I see a news item where a Patients is billed $50K+ for air ambulance.

Suppose one day a person who does not have future earning potential and gets a heart attack or some other medical emergency and he has limited funds that he want to be left to his kids rather than on health care, can that person deny such services and say that he will take his chances but will not get this costly treatment or ride?

  • You mean like through an advance medical directive? In other words, document that you don't want certain treatments?
    – C8H10N4O2
    Oct 19 '20 at 16:06
  • 2
    Honestly, you'd be better off converting your assets into something that can't be taken over medical billing. That's a somewhat different question, but could include giving your children part of their inheritance immediately or setting up an annuity. Oct 19 '20 at 18:34
  • 2
    I believe the usual solution to this is insurance. Or move to a country where they don't charge you. Oct 19 '20 at 23:44

Yes, but there are plenty of situations in which the plan won't work

There are relatively few situations in the United States in which you can be forced to receive medical services. Once you have received a service, though, you typically have to pay for it. And it is famously difficult (if not quite impossible) to determine how much a medical service will cost before it has been rendered-- you can't necessarily know that a particular service will be expensive in advance.

A classic example is an ambulance (or air ambulance, as in the situation you reference). Once an ambulance is called, someone will usually end up paying for that call. If you are unconscious or otherwise not capable of refusing the ambulance, you will probably end up being billed for the ambulance. It is very difficult to predict how expensive an ambulance ride will be. There are average costs, but lots of edge cases which result in much higher bills.

Other examples typically include situations in which your preferences are overridden, such as being committed to a psychiatric facility. That you don't want to be there doesn't mean you don't have to pay the bill.

If your main goal is to leave your money to heirs and make sure that it isn't spent on medical bills instead (whether you want those services or not), you have better and more secure options than relying on denying medical care. Another question on this stack, focused on estate and probate planning, can provide some good ideas on how to approach that.


For situations similar to what is described here, almost certainly not.

You are free to deny treatment or services. You can give medical power of attorney to someone you trust to approve or deny treatments if you are too ill to make decisions on your own. You can complete an advanced medical directive to tell whoever is making decisions on your behalf what sorts of treatments you want and what sorts of treatments you wish to avoid.

If your goals are financial rather than medical, however, these are unlikely to be helpful to you in the sorts of cases outlined in the article. In the case described, it is unlikely that a reasonable person could have determined the cost of the air ambulance in advance. The doctors that are trying to get the patient moved have no idea what the air ambulance is going to cost or what insurance is going to cover. The insurance company would know what is covered. The air ambulance company would likely know what it was going to bill (though it is terribly unlikely that the company would make that information easy to obtain). But it is highly unlikely that you could figure out from the hospital which air ambulance company was available, call the patient's insurance company, and determine what the the company would cover, then call the air ambulance company and find out what they would bill before a decision had to be made. When the doctors say that we have to transport the patient now, you don't have hours to spend on the phone trying to get someone to give you billing information. Similar issues potentially arise when the patient gets seen by a different provider, not just when they get transported from place to place, so you'd have to be on the phone constantly with insurance to understand what the bill was going to be.

From a human standpoint, you'd also be asking your loved ones to value your money over your life which is very unlikely to happen. Maybe you could find a cold-hearted stranger that would be willing to be your medical power of attorney (for a fee, I assume) that would commit to denying any treatment that would impact the amount your children would inherit upon your death. But if someone I loved was in the hospital, I'd gratefully authorize an air ambulance to save their life even if I knew that it would be terribly expensive and that they had expressed a desire not to have expensive treatments. I'd much rather have the person than the inheritance and I'd deal with them potentially being upset after they recovered.

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