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Why American ambulance rides are so expensive

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Re: Why American ambulance rides are so expensive

#71

Post by xp84 »

semiquaver wrote: post #47
xp84 wrote: post #22

I tell this story every time ambulance costs come up because it might be helpful to anyone. I once lived in San Francisco in the mid-2010s. In SF, the SFFD operates the vast majority of ambulances in the city. As in, 80%+. I once had the need to go to the hospital urgently and called 911. The ambulance that showed up was SFFD. They transported me and I recovered safely. I then got a bill from them saying that my insu…

> discovered the "life hack" of having an extremely inadequate network The article covers this. Ambulance providers are strongly incentivized not to join insurance provider networks, and as a result more than 80% of ambulance rides in the US are “out of network”. So the inadequacy of the network is probably not the insurer’s fault.

Be that as it may, the law in California forbids the insurance company from refusing to pay at the in-network rate in an emergency. As evidence, I'd submit the claim they immediately paid when called out on this.

If the insurance company weren't cynically exploiting people's lack of knowing their rights, they'd at least send a form letter to the patient saying "Please send us whatever proof from the hospital that you had a legitimate emergency and if approved, we'll pay percent." Instead, they pay nothing, shove their fingers in their ears, and let the balance bill come to the patient, and hope nobody tells on them.

The only ambulance rides that should be billed like this are frivolous ones, like if someone is rear-ended at 1MPH, are unharmed, and they lay on the ground and fake an injury and demand to be transported to try to support a fraudulent legal case.

Re: Why American ambulance rides are so expensive

#72

Post by defrost »

ethersteeds wrote: post #43
darth_avocado wrote: post #7

We’re all pretending this is an unsolvable problem when really most of the world has solved it by making ambulance (EMS) funding similar to fire and police departments. Somehow in any emergency I’ve seen, all three show up, often EMS before police or fire dept, and somehow that’s a service that has to be supplemented by insurance billings. The blog mentions it, but it’s one of those obvious things that somehow isn’t…

> most of the world has solved it by making ambulance (EMS) funding similar to fire... About 65% of the more than one million firefighters in the U.S. are volunteers, with nearly 19,000 fire departments being run completely by volunteers.

St. John's Ambulance service in Australia is a hybrid of core paid positions and volunteers (varying by region and demand).

In rural Australia most of the fire, ambulance, and emergency response service are volunteer manned and (locally) run, with federal and state assistance for equipment and costs.

Costwise AU Ambulances are either free (if you're a St. John's member - cheap per annum OR if covered by private / work insurance) or (a decade out of date number) a flat fee of $500.

Re: Why American ambulance rides are so expensive

#73

Post by pclowes »

skinfaxi wrote: post #64
pclowes wrote: post #48

Earlier quoted context omitted.

I don’t think it is reasonable to expect to have ambulance coverage across the entire United States. There is a lot of land with very few people. Choosing to live far away from others is also choosing to live far away from help. If a service is highly variable cost dependent and is unaffordable for the average individual to pay out-of-pocket it is unaffordable for the aggregate individual as well. There _should_ be s…

Why should there be ambulance deserts but not postal deserts?

Directionally, I am also fine with postal deserts or at least different delivery expectations for very rural areas.

But also because Postal Service is much cheaper than an ambulance service?

Re: Why American ambulance rides are so expensive

#74

Post by sarchertech »

groby_b wrote: post #39
vlian2088 wrote: post #18

Earlier quoted context omitted.

the reverse side of that medal is that in 'most of the world' EMS quality is ass.

Haven't yet seen a developed nation do worse than the US. If you prefer to compare against developing countries only, sure, winning by lowering the bar to the ground is an option.

What metrics are you using for that? The US ranks fairly close to the top for out of hospital heart attack survival, which is a good proxy for emergency medicine in general.

The US also has decent EMS response times. If you adjust for population density, the US has fantastic response times.

Re: Why American ambulance rides are so expensive

#75

Post by mothballed »

alistairSH wrote: post #61
jahnu wrote: post #23

Earlier quoted context omitted.

If you limit it to say the top 20 developed countries how does it look?

Just a quick Google indicates the UK, Germany, US, and Japan all have urban response times in the ballpark of 10 minutes.

And even then they do worse than the average half brained private driver on trauma calls, since for many medical issues speed trumps capability.

Re: Why American ambulance rides are so expensive

#76

Post by gerdesj »

gruez wrote: post #9

As much as I like articles that tries to use economics or finance to explain stuff, the "options" analogy is a bit hamfisted. The article starts off by noting about how ambulance is an "option" for a rescue, but even though the analogy might vaguely work, it's not really needed to answer the question. That can be answered far more simply: "medicare and insurance companies pay them too little, so they have to charge e…

Given you find this is _normal_ for a six mile ambulance ride: "and $11,670 as a “base rate.”"

