Complaints

• Initial Complaint

  06/21/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 1/6/2023 went .07 miles for 3 minutes (BLS). Was billed $3600.00. My private insurance paid Medic Ambulance $2500.00. My insurance company noted $3600.00 was above the usual and customary rate for BLS .07 miles for 3 minutes. Medic Ambulance is balance billing me for $1100.00 and is now saying I will be sent to collections on 6/22/2023 if I don't pay the balance. Medic Ambulance is grossly overcharging and balance billing me. If I were a Medi-cal patient there is no way Medic Ambulance would have A) received $2500 from Medi-cal nor B) would they balance bill me the difference. This is prime example of cost shifting and its wrong. (Medic Ambulance is the only responder to 911 calls in Solano County. Why would Solano County allow its people to be taken advantage of? Should we vote to make EMS tax funded because then we know this excessive over charging would not happen?) Hopefully ********** will add ambulance companies under the "No Surprise Act" soon like other states have so this stops happening to hard working people. I pray I never ever need help as I wont call 911 for help now knowing what Medic Ambulance does to the residents of Solano County with private health insurance. I am asking that Medic Ambulance does not send this to collections and to adjust this balance billing to zero as they have been paid sufficiently for the service provided. Thank You.

  Business response

  07/12/2023

  *****************, 

  I wanted to respond to your complaint about the pricing and payment for your ambulance transport on 1/6/23.  Unfortunately, we deal with insurance company underpayments on a daily basis and are forced to appeal and fight for proper reimbursement on the majority of our claims.  We have appealed this decision by your insurance company, ****************** and were unsuccessful.  The explanation given to us by your insurance company for the reduced payment was that you had reached your benefit maximum for this care and this type of service is not covered under your plan.  Our position on appeal was that this was a 911 emergency response and transport for your medical emergency and therefore should be covered at 100% of billed charges based on your plan coverage.  Since Anthem states you reached benefit maximums and the service is not covered, it would be best for your to file a grievance with your insurance company based on the fact that you pay your premiums to them and expect them to cover your emergency care and services.  

  In response to your statement about accepting Medi-Cal payment as payment in full and cost shifting, unfortunately that is state law and we are required to accept Medicare or Medi-Cal reimbursement as payment in full.  There is no such law currently in place for that same provision with private insurance companies.  Our struggle with constant underpayment from private insurance companies is a battle we continue everyday and hope for assistance and cooperation from patients and customers to aid us in remedying the situation so that we are able to continue to provide emergency and non emergency care for our community.  

  We are willing to help you in anyway possible to get this resolved with your insurance since it is our stance that they should have paid this in full.

  Thank you, 

  **************** 

  VP - Finance

  Customer response

  07/12/2023

   
  Complaint: 20217742
  
  I am rejecting this response because:
  1) I have ********** Blue Shield not Anthem 2) my plan does not have a maximum, they noted the amount charged was above the usual and customary rate for going .07 miles for 3 minutes and 3) ********** Blue Shield paid you a significant amount of money for the .07 miles 3 minute ride already!    I can understand youre having to deal with all types of state funded and private insurance companies and billing problems, however this particular charge is truly and utterly excessive and the dollar amount you received from ********** Blue Shield is more than enough to cover the service rendered. Please do not send to collections and please zero out the balance.

  Sincerely,
  
  ***************************

  Business response

  07/20/2023

  ****************, 

  After reviewing the payment we received from BCBS of Illinois (managed by Anthem), their EOB states that "Maximum benefit available for this service has been paid".  It is possible that translates to them processing the claim at Usual & Customary Rates, however insurance companies are required by law to produce proof how they determine what U&C rates are in our region.  After our appeal, they did not provide that.  Also, we are one of the lowest priced private ambulance companies in our *************** am not able to write off the balance for this claim.  I would urge you again to file a grievance with BCBS of Illinois and please include us on any phone calls or correspondence with them so that we may help you fight this underpayment.  

  Please contact me with any further questions or concerns.

  Thank you, 

  ****************

  VP Finance

  Customer response

  07/21/2023

   
  Complaint: 20217742
  
  I am rejecting this response because:

  Medic Ambulance is the only ambulance company that serves Solano County which has almost half a million people. This bill is grossly overcharged to patients like me with private insurance companies. (It would never be this high of an amount to a patient with state funded insurance program's i.e. Medi-Cal). I had filed an appeal and they stated the amount charged it is above the usual and customary rates. I will contact them again to see if their answer changes. I will also have to file a complaint with the *******************, Office of the ***************** ********** of ******** as I 100 percent believe this is extortion and it is not fair to me or any of ** in the county with private medical insurance. I will also contact Access ********** to help advocate for this balance billing business by ambulance companies to be outlawed in **********. 
  
  Sincerely,
  
  ***************************

  Customer response

  07/21/2023

   
  Complaint: 20217742
  
  I am rejecting this response because:

  Medic Ambulance is the only ambulance company that serves Solano County which has almost half a million people. This bill is grossly overcharged to patients like me with private insurance companies. (It would never be this high of an amount to a patient with state funded insurance program's i.e. Medi-Cal). I had filed an appeal and they stated the amount charged it is above the usual and customary rates. I will contact them again to see if their answer changes. I will also have to file a complaint with the *******************, Office of the ***************** ********** of ******** as I 100 percent believe this is extortion and it is not fair to me or any of ** in the county with private medical insurance. I will also contact Access ********** to help advocate for this balance billing business by ambulance companies to be outlawed in **********. 
  
  Sincerely,
  
  ***************************

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