Surprise ambulance bill shocks Camas family

When their first child was born five weeks early, David Feng and Christy Shum, of Camas, knew their entry into parenthood might be a little more complicated than they’d imagined, but nothing prepared them for the unexpected maze of medical billing they would soon encounter. Theodore “Theo” Feng was born at PeaceHealth Southwest Medical Center in Vancouver in mid-July 2022. “He was born five weeks early and was in the NICU (neonatal intensive care unit), but he didn’t have too many issues,” Feng said. “He wasn’t eating, but that was pretty common.” That changed pretty quickly after Theo developed breathing problems. Doctors recommended respiratory support and put Theo on a high-flow nasal cannula for a short period of time. When his breathing problems continued to worsen, doctors switched to a high-flow continuous positive airway pressure (CPAP) machine. “They thought it was pneumonia, but it wasn’t,” Feng explained. Theo’s neonatologist told the new parents they would need to transfer their son to a specialist at Oregon Health & Science University (OHSU)’s Doernbecher Children’s Hospital, located 17 miles away in Southwest Portland. Because he needed full-time respiratory support during his transfer from PeaceHealth to Doernbecher, Theo needed to use Life Flight’s ground ambulance services. “Once he got transferred to OHSU, he was quickly diagnosed with separate heart and lung diseases,” Feng said. “He had a couple small holes in his heart and an undeveloped lung, so those two diseases contributed to his breathing (difficulties).” Baby Theo would spend two months in the Doernbecher NICU before finally coming home to Camas with his parents. But one month into his NICU stay, Feng and Shum received another unpleasant surprise — a $7,088 bill for that 17-mile ambulance ride. “We were in shock,” Feng said. “We know healthcare is expensive … but we had already satisfied all of our deductibles and out-of-pocket maximums.” The family’s insurance company, United Healthcare, agreed to pay around $1,000, which left the Camas family on the hook for more than $6,000. Feng and Shum contacted Life Flight and United Healthcare to try to resolve the unexpected medical bill. “They pointed fingers at each other,” Feng said. “United Healthcare said, ‘We didn’t have a contract with Life Flight, so we’ll reimburse what we feel is the real cost of transfer,’ and Life Flight said, ‘That’s not a fair cost of transfer since he had respiratory support the whole time in the rolling ICU (intensive care unit) ICU. You have to talk to your insurance company to cover more.’” The family appealed the insurance company’s decision to pay just one-seventh of the Life Flight ambulance bill. “Theo was transferred from PeaceHealth Southwest Medical Center to Doernbecher Children’s Hospital NICU due to multiple medical issues,” they told the insurance company in early November 2022, about two months after receiving the surprise ambulance bill. The family included a statement from Life Flight as well as from Theo’s cardiologist at Doernbecher, stating that the ambulance transfer was medically necessary and that there was no other way to have transported the infant from the Vancouver hospital to the nearby children’s hospital in Portland. “PeaceHealth, in communication with OHSU, determined that there was a need to transfer this patient due to the level of critical care required,” Dr. Jennifer Huang, Theo’s doctor at Doernbecher, wrote to United Healthcare on Oct. 21, 2022. “Life Flight was required, as no other mode of transportation could meet the demand for urgency that was needed for this hospital transfer.” On Nov. 10, 2022, United Healthcare responded to the insurance appeal and upheld their decision to pay one-seventh the total cost of the ambulance transport. “We understand the appeal to state that these services should be covered because they were medically necessary … A UnitedHealthcare … resolution analyst looked at the appeal, the information sent, our policies, and Theodore Feng’s health plan documents to make the decision,” the insurance company stated in the Nov. 10 letter to Feng and Shum. In the end, the insurance company said they had covered 100% of what they’d determined was the “allowed amount” of the cost for Theo’s Life Flight ambulance transport. “For emergency health care services provided by an out-of-network provider, the allowed amount is a rate agreed upon by the out-of-network provider or determined based upon the higher of: the median amount negotiated with the network providers for the same service; 100% of the published rates allowed by the Centers for Medicare and Medicaid Services for the same or similar service within the geographic market; (or) the amount that would be paid under Medicare for the same service.” The insurance company told Feng and Shum that it wasn’t saying Theo’s ambulance transport wasn’t medically necessary, just that they had a set amount they would pay for this service, regardless of the fact that the baby may have required a higher level of medical care during his ambulance transport. “They said, ‘We paid what’s fair,’” Feng said. Life Flight did try to help the family by setting up a payment plan, but couldn’t discount the charges connected to the intensive-care ambulance transport. “They do provide a payment plan, but it doesn’t reduce the total cost of the bill,” Feng said of Life Flight. “That’s the only way they can help.” Thankfully, today, baby Theo is thriving. “Theo is doing well now, so we have the same struggles as normal parents,” Feng said, adding that his family is incredibly grateful for the medical services their son received. “Make no mistake; we will forever be grateful to the paramedics and transport staff from that day,” Feng said. But the family also feels unduly burdened by the unexpected ambulance bill. “Our understanding is that there are (few) regulations regarding surprise ground ambulance bills,” Feng said. “We’re hoping that raising awareness with the public will assist in pressing the issue forward with our elected leaders.” Ground ambulances left out of No Surprises Act The situation Theo’s family faced is, unfortunately, not unique. In fact, studies have shown that Americans who seek medical care — including one in five emergency department patients and up to 16% of those who visit in-network hospitals — know the pain of receiving a surprise medical bill after inadvertently receiving care from an out-of-network doctor, hospital or provider like Life Flight. Congress had been debating how to best address these surprise medical bills for years before deciding to include legislation in the 2020 omnibus spending bill. In July 2021, President Joe Biden directed Health and Human Services to prioritize the implementation of the new law. “No one should have to go bankrupt over a surprise medical bill,” U.S. Secretary of Health and Human Services Xavier Becerra stated in a news release issued in September 2021. “We are building on our ongoing efforts to deliver on President