ATHENS, Ga. — A family said it was left with a $3,000 bill for ambulance services after one of the largest ambulance companies in the southeast ended its relationship with one of the largest insurers.
This month, thousands of bills went out to people who had to take an ambulance ride to save their life after National Ambulance dissolved its contract with Anthem Blue Cross Blue Shield.
Kevin Todd said his family was part of that group after they needed an ambulance when his 2-week-old infant's heart stopped. His infant, Lawrence, was in his arms when he went into cardiac arrest.
"The way I described it to the doctors at the ER was, he just went 'Casper the Ghost' on me. He went completely pale," Todd described.
Todd is a firefighter and paramedic, and while his wife Catherine called 911, he started CPR.
"I took all those emotions I had and shoved them to the side and thought, 'I can't be dad right now; I have to try and save him,'" he recalled.
Halfway through their nine-mile ride on the ambulance to the hospital, Kevin said Lawrence "started gasping for breath." Doctors had to perform open heart surgery on Lawrence when he made it to the hospital.
"Lawrence's recovery has been nothing short of a miracle," Catherine said.
But the celebration of that miracle has been marred because the family is now dealing with a $3,000 bill -- and their insurance would only pay the out-of-network rate because the contract between National Ambulance and Anthem Blue Cross Blue Shield dissolved just days before Lawrence's emergency.
"How can you have an insurance company that says, 'well, your son died in your arms, and you needed an ambulance, and we are not going to cover that,'" he asked.
National EMS and Anthem Blue Cross Blue Shield couldn't reach a deal -- so both just stopped working together. For any emergency that happened after July 1, patients are on the hook for thousands of dollars.
"It is important to understand that ambulance services – like most health care services in the United States – are supported on a fee-for-service basis," a spokesperson for National EMS/ Priority Ambulance said. "We are not funded by taxpayer dollars."
The company said they rely on "reimbursement from private insurance companies like Blue Cross Blue Shield (BCBS), federal and state programs like Medicare and Medicaid (which are already proven to reimburse at or below the actual costs of providing service) and, at a much smaller amount, from patients."
According to the National Academy of Public Administration, a non-profit, only 11 states in the U.S. actually list EMS as an essential service.
National EMS said they had not received an increase in reimbursement rates from Anthem in three years. In that time, Social Security Administration cost-of-living rates increased by 5.9% in 2022 and a total of 8.8% over the last three years.
"This inflation impacts our operating expenses, including fuel costs and wages to our EMTs and paramedics, saving lives in the field," the company added.
It said it was forced to go out of network on June 21, 2022, to continue to "cover the costs of providing service to communities."
Regarding the Todd family, the company broke down the bill. They said the bill starts with "a base rate at the Advanced Life Support 2 (ALS2) level" because of the life-saving measures needed.
The company then said a mileage rate is added to "cover fuel costs and a small cost for disposable medical supplies. Anthem paid approximately 40% of the initial total bill. Once that payment was received, National EMS discounted the remaining out-of-pocket amount by 50% to $919.37. Payment plan options have been offered to the family."
A spokesperson for Anthem Blue Cross Blue Shield said,
"Anthem Blue Cross and Blue Shield in Georgia is constantly working with healthcare providers across Georgia to help ensure broad access to affordable healthcare. However, despite our best efforts there are some healthcare providers, including some ambulance services, that choose not to participate in our networks, and therefore may attempt to charge amounts in excess of Anthem’s payments."
With EMS not considered an essential service in Georgia, it's up to consumers to decide what company they want to do business with. The problem is, in an emergency, nobody has that choice.