Sandy West’s report sheds light on a striking incident involving Jagdish Whitten, who, while jogging in July 2023, was struck by a car as he crossed a bustling street in San Francisco. At just 25 years old, Whitten recounted the moment he flipped over the vehicle and landed on the street, ultimately managing to reach the curb. Bystanders alerted emergency services, but Whitten opted for a lift from friends to the Helen Diller Medical Center, a facility run by the University of California-San Francisco. He reflected, “I knew that ambulances were expensive, and I didn’t think I was going to die.”
Doctors at the hospital treated him for a mild concussion, a broken toe, and various bruises. However, due to the nature of his injuries, they decided he should be transferred via ambulance to Zuckerberg San Francisco General Hospital, the city’s sole trauma center. Following a brief ride, Whitten was evaluated by ER doctors, confirmed he received adequate initial treatment, and was sent home.
Then came the unexpected bill.
#### The Medical Procedure
Traumatic injuries, which can endanger life or limb, require specialized medical care. For individuals who have been hit by vehicles, this might involve stabilizing vital signs, diagnosing internal injuries, and addressing broken bones or concussions. As a Level 1 trauma center, Zuckerberg Hospital is equipped to handle severe injuries with advanced capabilities for resuscitation and life support.
Whitten noted that, despite being treated and released at the first hospital, the protocol dictated that he be transferred to a facility better suited to manage his trauma. The physicians conducted extensive assessments, including a CT scan and X-rays.
#### The Bill Breakdown
The cost of his ambulance ride: **$12,872.99**. This included a base fee of **$11,670.11**, mileage charges of **$737.16**, **$314.45** for EKG monitoring, and **$151.27** for “infection control.”
##### Billing Challenges: The Surprise Bill Issue
Ground ambulance services function within a fragmented system, encompassing both private and public entities with a lack of uniform regulations, leading to many operating outside of insurance networks. Typically, patients have little say in which ambulance service is utilized in emergencies.
While some laws provide a buffer against out-of-network ambulance bills, Whitten’s situation fell outside these protections. Insured under his father’s employer-sponsored Anthem Blue Cross plan, Whitten was taken aback by the near $13,000 bill he received months post-incident. His father, Brian Whitten, was astonished by the ambulance bill from AMR, a major ambulance provider, especially after Anthem denied the claim, stating the transport required pre-authorization.
“It didn’t make a whole lot of sense to me because the doctor is the one who put him in the ambulance,” Brian remarked, questioning the system.
A spokesperson for UCSF emphasized that transferring patients to facilities equipped to provide the best care is a standard protocol in healthcare. Patricia Kelmar from PIRG noted that ambulance services operate largely outside the competitive marketplace of healthcare pricing.
According to a recent study, about **80%** of ground ambulance rides result in out-of-network billing, often leaving patients with hefty out-of-pocket expenses—even when they didn’t directly choose that provider. These instances are referred to as “surprise bills.”
#### The Aftermath
Brian Whitten appealed the insurance denial for his son, leading to Anthem’s eventual approval, which resulted in a payment of **$9,966.60** to AMR. Still, this left Jagdish with a remaining bill of **$2,906.39** for his ambulance ride. Frustrated by the customer service barriers, Brian struggled to contest the remaining amount. Ultimately, he paid it, fearing negative repercussions on his son’s credit report.
However, a surprising turn of events occurred when he later found that AMR had silently refunded the payment. AMR’s vice president of revenue cycle management mentioned that an audit indicated the care given did not meet critical care criteria, thus prompting the refund.
#### Conclusion
In light of the challenges patients face with ambulance billing, there’s an urgent call for more comprehensive regulations to protect consumers. Federal protections currently address some surprise bills linked to emergency services but exclude ground ambulance transports entirely. Patricia Kelmar highlights the necessity for change, suggesting that the current billing system disincentivizes timely ambulance utilization in emergencies due to potential financial burdens.
### **Call to Action**
As the dialogue on medical billing continues to evolve, experiences like Whitten’s can fuel necessary reforms within the healthcare system. If you have faced confusing or exorbitant medical bills, sharing your story can help drive change and awareness.