What on earth would you consider normal for a helicopter ride from Exeter to London?

That's roughly 150 miles as the crow flies. Pilot, co-pilot and a medic, minimum crew for say 1.5 hours. Each way, so 300 miles of fuel and aircraft lifetime and three hours of crew cost, not to mention ground crew etc.

My dad got that on the firm when the shit hit the fan and he needed to be seen by specialists in the Royal Brompton and Royal Devon and Exeter decided that was his best shot at life. That was 15 years ago.

Anyway, the OP's bill looked pretty normal until the 11,000 base rate nonsense. How can that possibly be justified?

Re: Why American ambulance rides are so expensive

#77

Post by alistairSH »

Waterluvian wrote: post #11
arjie wrote: post #5

You don't have to pay them unless they're specific. I got a bill 3 years after being in an accident and I asked them for the documentation they legally have to provide me (itemization, the legal basis, detailed incident record, attempts on their part to contact insurance) of how they arrived at the sum. It's been a year since and they haven't given me anything. Besides this kind of billing is banned in California now…

The last thing I want at that time is to have to reason about any of this. I think I’m realizing that what I cherish about the healthcare system up here is not just that I don’t pay bills, but that I don’t even see a bill. Not that the bankruptcy inducing costs aren’t wretched, but I just cannot even imagine being put into a fucked up bureaucratic hell while my family is in a life altering crisis.

This applies to other things as well - retirement and education come to mind.

Anecdote: my uncle and BIL are auto mechanics. One in the US, the other in Scotland. Similar lifestyles - both own homes, have mechanical hobbies (vintage cars for one, Harleys for the other) - typical working class lives. The uncle in the UK just has much less mental overhead when it comes to major life planning.

Re: Why American ambulance rides are so expensive

#78

Post by charcircuit »

Avicebron wrote: post #40
charcircuit wrote: post #35

Earlier quoted context omitted.

>from everyone the service stands ready to rescue So compelled health insurance to use an ambulance? You could just as well make it optional and charge people without the insurance the full price.

So everyone's covered unless you explicitly opt-out?

Everyone is covered and you have the ability to pay someone to take on the risk of having to pay for an ambulance.

Re: Why American ambulance rides are so expensive

#79

Post by pclowes »

cogman10 wrote: post #69
pclowes wrote: post #48

Earlier quoted context omitted.

I don’t think it is reasonable to expect to have ambulance coverage across the entire United States. There is a lot of land with very few people. Choosing to live far away from others is also choosing to live far away from help. If a service is highly variable cost dependent and is unaffordable for the average individual to pay out-of-pocket it is unaffordable for the aggregate individual as well. There _should_ be s…

It's very often not a choice. But also, those rural areas are often the breadbaskets of the united states. Taking care of our farmers is important. Trying to frame it as a choice also misses a lot. It technically is, but you have to recognize there's a huge cost in uprooting your entire life and moving to a new location.

We give our farmers absolutely insane subsidies already.

It is not the government’s job to “take care of” anybody.

Everything has a cost, staying has a cost, leaving has a cost. The question is how much should the public be taxed to pay for individuals suboptimal decision-making? Or conversely, why am I subsidizing some billionaires remote horse ranch to have daily Postal Service and an ambulance standing by?

Can I move to the wilds of Alaska and then demand the same level of service as New York City? No that would be ludicrous.

Re: Why American ambulance rides are so expensive

#80

Post by darth_avocado »

toomuchtodo wrote: post #8
darth_avocado wrote: post #7

We’re all pretending this is an unsolvable problem when really most of the world has solved it by making ambulance (EMS) funding similar to fire and police departments. Somehow in any emergency I’ve seen, all three show up, often EMS before police or fire dept, and somehow that’s a service that has to be supplemented by insurance billings. The blog mentions it, but it’s one of those obvious things that somehow isn’t…

Very much so. We could fix this. We continue to choose not to, and will for some time into the future. Tangentially (think in systems), much of the US exists off of volunteer emergency services (fire and emt), which is rapidly evaporating. Average age of these volunteers is mid 50s. https://www.nfpa.org/news-blogs-and-articles/nfpa-journal/20... > For generations, volunteers have formed the backbone of the nation’s e…

There is no reason why this should be a blocker to solving the problem though. 80% of the population still lives in an urban area. You could create a system that works for the majority of the country’s population and then can figure out the rest.
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