t denied due to medical necessity. I work in physician billing, not ambulance billing, so there could be something I’m missing that a specialist in ambulance billing might suggest.

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Your insurer will decide, but most of the time, an appeal probably won’t work. Still, it doesn’t hurt to try.

I say this because insurers know ambulance services are emergencies, and they expect you might get a balance bill. They often choose not to pay out-of-network ambulances based on the billed charges for valid reasons. Some companies do pay based on billed charges, so if yours wanted to, they could.

If you appeal, don’t just focus on proving it was an emergency. Include reasons why you couldn’t use other transportation and justify the amount charged.

On a side note, balance-billing laws are being developed in many states to protect people from these situations with ambulance services.

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Thank you.
I’m not worried about proving it was an emergency because, as I mentioned, I was admitted through the ER. Both transports were for heart-related emergencies, and I was actually having a heart attack during the second one. I don’t see how I could have been transported any other way in that situation. I was furious when I found out they were out of network, even though I had no choice for emergency transportation.

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Yep…the next major issue our system needs to work out. I personally wouldn’t spend time trying to appeal.

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