When a patient is rushed by ambulance to the hospital, chances are they aren’t thinking about the cost of the ride or whether the ambulance provider is “in-network.” Their immediate concern is receiving emergency care.
Weeks or months later, they get hit with a surprise ambulance bill, usually thousands of dollars. The pain and stress of the initial emergency now have an added layer: financial hardship.
Fortunately, Texas has made it tougher for ambulance providers to blindside you with a surprise bill. On January 1, 2024, a new law went into effect preventing surprise ambulance bills for patients with state health insurance plans.
During the 88th Texas Legislature, lawmakers passed Senate Bill 2476, which prohibits out-of-network ambulance providers from sending patients surprise bills and requires insurers to cover the costs based on local rates set by counties and cities. If there isn’t a local ambulance rate, the insurers will pay the lesser of the 325 percent of the Medicare reimbursement rate or the full bill charged.
In this article, the personal injury team at Varghese Summersett explain the problem with surprise billing, the new law, and what it means for Texans.
Surprise Medical Bills
A surprise medical bill, often referred to as “balance billing,” occurs when patients receive care from a hospital, clinic, or medical provider that is not within their health insurance network, and then get billed the difference between what their insurer is willing to pay and what the healthcare provider charges.
This situation typically arises in emergency situations where patients do not have the ability to choose an in-network provider, such as emergency room visits, ambulance rides, or when receiving treatment from out-of-network specialists at in-network facilities. The result can be an unexpectedly high bill that the patient is responsible for, often amounting to thousands of dollars, adding financial stress to the patient’s recovery process.
Surprise Ambulance Bills
A surprise ambulance bill in Texas refers to an unexpected and usually costly bill that patients receive after relying on ambulance services during an emergency. This type of billing occurs when the ambulance service provider is not part of the patient’s health insurance network, leading to a situation where the insurance covers only a portion of the cost or none at all. As a result, the patient is left covering the significant difference between what the insurance pays and the total charge from the ambulance service.
These bills can be particularly shocking and burdensome, as individuals in need of emergency medical attention rarely have the opportunity to choose their ambulance provider or verify network status in the midst of a crisis.
Senate Bill 2476: Texas Puts the Breaks on Surprise Ambulance Bills
In 2019, Texas enacted the Surprise Billing Act to protect consumers from surprise medical billing. A similar federal mandate, the “No Surprises Act,” was enacted in 2022.
Unfortunately, neither mandate applied to ground ambulance services.
Texas Senate Bill 2746, authored by Judith Zaffirini (D-Larado), sought to close that gap by prohibiting municipalities from engaging in balance billing for ambulance services. The bill stemmed, in part, from a complaint filed by Keith Muschalek of Wilson County, who was charged $4092 for his son’s 33-mile ambulance trip to San Antonio.
The new Texas law, which passed in the fall and went into effect on January 1, 2024, requires a patient’s insurance carrier to cover all ambulance charges outside of their co-pay and deductible even when the ambulance company is out of network.
Unfortunately, because this is a state law, it only covers patients on state healthcare plans, such as state employees and teachers. State-regulated health plans cover about a third of Texans.
The new law doesn’t apply to Texans who have employer-sponsored plans, which are often self funded and are federally regulated. That’s why federal legislation is still needed. A federal task force is currently exploring the issue and is considering capping ambulance copays at $100, eliminating surprise or balance billing.
To find out if you have a state-funded insurance plan and are, therefore, protected from surprise ambulance bills, check your insurance card for “TDI” or “DOI” If you see it, then you are under a state-regulated plan.
Injured in an Accident? Contact Us.
We hope you found this information about surprise ambulance bills useful. If you or a loved one was injured in an accident due to someone else’s negligence, contact the experienced personal injury attorneys at Varghese Summersett.
Our team will assess your situation and explain your legal options. You may be entitled to substantial compensation for lost wages, medical bills, pain and suffering, and more.  Contact us today at (817) 207-4878 (HURT) for a free case evaluation.
