This toddler’s nearly 40-minute ambulance ride cost his family $16,000

Elizabeth Yoder was billed $9250 for a 64km ambulance ride for son Darragh, who had a serious infection. Photo / Maddie McGarvey, KFF Health News

Elisabeth Yoder’s son, Darragh, was 15 months old in August when he developed what at first looked to his parents like hand, foot and mouth disease. The common viral infection generally clears up in less than a week, but Darragh’s condition worsened over several days. His skin turned bright red. Blisters gave way to skin peeling off his face.

An online search of his symptoms suggested he had staphylococcal scalded skin syndrome, a serious bacterial infection. Yoder drove the toddler from their home in the small town of Mechanicsburg, Ohio, to the Mercy Health hospital in nearby Urbana.

Staff in the emergency room there confirmed that Darragh had scalded skin syndrome and said he needed to be taken by a private company’s ambulance to Dayton Children’s, a hospital about 64km away.

“I asked them: ‘Can I take him? Can I drive him?’” Yoder said. “And they were like, ‘Oh, absolutely not’.”

So, Yoder and her son got into the ambulance, with Darragh strapped in his car seat. The ambulance driver didn’t turn on the siren or drive particularly fast, Yoder said. The trip took about 40 minutes, she said. “It was fairly straightforward transportation from Point A to Point B.”

Yoder had heard that ambulance rides can be pricey. But she didn’t know how much her son’s ride would cost.

Darragh was hospitalised for three days and recovered from the illness.

Then the bill came.

The medical procedure

During the ride, the ambulance crew monitored Darragh’s vitals and an intravenous line, inserted at the hospital, carrying fluids and antibiotics, but he received no other medical treatment, Yoder said.

The final bill

The cost came to US$9250 ($16,437), which included a “base rate” charge of US$6600 for a “specialty care transport” and a mileage fee of US$2340, calculated at US$60 for each of the ride’s 64km. It also included US$250 for use of an intravenous infusion pump and US$60 for monitoring Darragh’s blood oxygen.

The billing problem

The children’s hospital charged only about US$3000 more for the toddler’s three-day stay than the ambulance company charged for the ride, Yoder said.

Darragh’s family doesn’t have health insurance, leaving them on the hook for the full charges. Their income is a bit too high for them to qualify for Medicaid, the public health programme that covers low-income residents, or for the Ohio Children’s Health Insurance Programme, which covers moderate-income kids.

The Yoders belong to a Christian healthcare sharing ministry, with members paying into a fund that helps reimburse them for medical bills.

Unlike health insurance, such arrangements do not offer members negotiated rates with ambulance companies or other medical providers. There are no state or federal billing protections that would help an uninsured patient in Ohio with a ground ambulance bill.

The federal No Surprises Act protects those with insurance from large bills for air ambulance transportation provided outside their insurers’ network agreements. But ground ambulance services aren’t covered by the law – and even if they were, that would not have helped the Yoders because they didn’t have insurance.

Patricia Kelmar, the senior director of health care campaigns for PIRG, a national advocacy group, said ambulance charges vary widely. She said she has seen per-km charges ranging from less than US$30 to more than US$80, as well as base rates that differ dramatically.

Some patients, such as those with traumatic injuries, need ambulances with highly trained staff and advanced medical equipment, Kelmar said, so it makes sense that those rides would be more expensive. But patients are rarely told what the ride will cost until they receive a bill.

Jennifer Robinson, a spokeswoman for Mercy Health, said that she couldn’t comment on a specific patient’s case but that the staff follows established medical standards. “When a patient requires a higher level of treatment, ambulance transfer between facilities is best practice to ensure appropriate care,” she said in an email.

Kimberly Godden, a vice-president for the ambulance company, Superior Ambulance Service, said a doctor at the first hospital requested a high-level transport for the patient, requiring specially trained staff.

“Our priority is always to ensure patients receive the highest-quality care when they need it most, and we respond to every call regardless of a patient’s ability to pay,” Godden said in an email. “Superior had the team and resources available to quickly and safely move the patient to the higher level of care they needed within the time frame set by the ordering physician.”

Godden said the company would offer a “charity care” rate to Yoder if the family qualified for it.

The resolution

Yoder said she repeatedly discussed the bill with ambulance company representatives, including the option for charity care. They told Yoder the best deal they could offer was to reduce the total by about 40%, to US$5600, if the family paid it in a lump sum, she said.

After discussing it for months, the family wound up agreeing to that deal, Yoder said. They put the charge on a new credit card, which gave them 17 months to pay it off with no interest.

They have agreed to payment plans with the two hospitals, which offered charity care discounts that dropped the bills to a total of about US$6800.

The Yoders expect the sharing ministry to reimburse them for about 75% of the payments they are making to the hospitals and the ambulance service.

The takeaway

Patients and their families should feel comfortable asking hospital staffers whether a recommended ambulance company is in their insurance network and how much the ride to another location will cost, said Kelmar, a national expert on such bills. “Shouldn’t the hospital know that?” she said. “I don’t think it’s that heavy of a lift.”

Kelmar said she doesn’t want to discourage people from taking an ambulance if a doctor says it’s necessary. Once consumers receive a bill for the service, she said, they often can negotiate down the price. It can help to look up what the ambulance service accepts as payment from government programmes. Those rates are often much lower than the full-price charges patients see on a bill.

If the family had been covered by Ohio’s Medicaid programme, the ambulance service would have been paid much less than it charged the Yoders. The public health programme pays ambulance services a US$413 base rate for “specialty care transports,” plus US$5.05 per mile. Those rates would have added up to US$609.95 for the transportation part of Darragh’s ambulance ride.

Yoder said she wishes she had driven Darragh straight to the children’s hospital. If she had skipped the local emergency room, she said, they would have arrived at the bigger hospital sooner and she would have saved thousands of dollars.

But she didn’t feel as if she had a choice about putting her son in the ambulance, she said. The doctor told her it was necessary, and the hospital staff had already inserted an intravenous line. “I wasn’t going to pull out his IV line and just leave,” she said.

Yoder said she remains uninsured because she hasn’t seen any private insurance options that suit her family’s circumstances. No matter who pays the ambulance bill, she thinks the charges were much too high. She understands that patients can often negotiate discounts, she said, “but you shouldn’t have to work so hard for it”.

Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical bills. Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the US Capitol and at the White House.

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