No Surprises Act violation? Balance billed for necessary ambulance ride
My husband went to the local ER (New Hampshire) at the end of March for extreme pain due to worsening ulcerative colitis. While there, we determined that surgery to remove the entire colon (total colectomy) was necessary as he had failed multiple medications.
The hospital we were at does not have a specialized colorectal surgery team, so a hospital transfer was required. Due to the severity of his condition, he was unable to be discharged and driven the 2 hours to the transfer hospital (Dartmouth Hitchcock, also in New Hampshire). He was transferred via ambulance, and we were not given a choice about which ambulance service to use.
We recently received a few things:
A check for about $900 from the insurance (Blue Cross Blue Shield of Alabama) because the ambulance service was apparently out-of-network
An EOB stating we may owe about $8900 to the ambulance service due to the ambulance charges "exceeding the maximum allowed amount"
A bill for the full $9800 from the ambulance company
I called the ambulance company and they said to call our insurance and appeal based on "out of network balance billing". We called our insurance, and when my husband mentioned that there was a Federal law prohibiting this, were told that this case was an exception to the No Surprises Act (the service rep did not specify why it was an exception), but that we can appeal, which we will do.
My question is, IS this a violation of the No Surprises Act? My husband received medically necessary non-emergency medical transport. If it is a violation, do we have no recourse but to appeal with the insurance, or is there someone else we can contact as well?
submitted by /u/Anxious-Library-2789
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