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NORTH CAROLINA: Crackdown on 'surprise' medical bills doesn't include ambulance costs

By Monica Laliberte, WRAL executive producer

5 On Your Side reporter

RALEIGH, N.C. — Congress is finally taking action to help curb surprise medical bills that patients receive for out-of-network charges, usually during a health emergency.

The No Surprises Act takes effect next January, but one bill not included in the legislation is the cost for an ambulance to a hospital.

A recent study found more than three out of four ground ambulance rides could result in an out-of-network bill.

“If we’re protecting patients from surprise billing once they get to the ER, why not protect them for the surprise bill on their way to the ER?” asked Chuck Bell, a Consumer Reports advocacy expert.

Ambulance providers and insurers often disagree on what is a fair rate for the life-saving service. Ambulance companies say they provide costly, labor-intensive services, and that insurance reimbursements are too low for them to be in-network.

So, like Donna Rosato of Consumer Reports, patients can face hefty bills.

"I had a cough that wouldn’t go away, and a mild fever spiked to 103 degrees," Rosato said. "I went to the emergency room, where I suddenly became unable to breathe. I was put on a ventilator for 10 days and spent a few weeks in an intensive care unit, where I slowly recovered from the flu and pneumonia."

When she finally got to go home, she was greeted with a pile of medical bills. The biggest was for the ambulance ride, which wasn't covered by her insurance company.

Some states are fighting back.

Ohio, New York, Colorado and Maryland passed laws against surprise medical bills that include restrictions on ground ambulance billing.

In North Carolina, consumers can ask insurers to review a claim. If it’s still not covered, they can contact the ambulance company and request they lower the charge and set up a payment plan.

“Talking to my insurer did the trick," Rosato said. "A few weeks later, I got a notice that Aetna paid the ambulance provider an additional $1,500, covering all but $283 of the original $3,000 bill."

Congress could eventually add protections from surprise ground ambulance bills to the No Surprises Act.

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