Not Serious Enough To Turn on the Siren, Toddler’s 39-Mile Ambulance Ride Still Cost Over $9,000

Elisabeth Yoder’s son Darragh was 15 months old in August when he developed what, to his parents, initially looked like hand, foot and mouth disease. The common viral infection usually clears up within a week, but Darragh’s condition worsened for several days. His skin turned bright red. The blisters gave way to skin peeling off his face.

An online search for his symptoms suggested he was suffering from staph scalded skin syndrome, a serious bacterial infection. Yoder drove the toddler from their home in the small town of Mechanicsburg, Ohio, to Mercy Health Hospital in nearby Urbana.

Emergency room staff quickly confirmed that Darragh was suffering from scalded skin syndrome and said he needed to be transported by a private company ambulance to Dayton Children’s Hospital, a hospital about 40 miles away.

“I asked them, ‘Can I take him? Can I drive him?'” Yoder said. “And they said, ‘Oh, absolutely not.'”

So, Yoder and his son got into the ambulance, with Darragh strapped into his car seat. The ambulance driver did not activate the siren and did not drive particularly fast, Yoder said. The ride took about 40 minutes, she said. “It was a pretty simple transportation from point A to point B.”

Yoder had heard that ambulance rides could be expensive. But she didn’t know how much her son’s ride would cost.

Darragh was hospitalized for three days and recovered from his illness.

Then the bill arrived.

The medical procedure

During the ride, the ambulance crew monitored Darragh’s vital signs and had an intravenous line inserted at the hospital, carrying fluids and antibiotics, but he received no other medical treatment, Yoder said.

The final bill

$9,250, which included a “base fare” charge of $6,600 for “specialty care transportation” and a mileage charge of $2,340, calculated at $60 for each of the 39 miles of the trip. It also included $250 for the use of an intravenous infusion pump and $60 for monitoring Darragh’s blood oxygen.

The problem: no insurancethis, few protections

Children’s Hospital only charged about $3,000 more for the little child’s three-day stay than what the ambulance company had charged for the ride, Yoder said.

Darragh’s family does not have health insurance, forcing them to pay the full cost. Their incomes are a little too high for them to qualify for Medicaid, the public health program that covers low-income residents, or the Ohio Children’s Health Insurance Program, which covers moderate-income children.

The Yoders belong to a Christian health care sharing ministry, whose members pay into a fund that helps reimburse their medical expenses.

Unlike health insurance, these agreements do not offer their members negotiated rates from ambulance companies or other medical providers. And there are no state or federal billing protections that would help an uninsured patient in Ohio with a ground ambulance bill.

The federal No Surprises Act protects insured individuals from large air ambulance transportation bills provided outside of their insurers’ network agreements. But ground ambulance services aren’t covered by law — and even if they were, it wouldn’t have helped the Yoders, since they didn’t have insurance.

Patricia Kelmar, senior director of health care campaigns for PIRG, a national advocacy group, said ambulance costs vary widely. She said she’s seen per-mile fees ranging from less than $30 to more than $80, as well as base rates that differ significantly.

Some patients, such as those with traumatic injuries, need ambulances staffed by highly trained staff and advanced medical equipment, Kelmar said, so it makes sense that those rides would be more expensive. But patients are rarely informed of the cost of the ride until they receive a bill.

Jennifer Robinson, a spokeswoman for Mercy Health, said she could not comment on a specific patient’s case, but said staff followed established medical standards. “When a patient requires a higher level of treatment, ambulance transfer between facilities is the best practice to ensure appropriate care,” she said in an email to KFF Health News.

Kimberly Godden, vice president of ambulance company Superior Ambulance Service, said a doctor at First Hospital requested high-level transport for the patient, requiring specially trained personnel.

“Our priority is always to ensure patients receive the highest quality care when they need it most, and we respond to every call regardless of the patient’s ability to pay,” Godden said in an email. “Superior had the team and resources to quickly and safely move the patient to the higher level of care they needed within the time frame set by the treating physician. »

Godden said the company would offer a “charity care” rate to Yoder if the family qualified.

The resolution

Yoder said she has discussed the bill several times with representatives of the ambulance company, including the option of charity care. They told Yoder the best deal they could offer was to reduce the total by about 40 percent, to $5,600, if the family paid it as a lump sum, she said.

After months of discussions, the family finally agreed to the deal, Yoder said. They charged the amount to a new credit card, giving them 17 months to repay it interest-free.

They agreed to payment plans with both hospitals, which offered discounts on charity care that brought the bills down to a total of about $6,800.

The Yoders expect the Ministry of Sharing to reimburse them about 75 percent of the payments they make to hospitals and ambulance services.

Takeaways

Patients and their families should feel comfortable asking hospital staff whether a recommended ambulance company is in their insurance network and how much it will cost to travel to another location, said Kelmar, a national expert on the subject. “Shouldn’t the hospital know?” she said. “I don’t think it’s that heavy.”

Kelmar said she didn’t want to discourage people from taking an ambulance if a doctor deemed it necessary. Once consumers receive a bill for the service, she said, they can often negotiate the price down. It may be helpful to research what the ambulance service accepts as payment under government programs. These rates are often much lower than the full rates patients see on a bill.

If the family had been covered by Ohio’s Medicaid program, the ambulance service would have been paid far less than what it charged the Yoders. The public health program pays ambulance services a base rate of $413 for “specialty care transportation,” plus $5.05 per mile. Those fares would have totaled $609.95 for the transportation portion of the Darragh ambulance ride.

Yoder said she wishes she had driven Darragh straight to Children’s Hospital. If she had avoided the local emergency room, she said, they would have gotten to the larger hospital sooner and she would have saved thousands of dollars.

But she didn’t feel like she had a choice whether to put her son in the ambulance, she said. The doctor told her it was necessary and the hospital staff had already inserted an IV line. “I wasn’t going to take his IV out and leave,” she said.

Yoder said she remains uninsured because she hasn’t seen any private insurance options that fit her family’s situation. Regardless of who pays the ambulance bill, she thinks the charges were way too high. She understands that patients can often negotiate discounts, she said, “but you shouldn’t have to work so hard for it.”

Bill of the Month is a participatory survey carried out by KFF Health News And The Well-Being of the Washington Post which dissects and explains medical bills. Since 2018, this series has helped many patients and readers reduce their medical bills, and it has been cited in states, at the U.S. Capitol, and at the White House. Do you have a confusing or scandalous medical bill you want to share? Tell us about it!