A $52,112 Air Ambulance Ride: Coronavirus Patients Battle

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Last year, Congress abandoned its attempt to prevent surprise bills like this one, and coronavirus patients are now paying the price. Bills submitted to The New York Times show that patients often face surprise charges from out-of-network doctors, ambulances and medical laboratories they did not pick or even realize were involved in their care.

The plan to ban these kinds of bills was popular and bipartisan, and it was backed by the White House. It fell apart at the 11th hour after private-equity firms, which own many of the medical providers that deliver surprise bills, poured millions into advertisements opposing the plan. Committee chairs squabbled over jurisdictional issues and postponed the issue. Then the pandemic struck.

“She was intubated and on a ventilator when her providers felt it was necessary that she be transferred,” said Leslie Pierce, a division chief at the Pennsylvania Insurance Department, who handled the complaint that the patient submitted to the agency. “She had no decision in the selection process.”

In recent years, numerous states have enacted laws that restrict surprise out-of-network billing similar to the one Congress nearly passed. But states cannot regulate air ambulance fees. Courts have repeatedly interpreted the 1978 Airline Deregulation Act as protecting air ambulances from any state rate setting.

Only the federal government can intervene by amending the Airline Deregulation Act. The congressional package would have done that, even though the air ambulance industry has generally opposed this policy.

Ground ambulances, another source of surprise bills for coronavirus patients, have also largely escaped billing regulations. California passed legislation in 2017 that barred most types of surprise medical bills, but it excluded ambulances. The congressional deal that nearly passed also did not include ambulances. Legislators may be reluctant to regulate ambulances because many are run by local and municipal governments, which rely on the charges for revenue.