Elizabeth Yoder's son, Darragh, was 15 months old in August when he developed what at first glance to his parents appeared to be a hand, foot and mouth disorder. General viral infection usually clears up in less than a week, but Darragh's condition worsened within a few days. His skin turned bright red. The blisters gave way to skin peeling off his face.
An internet search of his symptoms revealed that he had staphylococcal scalded skin syndrome, serious bacterial infection. Yoder drove the baby from his home in the small town of Mechanicsburg, Ohio, to Mercy Health Hospital in nearby Urbana.
Emergency room staff quickly confirmed Darr had scalded skin syndrome and told him he needed to be taken by private ambulance to Dayton Children's Hospital, about 40 miles away.
“I asked them, 'Can I take it?' Can I take him?'” Yoder said. “And they were like, 'Oh, absolutely not.'
So Yoder and her son got into the ambulance while Darrah was strapped into his car seat. The ambulance driver did not turn on the siren and was not driving particularly fast, Yoder said. The trip took about 40 minutes, she said. “It was a pretty simple transportation from point A to point B.”
Yoder has heard that ambulance rides can be expensive. But she didn't know how much her son's trip would cost.
Darragh was hospitalized for three days and recovered.
Then the bill came.
Medical procedure
During the trip, EMS crews monitored Darr's vital signs and the hospital's IV fluids and antibiotics, but he did not receive any other medical care, Yoder said.
Final bill
$9,250, including a $6,600 “base rate” for “special purpose vehicles” and a $2,340 mileage charge calculated at $60 for each of the 39 miles traveled. It also included $250 for the use of an intravenous infusion pump and $60 for monitoring Darrah's blood oxygen levels.
Problem: no insurancece, few protections
The children's hospital charged just $3,000 more for the baby's three-day stay than the ambulance company charged for the trip, Yoder said.
Darrah's family does not have health insurance, so they will have to pay the full cost of treatment. Their income is too high for them to qualify for Medicaid, a public health program that covers low-income residents, or the Ohio Children's Health Insurance Program, which covers middle-income children.
The Yoders belong to a Christian health care sharing ministry whose members contribute to a fund that helps them pay off medical bills.
Unlike health insurance, such arrangements do not offer participants negotiated rates with ambulance companies or other health care providers. And there are no state or federal bill protections that could help an uninsured patient in Ohio pay their ground ambulance bill.
The federal No Surprises Act protects those with insurance from large bills for air ambulance transport provided outside of their insurer's network agreements. But Ground ambulance services are not covered by law—and even if they had, it wouldn't have helped the Yoders because they didn't have insurance.
Patricia Kelmar, Senior Director of Health Campaigns for PIRGa national advocacy group, said the cost of ambulance services varies widely. She said she has seen per-mile charges vary from less than $30 to more than $80, and base rates vary significantly.
Some patients, such as those with traumatic injuries, require ambulances with highly trained personnel and advanced medical equipment, so it makes sense that such trips would be more expensive, Kelmar said. But patients are rarely told how much a trip will cost until they receive a bill.
Jennifer Robinson, a Mercy Health spokeswoman, said she couldn't comment on a specific patient's case, but said staff follow established medical standards. “When a patient requires a higher level of care, transfer by ambulance 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 the first hospital requested a high-level patient transport that required specially trained personnel.
“Our priority is always to ensure patients receive the highest quality care when they need it most, and we answer 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 he needed within the time frame set by his prescribing physician.”
Godden said the company will offer Yoder a “charity care” rate if the family qualifies.
Resolution
Yoder said she has discussed the bill multiple times with representatives of ambulance companies, including the possibility of providing charity care. They told Yoder the best deal they could offer was to reduce the total amount by about 40%, to $5,600, if the family paid it in one lump sum, she said.
After months of discussions, the family agreed to the deal, Yoder said. They transferred the payment to a new credit card, which gave them 17 months to repay without interest.
They negotiated payment plans with two hospitals that offered charity care discounts, bringing the total bill down to about $6,800.
The Yoders expect the distribution ministry to reimburse them for about 75% of the payments they make to hospitals and ambulance services.
Conclusion
Patients and their families should feel comfortable asking hospital officials whether the recommended ambulance company is in their insurance network and how much it will cost to go elsewhere, said Kelmar, a national expert on such bills. “Shouldn’t the hospital know about this?” she said. “I don’t think it’s such a heavy load.”
Kelmar said she doesn't want to discourage people from using the ER if a doctor says it's necessary. Once consumers receive a bill for a service, they can often negotiate a lower price, she said. It can help to find out how much the ambulance service accepts as payment under government programs. These rates are often much lower than the full cost patients see on their 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. Public health program pays for ambulance services base rate $413 for “special purpose vehicles” plus $5.05 per mile. Those rates would have totaled $609.95 for the transport portion of Darr's ambulance ride.
Yoder said she wished she could take Darr directly to the children's hospital. If she had skipped the local ER, she said, they would have arrived at the larger hospital sooner and she would have saved thousands of dollars.
But she didn't feel she had a choice about putting her son in the ambulance, she said. The doctor told her it was necessary, and hospital staff had already administered an IV. “I wasn’t going to yank his IV and just walk away,” she said.
Yoder said she remains uninsured because she hasn't seen any private insurance options that fit her family's circumstances. Regardless of who pays the ambulance bill, she believes the costs are too high. She understands that patients can often negotiate discounts, she said, “but you don't have to work as hard for it.”
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