Biden’s Competition Executive Order by promoting transparent out-of-network costs, exposing inflated health care costs and taking consumers out of the middle ultimately to help lower their bills.” Consumer advocates, patients and others soon discovered Congress had left one of the main sources of these surprise medical bills – those connected to ground ambulance services — out of the No Surprises Act. As the American Academy of Professional Coders (AAPC), a national association for medical coders has noted, despite the fact that nearly 80% of all ground ambulance rides result in the type of unexpected medical bills the No Surprises Act, which went into effect on Jan. 1, 2022, was supposed to protect against, the “sheer complexity” of ground ambulance billing, with a web of ambulance providers ranging from local fire departments and nonprofits to for-profit companies and hospitals, made it tough for Congress or the Biden-Harris Administration to include in the No Surprises Act. “The sheer variety of ways that ground ambulances are currently owned, operated, and paid for make it impossible to regulate the service as a single entity as things stand,” an AAPC article explained in January 2022. “The complexity of working with local governments was one reason why ground ambulance coverage was excluded from the (No Surprises Act).” The Act did, however, include a requirement that federal agencies form an advisory committee to review ground ambulance “surprise” billing and find a way to better protect patients from these types of unexpected fees. Patricia Kelmar, senior director of the national Public Interest Research Group (PIRG)’s health care campaigns, is the consumer representative on that advisory committee. “There is a federal Ground Ambulance and Patient Billing Advisory Committee currently tasked with addressing this problem,” Kelmar told The Post-Record. “I am also working with college students at WashPIRG who are working on this campaign — gathering petition signatures and meeting with state legislators.” In an article she wrote for the U.S. PIRG’s website in December 2022, Kelmar noted “studies show about half of emergency ambulance patients with insurance are at risk of receiving a surprise medical bill” and said that, although 10 states current have laws on the books to protect patients insured by state-regulated health plans from these out-of-network ambulance bills, “that means that 60% of those who get their insurance coverage through a self-funded plan offered by their employer are left unprotected” even in states that have tried to address the issue. “Insured patients need a federal solution, modeled after these state laws, to ensure protection across all 50 states,” Kelmar stated. The U.S. PIRG is currently gathering stories about surprise ambulance billing to bring to the Congressional advisory committee. “These personal experiences help decision makers understand exactly how this issue impacts their communities,” Kelmar stated. To share a personal story regarding surprise ground ambulance billing, visit tinyurl.com/yhewvjyv Washington students take on issue, lobby legislators University of Washington senior Parnian Karimi is the board vice chair of the WashPIRG Students group and coordinator for WashPIRG Students’ affordable healthcare campaign. Four years ago, when Karimi first joined the student-run WashPIRG, the group was mainly focused on the high cost of prescription drugs. In 2022, the group helped pass a bill that will create a prescription drug affordability board to oversee new prescription drug price limits to better protect Washingtonians. This year, WashPIRG Students has shifted its affordable healthcare focus toward ending surprise ground ambulance billing – an issue Karimi said is impacting Washingtonians of all ages and backgrounds. “There are a mountain of stories,” Karimi said of Washingtonians who have either been impacted by a surprise ambulance bill or those who actively try to avoid taking an ambulance — even during an emergency situation — because they know they can’t afford the cost. “That’s something I see in my generation,” Karimi, 22, a biology major at UW who is currently applying to medical schools to be a doctor. “There is a fear of calling for an ambulance.” Karimi and her peers at WashPIRG Students have heard from hundreds of people who have been, or worry they will be, stuck with a costly bill after taking an ambulance. “Calling an ambulance can mean the difference between life and death in an emergency,” the WashPIRG Students’ group states on its affordable healthcare campaign website. “Nobody should be scared to call an ambulance out of concern for costs. The problem is that patients themselves generally don’t choose their ambulance service. … Studies show about half of emergency ambulance patients end up with a surprise medical bill from an out-of-network charge for the transportation services, and it’s not cheap. … That’s why we’re working to include ground ambulances in Washington’s No Surprises Act, which exempted ground ambulances.” When the WashPIRG students approached state legislators earlier this year, they were met with open ears. “The first legislator we talked to immediately said, ‘This happened to my wife,’ and every legislator we’ve talked to has agreed with us that this is an important issue,” Karimi said. The students have not been able to find a legislator willing to sponsor a bill that might end surprise ground ambulance billing in Washington state, but Karimi said they are hopeful they will in the future. The WashPIRG Students leader encourages Washingtonians impacted by these types of surprise ambulance bills to contact their own legislators and tell their personal stories. “Stories are always helpful,” Karimi said. “You can tell them to your legislator … write a letter to the editor … or mobilize people in your community. Showing support from a group is incredibly impactful.” The WashPIRG Students group often hosts trainings to help people understand how they might be able to impact the policymakers in their local areas and throughout the state. “We want students around Washington to remember that they have a direct line to their legislators,” Karimi said. “Get the numbers to your legislators’ offices and call them. Speak to their assistants. Get together with your clubs or peers and email postcards or letters (to legislators). Go to Olympia and ask for a meeting. Or ask for a Zoom meeting. Go to your legislators’ offices. Attend protests and go to community meetings. … We want students to know: You have so much power and there is so much you can do.” Karimi encourages Washingtonians who want to help make positive changes in their own communities to keep a positive outlook. “We see negative news all the time and it can be hard to not get sucked up in it,” Karimi said. “But there are solutions to these problems. We can make tangible changes. Things are not hopeless.” To learn more about WashPIRG Students, visit WashPIRGstudents.org.

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