I'm sorry to hear about the problem you are having. Unfortunately many health systems often employ a mix of in-network and out-of-network staff and services across all types of services. This is often a way to charge more than they know the insurance company would be willing to pay. This is why I ask every provider (all doctors, nurses, etc.) whether they are in my network, even if they all practice in an in-network hospital, and have an in-network ambulance service on speed dial.
If you save $1,000.00 by finding an in-network ambulance service and putting them in your phone and this takes 6 minutes, this could be the one time in your life that you ever made $10,000 an hour!
What you can do to remedy the situation depends on your specific coverage. Here are my recommendations based on career experience in health insurance:
1) Get a copy of your policy's Benefit Booklet. Emergency care is sometimes treated differently.
This document is different than your enrollment materials, and spells out in detail what services your plan does or does not cover, and under what circumstances. For example, my benefit booklet describes what I am covered for in terms of ambulance and hospital services, how the coverage differs based on whether it is an emergency, under what circumstances these services are not covered, and a disclaimer about how out-of-network benefits are paid compared to in-network coverage.
2) If you are covered and submitted the claim yourself, call your insurance company.
Sadly, if you submitted the ambulance claim yourself because it was out-of-network, it is entirely possible that your insurer simply did not connect the dots and realize that this service was connected to the other services that were provided on an emergency basis. Many insurance companies are still in the IT dark ages and are simply unable to make those types of connections automatically. It is possible that they treated the claim as if it were a separate event and not an emergency.
Not covered? It's not over yet
If you are not covered under these circumstances, you may be out of luck. While the extra cost was a surprise to you, they would be within their contractual rights to only pay what was specified in your benefits. This is often based on the "usual and customary" amount for your geographical area. Your insurance company should tell you this amount if you ask. For example, if you are covered at 60% of the usual & customary cost, that means that your insurance company feels that this service should have only cost $625.00, and is paying you 60% of that amount or $325.00 based on your coverage.
Unfortunately, many ambulance services do not contract to be in-network providers precisely because they know they would be able to charge less, resulting in a "Gotcha" situation for an unaware patient. Some insurance companies (like mine) will send out warnings about these types of situations, but are often short on specific examples.
In this case, your best bet may be to negotiate directly with the ambulance service, and if at all possible, find a friend or friend-of-a-friend in the media or in government to cover your story in a newspaper/website/etc. and apply social pressure on both the insurer and the ambulance service. There are many examples where one or both parties agreed to negotiate a lower cost for these types of events because the situation the patient is being put in does not pass the public's "sniff test". In this case, you can also do the following:
3) Demonstrate that the service was medically necessary.
Ask the hospital to attest that your family member needed an ambulance and if possible, that this particular ambulance service was needed for a medical reason as opposed to an alternate in-network service (if one was available). You need to establish that you did not use the ambulance for convenience. Find out if any in-network ambulance services were available in your area. If not, that may also strengthen your case.
4) Demonstrate that you did not travel farther than necessary.
If you traveled to the nearest hospital available, that is more consistent with emergency care and may strengthen your case. While your trip was less than 60 miles, 60 miles is considered a fairly long ambulance ride outside of rural areas, but would be justified regardless of distance if you went to the nearest hospital that could treat your family member.
If you can effectively demonstrate that you didn't have a choice, or that there was no better option, you may be able to negotiate. If your only reason is that "I didn't know", you will have a tougher time.