Very expensive ambulance bills are driving these families into debt, but a new California law bans the practice.

The COVID-19 pandemic has taken a toll on Danielle Miele’s family, but after two exorbitant ambulance bills, she’s afraid to call 911.

Miele said his teenage son attempted suicide in 2022. His mental health deteriorated during the pandemic and he required ambulance transport from the Roseville emergency room, where Miele took him to a treatment center in San Mateo. The ambulance company imposed an out-of-network fee of $9,000 on Miele, which was sent to collections “almost immediately,” he said.

The virus also caused Miele to experience seizures that mimicked the symptoms of a heart attack, he said. Miele called 911 when the first seizure occurred. Without health insurance, the 15-minute trip to the hospital cost $4,000.

“The last time I had a seizure, I basically said, ‘I’m going to die here at home… I’m not going to call another ambulance,’” Miele said. “Maybe I’d rather die at home than have more medical debt.”

A new California law that goes into effect Jan. 1 targets “surprise” ambulance bills that left the Miele family in debt even though they had health insurance. These bills represent out-of-network charges for commercially insured patients who have no control over which ambulance company responds to a call for service.

Under the new law, patients will only have to pay an amount equivalent to what they would have paid for an in-network service. Health insurance and ambulance companies will have to pay the bills directly, even if they don’t have a valid contract.

Supporters of the new law say it will make a big difference for thousands of families like Miele’s. When Mila’s son needed emergency hospitalization at a psychiatric hospital for the second time, the ambulance company that arrived was part of the family’s insurance network. Your copay: $83.00.

Ambulance companies have not opposed the law, which includes guarantees that health plans will reimburse them.

Californians Receive Millions in Surprise Bills

The Association of California Health Plans, which represents insurers, opposed the bill before it became law because it could lead to a $67.3 million increase in premiums statewide. In contrast, people with commercial health insurance could save about $44.5 million on ambulance rides, according to a legislative analysis.

Kathy Van Dienz, legislative advocate for Health Access California, said the law closes a long-standing gap in protecting California consumers from surprise medical bills for those with commercial insurance. Health Access California, a consumer advocacy group, sponsored the new law.

“This is the last remaining gap, but it’s really big,” Van Dienze said. “You may be insured, but it doesn’t matter.”

About 14 million Californians with state-regulated commercial health plans would benefit from the law’s protections. According to an analysis by the Kaiser Family Foundation, 73% of all ground ambulance transports in California in 2018 resulted in out-of-network charges among people with large employer-provided insurance. California also has the highest average surprise ambulance bill in the country: $1,209, according to a study published last year by the U.S. Public Interest Research Group.

In a statement at the time of the bill’s passage, Assemblywoman Tasha Boerner, a Carlsbad Democrat who sponsored the measure, said people have no control over which ambulance company picks them up during a crisis.

“The last thing a person should be thinking about when calling 911 is whether they can afford an ambulance ride,” Boerner said in a statement.

The law also protects uninsured people from receiving expensive ambulance bills by capping their out-of-pocket costs at the Medi-Cal or Medicare rate, whichever is higher. Medi-Cal is a government health insurance program for very low-income residents that protects its members from such bills.

About 6 million Californians enrolled in federally regulated health plans would not be protected by the law, but a national committee is working to address the No Surprises Act, which protects Americans from many types of surprise bills, including air ambulance transportation. does not apply to ground ambulance travel. These are typically Californians who work for large private multinational companies or multi-state companies with self-funded health plans. Californians can ask their employers what type of health insurance plan they offer.

$4,400 bill for newborn ambulance ride

Laney Arebalo and her family are grateful that future emergencies will be covered in California. Their health insurance company doesn’t have a contract with any ambulance company in San Luis Obispo County, where they live, so they have no choice but to pay out of pocket.

In September, minutes after Arebalo gave birth to her son, Brady, doctors decided to transfer him to a larger hospital about 20 miles away. Brady had difficulty breathing and had to be admitted to the neonatal intensive care unit. An ambulance arrived and took him away.

Over the next month, letters began to arrive from the ambulance company: According to him, Arebalo owed $4,400 for transport.

“You know, here I am, less than two months after giving birth, and they told me they were sending me to training camp,” Arebalo said.

Insurance covered nearly all of Brady’s five-day hospital stay, which totaled $109,000, but did not pay for the out-of-network ambulance ride, Arebalo said. The insurance company ultimately paid about a third of the bill after Arebalo filed a claim, but the remaining unexpected costs still weighed heavily on the family’s finances. She ended her maternity leave early to return to work as a special education teacher and help pay the bills. The payment plan is $200 per month.

“It was definitely a surprise bill, and I’m still paying it,” Arebalo said.

This post was produced with support from the California Health Care Foundation (CHCF), which works to people have access to the care they need, when they need it, and at a price they can afford. Visited www.chcf.org To get more information.