Inter-hospital transfer with out of network ambulance bill
Do I have any recourse if an out-of-network ambulance was utilized when an in-network one should have been used for a non-emergency inter-hospital transfer?
Last month, a family member was pink-slipped and taken into the local Emergency Room/hospital (in-network for our Insurance). After they were stabilized, the Hospital said they needed to be transferred (admitted) for higher care (admitted) to the regional hospital where a psychiatric unit was available.
We explicitly and directly explained our concern that both the destination hospital and the ground ambulance service were very expensive (we have already met both our in-network and out-of-network out of pocket maximums for the year due to many medical bills), and that our insurance would not cover it, however we we were told repeatedly that they were specifically ensuring that the transfer and admission would be preauthorized. We were told that the appropriate preauthorizations had been obtained and that it was covered by multiple individuals. We also received notification from our Insurance Provider that a preauthorization was approved.
We have now received a nearly $2k bill from the Ambulance Service Company, for the inter-hospital transfer (non-emergency transfer which we were told was mandatory and required.) – this is after our Insurance paid $800 based on the amount that Zelis says is “reasonable and customary”.
Included with the bill was a letter recommending that appeal/escalate based on the fact that “Emergency medical transportation should be in-network as you have no choice in determining which provider to use” and that “Ambulance rates are set and controlled legally by the State, therefore the insurance company should reimburse and allow all charges at 100% of the billed charge”. In addition, we found out later that there ARE multiple designated non-emergency secure behavioral transport providers that are in-network for the hospital AND our insurance, but were not used, and should have been (as opposed to a full blown medical ambulance).
In short, we are now being told we are on the hook for >$2k because a transfer was not requested correctly/pre approved by the hospital and they didn’t use an in-network provider.
