Complaints

• Initial Complaint

  04/27/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 12/22/2022 Medic Ambulance took me to **********************. I had an obvious trauma to my back, evident both from what happened, which I told the EMT's, and my symptoms, which included severe pain in my back and inability to move. Instead of taking me to *****************, which is the same distance, which Medic Ambulance lists as a base hospital for ****** country, and which has a trauma center, they took me to ****** (which is not able to treat trauma) depositing me in an easy chair, not a stretcher, thereby endangering my back and putting me at risk of paralysis, and victimizing me with additional enormous costs for the transfer, which happened shortly after. I had WV Medicaid and a supplemental insurance at the time, and was visiting my parents, both of whom had health problems, to help them move into their home. After my back break I was unable to even fly back home for more than a month and was unable to work for several months, depleting my savings. I notified Medic Ambulance of all of my insurance coverage. They declined to charge Medicaid, only charging my supplementary insurance, which paid ****** despite multiple appeals. This process just concluded in March, largely due to Medic not following up with them. In WV the ambulance company would have negotiated with the insurance company, but medic ambulance charged me 2874 for the initial ride and 4152 for the transfer, after insurance. Both bills include numerous outrageous charges (e.g. 167 dollars for "decontaminate", which operations confirmed amounts to briefly wiping down the ambulance with an antiseptic wipe) and 44 dollars for "advanced PPE", which operations confirmed is a face mask and gloves (under a dollar to buy). Medic is now threatening to send this bill to collections. I have no assets and little income. Medic has been beyond inhumane and unjust. Hopefully too many people have not died or suffered permanent disability trying to avoid the hardship these bills cause.

  Business response

  05/09/2024

  On the morning 12/22/22; We received an emergency call to which Medic and Vallejo Fire responded. After the assessment, the fire department personnel and Medic staff decided the patient needed to be transported to the closest hospital which in this case was Sutter Solano, in *******. To be clear, these hospitals are not in the same city and are not the same distance from the pick up location. Later that afternoon the patient was transported to the other hospital mentioned in the complaint. The only information we were given on insurance was for the insurance Caresource, as per our crew. The hospital face sheets didn't have anything nor state that the patient had Medicaid. The insurance underpaid one of the transports, and  for the other transport the patient insurance applied the balance to the patient's deductible, which would be the patient responsibility to pay. In March 2024, we discounted the bill by 20% after receiving a hardship request from the patient. The patient was still upset about the bill, and  at this point was when we were advised of the Medicaid insurance being active at the time of the incident, as per the patient. We asked for that information and on April 9th 2024,  the Medicaid information was provided. We cannot check eligibility due to the address we have doesn't match the patient address Medicaid has on file. We have asked the patient to provide the proof of Medicaid eligibility at the time of the incident. We have yet to receive the proof of eligibility and will now be attempting to bill with the Medicaid information we were given, without knowing if pt was actually eligible. Our Billing Supervisor and patient have been in contact via email the entire duration.

  Customer response

  05/12/2024

   
  Complaint: 21635817
  
  I am rejecting this response because: 

