Many insurance companies are purposely and improperly using the No Surprise Billing act and similar State acts to underpay ambulance companies and get away with it.
If your billing company and/or your internal billing is not paying attention to what private insurance companies are paying, what they are writing off– and worse–what they are telling their patient the new law allows them to do, you are allowing them to rip you off. You earned these payments and the insurance is paid by the patient for a plan that covers these fees for their patients.
This misuse of the laws, whether on purpose or by mistake is likely costing you money that you’ve earned. Trust me: they know they are doing it and are doing it by design. Many times I have seen a letter to a provider or to a patient quoting the law and leaving off the paragraph before that says this only applies to Emergency runs or this does not apply to Ambulance Transport. Do they really mistakenly leave off that section of the law?
What are they doing? They are sending a small payment or a smaller-than-billed contractual rate payment to private and government ambulance companies they are not contracted with.
Along with that, they then tell their patient they cannot be billed for the balance but only any copay or deductible they may have. THIS IS NOT THE LAW. Before the No Surprise Billing act, states like Colorado had a maximum of 3.5 times Medicare rates and they tried to send contractual payments. Florida has a law less exact that said no more than customary rates in the area and again the insurance companies tried to pay their contractual rates.
All this results in Insurance Companies trying to pay $350-$650 for a run where they may owe you $1300-$1500. Worse, they are telling their patients in writing that they do not have to pay the balance.
Fortunately the solution is simple, but also time-consuming and costly. But it is necessary if you want to collect all of your properly owed fees.
Step one: Make sure you check your EOB. There should not be write offs for commercial insurance, unless you are under contract with them.
Step two: Send a bill to the patient for the balance their insurance company should have paid but did not pay. If you want to save time and help your patient, include a document explaining why their insurance owes the money, what the law really is, and how they need to contact their insurance and get it properly paid so they are not stuck with the bill or sent to collections for non-payment. Provide the patient the tools to correct their insurance company.
At Sharp we also offer to get on a three-way conference call with the patient and their insurance to correct their insurance company’s misperception.
This is important if you do not want to leave hard earned money on the table. If you are not familiar with the No Surprise Billing act or the state laws in your area: get familiar with them. The insurance companies are misquoting these laws and sending threatening letters about how you cannot bill their patients and may be violating the law. These letters usually misquote or cherry pick aspects of the law, intentionally misleading your patient, and often leaving them frustrated and angry with their ambulance company, as a result.
This is an example of the statement they often leave off:
Federal Law
Main Statement in the Federal Law
Emergency and post-stabilization care and nonemergency care in in-network facilities; applies to fully insured and self-funded plans. Includes air ambulance services, but not ground ambulance services.