Health insurance companies are raising rates. Employers are decreasingly providing health benefits. Bernie Sanders’ plan for expanding Medicare won’t reduce costs, many experts say.
But this is not a story about that. This is a story about a single, 12-minute ambulance ride.
Back in February, my daughter was in a rehearsal for a student musical at Edward R. Murrow High School in Midwood. She bumped her head on a piece of scenery. The school called an ambulance. The ambulance took her to Methodist Hospital in Park Slope exactly 4.5 miles away.
I just got the bill today: $2,056.95.
No ice pack. No treatment. Yet the ambulance company billed my health insurance company $2,056.95 for a fancy taxi ride from Midwood to Park Slope. Uber charges $14 for the same trip.
Now, the good news: I’m not on the hook for even a dollar of that bill. That’s also the bad news in this story. Everyone knows that it doesn’t cost $2,056.95 to transport a 14-year-old girl with a bump on her head from a school to a hospital two neighborhoods away. But the ambulance company and the health insurance company have worked it out so that both can benefit from inflated billing.
And to whom does that cost get passed on? To you or your employer (if you’re still lucky enough to have a boss that provides health care).
I couldn’t understand how a $14 Uber became a $2,056.95 ambulance ride, so I called my health care company, which paid out $1,686.70 of the ambulance bill. A man named Jermaine told me not to worry, I would not be billed for the remainder.
“It’s in network, so you won’t be balance-billed,” he said, inventing verbs. “The ambulance was sent by the hospital, which is in-network. We pick up 80%, and the hospital accepts that as payment in full.”
That’s weird, I said.
“It all depends on how the contract is set up,” he said. “It’s kinda crazy.”
I’m always amazed how honest people will be when they don’t know they’re talking to a journalist. So I called the ambulance company to see if I could learn more.
I got another candid man named Timothy, who said the vast majority of the ambulance cost — $1,946.70 — was the “base rate” for dispatching an ambulance. That sounded like a lot, so Timothy looked into it more. Apparently, my daughter’s bump required an “advanced level of service” because it was a “potentially major injury.”
A little knock on the head?
“A head injury allows us to send out an advanced level of service as opposed to basic life support,” he said. “That crew can provide more intervention because of their training. There might have been internal bleeding. Or she might have needed a neck brace. This was not just basic life support if she had a fever or a cough.”
Fair enough. But no one in that well-trained crew actually checked for internal bleeding. My daughter didn’t even get an ice pack (the school nurse provided that).
So in the end, she got a $2,056.95 bus ride from Midwood to Park Slope.
To me, the way the health care companies and the health care providers work is like a Mafia hit. The public doesn’t have to worry about it because it’s one crime family bumping off another crime family. But we do have to worry about it in the same way the cops had to worry about collateral damage from mob wars: there is a cost beyond the immediate hostilities. Yes, it’s one hand washing the other (and then overbilling for the hygiene replenishment procedure). But the public needs to be aware that our medical insurance costs are so high because insurance companies are being overbilled by health care providers who have to overbill because they’ll only get a portion of the money back.
No wonder health insurers in New York want to boost rates next year by an average of 17.3% for individual policies, according to data released Wednesday.
I’m certainly not the first person to point out our nation’s health care problem. Malcolm Sparrow at Harvard has written extensively about health care overbilling, arguing that it costs $270 billion a year — or roughly 10% of all health care spending. Steven Brill wrote a series of articles in 2013 in Time that pointed out that medical providers charge whatever the hell they want. “The only constant is the sticker shock for the patients,” he wrote.
Again, this isn’t about any of that. This is about a single ambulance ride. Though maybe it’s about a lot more than that.
Writer’s note: My daughter, by the way, is completely fine (and ended up winning an award for her performance two days later, by the way). Kudos to the school for taking every precaution lest her injury was worse than a layman could predict. She didn’t have a concussion, as it turned out. The nausea she experienced — which led to that diagnosis — was all experienced by that ambulance ride. Mine, too.
