TEXAS VIEW: An ambulance should bring help, not a shocking billTHE POINT: Texans shouldn’t have to check their bank balance before deciding whether they can afford to call for an ambulance.

People don’t call for an ambulance because they want to. They call because they are facing a life-and-death medical emergency and don’t know where else to turn. Once help arrives, it should be the first step to recovery, not a ride to financial pain and worry down the road.
But that is what sometimes happens in Houston and across Texas because of a loophole in the state’s recently passed law to protect consumers from surprise medical bills.
An investigation by Houston Chronicle reporter Jenny Deam found that some people who make a 9-1-1 call for urgent medical assistance are being hit with four-figure ambulance charges they thought would be covered by their insurance. Depending on the policy, the consumer can be on the hook for some or all of the costs.
Most people have learned to navigate the “in-network,” “out-of-network” restrictions for routine medical needs. But that isn’t something most of us think about when calling for an ambulance, and it shouldn’t be.
Deam’s reporting found that all city-run ambulance services in Houston, the nation’s fourth-largest city, are out-of-network for all insurers, creating the likelihood of the very definition of a surprise medical billing.
The best hope for fixing the problem is to revisit the issue in the session of the Texas Legislature that begins Jan. 12. In the meantime, ambulance operators, insurance companies and other involved parties must do what they can to help consumers cut through the red tape and resolve billing disputes quickly.
Take the case of Michael Schwab, whose 1-year-old daughter suddenly went into convulsions at the family’s west Houston home. Deam reported that the seizure had ended by the time the ambulance arrived but in an abundance of caution, the girl was transported to Texas Children’s Hospital in Katy, six miles away, for a full exam.
When the ambulance bill arrived from the city, he was in for a shock: He owed $1,976.92. And because it was out-of-network his insurance plan didn’t cover any of it. As Schwab tried to navigate the system, he said the bill was turned over to a collection agency.
Things eventually worked out for Schwab as his daughter’s health scare was likely caused by a childhood viral infection with no complications. And Boon-Chapman, the company that administers his employer’s health plan, stepped in to negotiate the bill.
Nyle Leftwich, CEO of Boon-Chapman, said “99.8 percent of the time” the provider settles, usually agreeing to take some percentage of the federal Medicare rate for the treatment.
That’s how it should work, but too often doesn’t. The process can leave people arguing with the insurance company on one hand and the ambulance bill collectors on the other, while still coping with the emergency that prompted the 9-1-1 call in the first place.
The good news is that state Sen. Kelly Hancock, R-North Richland Hills, who has led the fight against surprise medical billings since 2009, says he and other lawmakers are ready to look at closing the ambulance-sized loophole when the Legislature convenes next month.
Hancock’s work on the 2019 Texas law sought to fix part of the problem by prohibiting doctors from sticking patients covered by state-regulated policies with bills that insurance companies refused to pay, requiring instead that the providers and insurers work out any differences over in- or out-of-network particulars themselves.
The legislation, however, didn’t cover ambulance bills because Hancock said there hadn’t been a lot of complaints about the issue filed with the Texas Department of Insurance and that ER costs and out-of-network billings had been the priority.
Gerard O’Brien, CEO and founder of ORION EMS, one of Houston’s largest private ambulance companies and president of the Texas Ambulance Association, told Deam that ambulance companies tend not to join insurance networks because they find in-network rates too low to be sustainable for their businesses.
He did say, however, that his industry is open to working with legislators to look at current pricing practices and try to come up with a solution that is “reasonable” for his members and the industry at large.
All sides need to come to the table during the session and work out a solution. Texans shouldn’t have to check their bank balance or flip through pages of their insurance policy before deciding whether they can afford to call for an ambulance.