Traumatic injuries are those that threaten life or limb, and some facilities specialize in providing care for them. For someone hit by a car, that can include<\/a> stabilizing vital signs, screening for internal injuries, and treating broken bones and concussions. Zuckerberg Hospital is a Level 1 trauma center, meaning it can provide any care needed for severely injured patients.<\/p>\n In emergency medicine, it is standard to transfer patients to centers best equipped to provide care. Ambulances are typically used for transfers because they are able to handle trauma patients, with tools to aid in resuscitation, immobilization, and life support.<\/p>\n At the first hospital, Whitten said, doctors performed a thorough workup, including a CT scan and X-rays, and advised him to follow up with his primary care physician and an orthopedic doctor. He was evaluated at the second hospital and released without additional treatment, he said.<\/p>\n The Final Bill<\/strong><\/p>\n $12,872.99 for a 6-mile ambulance ride between hospitals: a $11,670.11 base rate, $737.16 for mileage, $314.45 for EKG monitoring, and $151.27 for \u201cinfection control.\u201d<\/p>\n The Billing Problem: Surprise Bills Are Common With Ground Ambulances<\/strong><\/p>\n Ground ambulance services are operated by a hodgepodge of private and public entities \u2014 with no uniform structure, or regulatory oversight, for billing \u2014 and most function outside insurance networks. Patients don\u2019t typically have a choice of ambulance provider.<\/p>\n There are state and federal laws shielding patients from out-of-network ambulance bills, but none of those protections applied in Whitten\u2019s case.<\/p>\n Whitten was insured under his father\u2019s employer-sponsored health plan from Anthem Blue Cross. So when he received a nearly $13,000 bill months after his short transfer ride, he sent a photo of it to his dad.<\/p>\n Brian Whitten said the bills from the two hospitals \u2014 and the family\u2019s out-of-pocket responsibility \u2014 were in line with what he had anticipated. But he was stunned by his son\u2019s ambulance bill from AMR, one of the nation\u2019s largest ambulance providers. Anthem Blue Cross denied the claim, saying the ambulance was out-of-network and required pre-authorization.<\/p>\n \u201cIt didn\u2019t make a whole lot of sense to me, because the doctor is the one who put him in the ambulance,\u201d Brian Whitten said. \u201cIt\u2019s not like somehow he just decided, \u2018Hey, can I take an ambulance ride?\u2019\u201d<\/p>\n Kristen Bole, a UCSF spokesperson, said in a statement that the health system\u2019s standard of care is to stabilize patients and, when appropriate, transfer them to other medical facilities that are most appropriate to care for patients\u2019 needs, adding that ambulance transfers between hospitals are standard practice.<\/p>\n While the medical system at large relies on negotiated prices for services, ambulance services operate largely outside of the competitive marketplace, said Patricia Kelmar, senior director of health care campaigns for PIRG, a nonpartisan consumer protection and good-government advocacy organization.<\/p>\n Ambulance transfers between hospitals to ensure the highest quality of care available are fairly common, Kelmar said. And with many hospitals being purchased and consolidated, it would follow that the number of ambulance transfers between facilities could increase as specialized medical units at any given hospital are downsized or eliminated, she said.<\/p>\n According to a study<\/a> of private insurance claims data conducted in 2023, about 80% of ground ambulance rides resulted in out-of-network billing.<\/p>\n Generally, out-of-network providers may charge patients for the remainder of their bill after insurance pays. In some cases, patients can be on the hook even when they did not knowingly choose the out-of-network provider. These bills are known as \u201csurprise\u201d bills.<\/p>\n \u201cIt\u2019s a financial burden, a significant financial burden,\u201d said Kelmar, who is a member of the committee created to advise<\/a> federal lawmakers on surprise bills and emergency ambulance transportation.<\/p>\n Eighteen states have implemented laws regulating surprise ambulance billing. A California law cracking down on surprise ambulance billing took effect on Jan. 1, 2024 \u2014 months after Jagdish Whitten\u2019s ambulance ride.But Kelmar said those state laws don\u2019t really help people with employer-sponsored insurance, because those plans are beyond state control \u2014 which is why federal legislation is so important, she said.<\/p>\n As of 2022, federal law protects patients from receiving some surprise bills, especially for emergency services. But while lawmakers included protections against air ambulance bills in the law, known as the No Surprises Act<\/a>, they excluded ground ambulance transports<\/a>.<\/p>\n The Resolution<\/strong><\/p>\n Whitten\u2019s father filed an insurance appeal on his son\u2019s behalf, which Anthem granted. The insurer paid AMR $9,966.60.<\/p>\n Michael Bowman, a spokesperson for Anthem, said AMR had not submitted all the information it required to process the claim, leading to the initial denial. After consulting with AMR, Anthem paid its coverage amount, Bowman said.<\/p>\n But the insurer\u2019s payment still left Whitten with a $2,906.39 bill for his out-of-network ambulance ride. Brian Whitten said he called an AMR customer service number several times to contest the remaining charges but was unable to bypass its automated system and speak with a human.<\/p>\n \u201cI couldn\u2019t find a way to talk to somebody about this bill other than how to pay it, and I didn\u2019t want to pay it,\u201d he said.<\/p>\n Unsuccessful and frustrated, Brian Whitten paid the remaining bill in January 2024, he said, concerned it would be turned over to a collection agency and hurt his son\u2019s credit \u2014 and his well-being.<\/p>\n There was one more twist: He was shocked when he later reviewed his credit card statements and discovered that AMR had quietly but fully refunded his payment in October.<\/p>\n \u201cIt\u2019s amazing that he got his money back,\u201d Kelmar said. \u201cThat\u2019s what\u2019s shocking.\u201d<\/p>\n In a statement, Suzie Robinson, vice president of revenue cycle management with AMR, said the company\u2019s third-party billing agency regularly performs audits to ensure accuracy. An audit of Jagdish Whitten\u2019s bill \u201crevealed that the care provided did not meet the criteria for critical care,\u201d Robinson said, which prompted the full refund.<\/p>\n Robinson said audits indicated fewer than 1% of its 4 million medical encounters annually are billed incorrectly.<\/p>\n The Takeaway<\/strong><\/p>\n Robinson said patients who feel that AMR has billed them incorrectly should contact the company via email.<\/p>\n For patients in need of an ambulance in an emergency, there are few protections \u2014 and usually few options: Sometimes you don\u2019t have a better choice than to get in.<\/p>\n Federal protections<\/a> require that health plans cover certain surprise bills, with patients paying only what they would if they had received in-network care. Expanding those protections to ground ambulance bills would require Congress to act.<\/p>\n Ambulance providers deserve to be appropriately compensated for their vital role in our medical system, Kelmar said. But the system as it stands almost incentivizes providers to charge a higher rate, which can lead to surprise billing and financial hardship for patients and their families, she said.<\/p>\n Kelmar said she worries not just about the debt those bills create for consumers but also that people may decline vital ambulance transportation in an emergency, for fear of getting hit with an exorbitant bill.<\/p>\n \u201cWe just need to bring some sense back to the system,\u201d she said.<\/p>\n Bill of the Month is a crowdsourced investigation by\u00a0<\/em>KFF Health News<\/em><\/a>\u00a0and\u00a0<\/em>The Washington Post\u2019s Well+Being<\/em><\/a>\u00a0that dissects and explains medical bills.\u00a0Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share?\u00a0<\/em>Tell us about it<\/em><\/a>!<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n![](\"https:\/\/fctuckerbatesville.com\/wp-content\/uploads\/2025\/02\/Whitten_BOTM_02-resized-scaled.jpg\")
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