  When Medic Ambulance showed up on 12/22/2022 I had every sign of a back break- I couldn't move and had extreme pain in my back such that I could barely even talk from falling down the stairs and landing on my back. This was communicated to the EMT's during the assessment. There were no fire truck or fire personnel present, and this would not relate to my bill from Medic in any case. There is less than five minutes difference in driving time from my pickup location to Sutter Solano vs Northbay. A back break is a trauma and always severe due to risk of damage to the spinal cord. Medic routinely picks up people with life-threatening trauma, are in a sense trauma specialists, and they are aware of the services each hospital is able to provide.  Northbay has a trauma center but ****** does not. As a result ****** does not have the equipment to assess the severity of a back break, the personnel to intervene were the break to be encroaching on my spinal cord (which could result in permanent paralysis), or the equipment to monitor and care for a back break. I was offered no choice in hospital, and Medic, who was familiar with both hospitals and their facilities, rather than making the choice that was best for me, took me to ******, exposing me to undue suffering and putting me at risk of paralysis. For my transfer to Northbay by Medic after I was consequently charged more than ***** dollars, a rate of more roughly ****** dollars per hour. My insurance applied an amount equal to the amount paid for the initial trip to the deductible for this transport, so it applied to only a portion of the bill, not leaving the entire thing as my responsibility as suggested by Medic. Medic despite my regularly contacting them and assisting in the process took more than a year to process my insurance claim, delaying the submission of my income and asset-dependent hardship application, which otherwise would have reflected my having been incapacitated for five months without income, which depleted my savings. I have requested to appeal the hardship application multiple times and have received no response and been told will send the bill to collections if not paid.  I am currently at the ************* poverty line so am still in hardship, and I should never have been taken to ****** and never have been charged such horrendous amounts to begin with. I had told a staff member at Medic about my Medicaid shortly after my injury but was only told in April of 2024that Medic did not my Medicaid information recorded.  I immediately sent Medic my Medicaid claim information and have received NO correspondence from them since. I sent them an email on May 9th to follow up and have still received no reply. I then contacted my Medicaid office, who told me that any discrepancies in address should not be a barrier to claim submission (so I don't know what the problem is regarding this.) After I submitted my Medicaid information to Medic and without my receiving any information whatsoever about whether they planned to bill Medicaid Medic also sent me a bill for my transport to ****** for the amount mentioned in my complaint that said it must be paid immediately. I do not know the exact amount for the transfer bill, only that they previously sent me a bill for over ***** dollars for this. Currently I anticipate at least ***** dollars total in bills (even after the 20% "discount"). This would pose an enormous hardship on me- I am currently surviving on the bare minimum, as Medic ambulance is aware, and have no assets. This amount is more than twice my income after expenses of daily living for an entire year.  The charges on my bills are beyond outrageous as mentioned (e.g. 166 dollars for briefly wiping the ambulance down with an antiseptic wipe, something that should be standard practice).  Additionally, in other states I never would have been balance billed. I have been exposed to enormous stress and suffering in this process which has further impacted my health. I demand that my bill be reduced, following whatever actions Medic takes with WV Medicaid, to a reasonable amount rather than my continuing to be victimized and arbitrarily charged despite the fact that I did not receive optimal care, and the bills are the result of a transport, wasting time and endangering my health, to a hospital that could not help me. 

  
  Sincerely,
  
  Kestrel *************************

  Business response

  05/16/2024

  As stated, we are attempting to bill. We have attempted 2 phone calls since May 9th and left voicemails with no response. We are still requesting the proof of Eligibility at the time of the transport. The system will not allow us to verify eligibility for the date of service because the information we have is apparently different from their database; which could affect the processing of the claim we are submitting. If/When we receive the proof of eligibility we will be able to work with you further. So if you can please provide that ASAP. Regarding treatment, our crew followed Solano County protocols for your treatment; if you have any further questions regarding this you can call our offices to speak to our QA Department as we cannot provide treatment information via a public platform. Our phone number is ************. Thank you for your time.

  Customer response

  05/21/2024

   
  Complaint: 21635817
  
  I am rejecting this response because: 

  According to all indications I should have been taken to NorthBay, or at the very least been given a choice, given Medic's knowledge of transfers and the medical facilities of both. If that is not in the protocol I would question what type of care Medic Ambulance really provides. While I am glad Medicaid is being billed I received a total of ONE phone call (which I missed due to being at work) and one message, in total, carried out six hours before Medic's BBB response was sent. I then received an email message saying that Medicaid has been successfully billed although a response has not yet been received from them. It also said the claim will likely be denied due to the fact that it was not submitted within a year. However, it was Medic Ambulance's responsibility to record information given and inquire as to full insurance coverage in a non-emergency situation. Also, because the claim took so long to process due to Medic not following up with my other insurance,  Medicaid could not have been billed prior. The person who emailed me informed me that my rates will be dropped to Medicaid rates but I will still likely as mentioned be responsible for the bill. While I welcome any drop in the bill I will await the final bill.  Hopefully it is just and I don't need to file another complaint/ follow up with additional regulatory bodies. 
  
  Sincerely,
  
  Kestrel *************************

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