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I recently had a medical scare that sent me to the hospital by ambulance in New York City. When the bill came due my insurer covered the emergency room visit but did not cover any of the costs of the ambulance. Problematically, the cost of the ambulance ride ended up being 3x the total cost of the doctors and tests performed in the emergency room sticking me with a very large bill. These ambulance costs are treated completely separately, seemingly not covered at all and not even applied to my annual deductible.

What actions or recourse do I have in this matter? I don't mind paying my fair share but to be stuck with 100% of a large bill and not even have it apply to a deductible seems unfair.

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    Read through your insurance policy. If it says they cover it, then you can appeal. If it says they don't, then you'll need to foot the bill. If needed, many companies (like ambulance services) will let you arrange a payment plan. If your insurance is provided by an employer, then speak with HR and let them help you figure it out. – BobbyScon May 24 '16 at 0:25
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    The reason for the denial is key. Do they suggest it was not an emergency that requires an ambulance? Or was it something else - such as ambulance services being non-covered events. – Joe May 24 '16 at 4:23
  • how can an ambulance ride costs more than 3x times the costs of doctors and tests? – Ant May 24 '16 at 8:09
  • @Ant Paramedics are paid pretty well (hopefully), and have to sit around on the clock a fair bit just in case they get called - and the call-out might have been 10+ minutes there and back for two in a vehicle. Compare this to fifteen minutes of a doctor's time and an X-ray, and it could be reasonable. – SomeoneSomewhereSupportsMonica May 24 '16 at 9:12
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You need to understand why it was not covered. It's possible there's an error in the billing. This could be something as simple as a missing tax id number. Earlier this year claims codes changed from ICD9 to ICD10, that has caused some "denials" that were strictly related to an "incorrect" billing code. This could be a requirement for prior authorization. Contact your insurance carrier and understand the reason for the $0/0% coverage of this ambulance ride and go from there.

Separately, IF this is not covered at all, it makes sense that it would not apply toward your deductible. Only covered expenses will accrue toward your deductible and out of pocket maximums. With that said, it's odd for an emergency ambulance ride to be truly not covered.

As an aside, a number of years ago I was hauled away to an emergency room in an ambulance. I arrived unconscious. The entire claim was denied on the basis of prior authorization. The carrier did the right thing and waived that requirement after the fact.

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