Blog // HealthSmart Blog // March 2020

Another Medical Bill? Surprise!

3/24/2020 10:03:58 AM

Another Medical Bill? Surprise! Plus, How to Avoid Getting Taken for a Ride by an Air Ambulance Company

by Scott Geyer, Senior Vice President of Client Services

If you’ve ever been to the emergency room or had a surgery, you likely know that the bill you get from the hospital isn’t the only bill you’re going to receive. Soon, you may receive a bill from the doctor (or doctors) you saw. Then there’s the lab work. Did you have an anesthesiologist or radiologist? You can expect another bill from them too. But that’s not even the bad news. What happens if one or more of these providers are not in your network? Now you know what surprise billing is.

What is surprise billing and who are the common providers who may surprise bill your member?  

In simple terms, a surprise bill is a bill received by a member, commonly from a non-network provider they did not intend to see or may not have seen for their healthcare needs. Typically, ancillary type providers such as radiologist, anesthesiologist and emergency room physicians have a higher probability to send a surprise bill. Additionally, ambulance companies, both ground and air ambulance, as these providers normally do not participate in a PPO network.

How surprise bills impact your members

Because these providers are not participating in a PPO network, your members are being billed for the amounts considered over reasonable and customary. This means your members can receive an unexpected bill which could be thousands or even tens of thousands of dollars for expenses excluded by your plan.

Let’s talk about air ambulance claims

While surprise billing from air ambulance companies has been going on for years, these billings could have the greatest financial impact on your members. While there has been a 14 percent drop in air ambulance services from 2008 to 2017, the average cost has risen 144 percent over this same period  With average costs between $28,000 and $42,000 per trip, even a 50 percent reduction in the allowable amount could leave your member with a surprise bill of $14,000 to $21,000! A recent trend we are seeing with air ambulance companies is the use of a waiver and the assignment of benefits to the air ambulance companies. These waivers, if signed by your members, may require the member to release of information – including PHI – to the company, turn over appeal rights to the company and cooperate with the provider to maximize payment. “Cooperating” can include having the member request any payers to pay up to the full amount of the provider’s charges. So now your members could become bill collectors.

What should you do to assist your members with air ambulance claims? 

The best thing you can do for your member in this situation is to provide guidance. In some states, the state Department of Insurance may provide additional protections to the member. It may also be in the member’s best interest to obtain their own legal counsel before signing any agreement with the air ambulance company. Directing them to other resources may be the best thing you can do for them.

Learn more about surprise billing

Visit these helpful resources to learn more about surprise billing. 

  • What is surprise billing? – USC-Brookings Schaeffer on Health Policy
  • Surprise billing legislation: What employers need to know – Employee Benefit Plan Review
  • Add ‘Surprise Billing’ to U.S. Health Care Worries – Bloomberg

[1]“Air Ambulances – 10 Year Trends in Costs and Use,” by John Hargraves and Aaron Bloschichak, Published November 7, 2019, Healthcare Cost Institute,

Scott Geyer is Senior Vice President of Client Services for HealthSmart. Scott has overall responsibility for HealthSmart client relationships and has been serving our customers for more than 23 years.