The only thing on their mind was getting their daughter the care she needed.
“We were just trying to manage and get through so I wouldn’t have even thought to ask if the ambulance was covered,” remembered Amanda Mertens.
She wasn’t thinking of the medical bills when the doctors said her 15-year-old daughter, Liliana, had to be transferred to a different hospital. While they waited hours for an available ambulance, the family did offer to drive Liliana but were told she could only be admitted by an ambulance.
“It was almost more frustrating than stressful because I just wanted to be at the hospital I was going to have to stay at and they kept telling me it was going to be soon and it took hours,” Liliana Mertens said.
Eventually, the ambulance came and she got the care she needed. Months later, a reminder of the trip appeared in the Mertens’ mailbox in the form of a $4,700 bill.
“I thought they didn’t run my insurance, so I said, ‘Oh that’s weird,’” Amanda Mertens remembered.
The Mertens have private insurance and had met their deductible but they found out the bill was correct and the ambulance was out of their insurance’s network.
“She went 38 miles at $77.50 per mile which is almost $3,000 of the bill, that seems a bit excessive,” explained Liliana’s father Scott Mertens.
The family tried to appeal the bill but has continuously been denied.
“The insurance company has said, ‘We have a set rate of $695’. So, the insurance company has a number that they are willing {to pay} and the ambulance has a number that they are willing {to pay} and somehow I have to be the arbitrator,” Scott Mertens explained.
The family is frustrated that they are stuck with a bill for a service they had no say in.
“They are taking advantage of vulnerable people and we didn’t have the options to make decisions. We were in a very acute situation and we were vulnerable so we just did what we were told,” Amanda Mertens said.
Ambulance providers are also frustrated with the current process.
“It gets into a pretty lengthy cycle to collect funds for the services we’re providing. It’s definitely a challenging aspect being in the ambulance business,” said Dennis Cataldo, the president of Cataldo Ambulance Service.
Cataldo’s company has served the Boston area for nearly 50 years. He said the cost to deliver care has gone up, but the amount of money the insurance companies are willing to reimburse has not.
“I think the industry, not only here in Massachusetts, is pretty fragile right now; much more fragile than most people realize. People see ambulance bills $1,500, $2,000 and think that everyone in the ambulance business is making money hand over fist,” Cataldo said. “I can assure you that is not the case. This last 24 months has probably been the most difficult stretch in our industry’s history here in Massachusetts.”
When insurance companies do not fully cover the cost of services, the burden to collect payment is placed on ambulance companies.
Cataldo supports further regulation that will help ambulance providers get paid and save patients from high bills.
This is also something that Massachusetts Attorney General Andrea Joy Campbell is pushing for after hearing hundreds of complaints.
“This issue affects the most vulnerable. Those who are in desperate need of some type of care and so to call and then go to your provider and then maybe weeks or months later receive a bill that is in the thousands, it’s just not sustainable and of course not good consumer protection,” Campbell said.
Her office made recommendations last fall including creating a cap for out-of-network ambulance rides.
It’s something at least 16 other states have already established. The regulation would make ambulance bills lower and more consistent for patients and help create a more sustainable industry for ambulance providers.
“We have the ability to make sure that consumers when they are seeking an ambulance provider are not incurring thousands of dollars in a bill later,” Campbell said.
Without action, Campbell predicted the long-term impacts will have far-reaching consequences.
“We will see debt increase for residents in Massachusetts, which doesn’t affect just them but the economy here. There are definitely ripple effects inside the healthcare context and outside the healthcare context,” Campbell said.
In 2022, 31,000 Massachusetts residents were sent to collections for ambulance bills totaling more than $27 million, according to the report from Campbell’s office.
“We are saying to the state and to policymakers, ‘You got to fix the rate here, you gotta make it fair and reasonable,’” Campbell said.
The federal government passed the No Surprise Act to protect patients from other high medical bills from out-of-network providers. The law does not include ambulance bills so it has been up to states to set further regulation.
A few bills have been filed by Massachusetts state lawmakers in the last year that aim to reduce surprise ambulance bills. None have received significant action yet.
It’s a similar story in New Hampshire where the Mertens live and where they took the ambulance from.
New Hampshire patients had the highest rates of surprise ambulance bills with 81% of patients taking an ambulance from an out-of-network provider, based on a report released this year from the New Hampshire Insurance Department.
The department recommends state leaders prohibit balance billing and create out-of-network rates to relieve commercial insured consumers the “disproportionate” burden of funding the ambulance industry in the state.
The Mertens have managed to slightly lower their bill but believe they soon will have to pay the $4,000 bill. Beyond the bill, they want to continue to bring awareness to this issue impacting tens of thousands of people each year.
“We’re advocating for others moving forward because it’s just not right. It’s not the right thing to do,” Amanda Mertens said.
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