DENVER — It has been two years since Colorado passed a law to prevent patients from being stuck with surprise medical bills.
But it comes as no surprise that Denver7 Investigates has learned there are exceptions.
All publicly funded EMS ambulance and fire services are exempt from the state’s surprise billing law, a lesson a Denver woman said she had to learn the hard way.
“From what I understood, it was emergency care,” said Crystal, a patient who only wanted to use her first name. “It’s completely asinine. Why you would not be covered?”
Crystal took two ambulance rides in early 2021 and then got two bills from Denver Health Paramedics for nearly $1,800.
“Almost $900 for each bill,” she said. “It’s not right. There’s no way I was going to call an Uber to get in because it’s cheaper.”
Denver7 Investigates has been looking into Coloradan’s cost of care, and recently exposed how contract disputes between doctors and patients are leaving patients caught in the middle and forced to pay unexpected out-of-network medical bills.
While contract disputes aren’t at the center of Crystal’s story, this isn’t an issue unique to Denver Health as the exemption applies to all publicly funded ambulance and fire services statewide.
“It seems as though that’s just almost unacceptable. When you dial 911, you shouldn’t have to be going down this route of ‘is this in my network? Will this be covered?’” Crystal said.
Tim Dienst, head of advocacy for the Emergency Medical Association of Colorado, said this is not about making a profit and more about the economics for public ambulance providers.
“You can literally go from hero to goat in a matter of a postage stamp,” he said. “They have to understand the nature of the business. It doesn’t matter who you are, we have to provide the same service to every patient when they call.”
Dienst said Medicaid and Medicare both pay rates much lower than what it costs to take an ambulance. To stay in business, EMS providers then must bill other patients more money to make up for it, a practice known as balance billing.
“We still balance bill patients because we have no other option. Either cut services or charge patients and payers,” Dienst said. “I can’t think of any EMS agency in the state that is looking to go out and gouge anybody.”
Crystal’s insurance company, UnitedHealthcare, sees it differently.
“Denver Health Paramedics is exempt from Colorado’s surprise billing law and, unfortunately, it’s taking advantage of that exemption to bring in more revenue by surprise billing patients,” a UnitedHealthcare spokesperson said in an emailed statement. “We hope Denver Health Paramedics will stop surprise billing our members, and we will do everything we can to protect them from the financial impact of these bills.”
In responding to the accusations, Denver Health Paramedics said in a statement that it is following the rules of the law and is “mission-driven, not-profit driven.”
“It really is hard because medical… You can’t plan medical,” Crystal said.
Crystal now feels caught in the middle between two medical giants.
“It’s almost worse when the medical bills come in than it is having the injury itself,” she said.
Crystal said UnitedHealthcare is trying to take care of her bill, but as of now, she is still waiting for it to be resolved.
Congress recently passed legislation called the “No Surprises Act” to protect people from surprise bills. It takes effect in 2022, but like Colorado’s law, it also exempts ambulances. The federal legislation did create commission that is currently looking into ground ambulance bills.