441–450 of 536 posts
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That is not required complexity. You can just send the bill to the customer.
Who is the “you” in this scenario?
> The standard answer is greed: rapacious ambulance operators, owned by villainous private equity firms, exploit patients at their most helpless. But I don’t think that’s actually what’s going on. Ambulance providers are chronically unprofitable businesses; margins are thin, crews are underpaid, and operators exit the industry every year. The author does not understand how private equity extracts money. The high-liab…
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Uh, a new Bell 407 is north of $4 million and that's before it's equipped for medical flights. You aren't buying one of these for $500k used, at least not one that's air worthy. Eurocopter EC135 are a bit cheaper, but not by much.
-> https://www.globalair.com/aircraft-for-sale/helicopters
But you don't have to believe my story, you are totally entitled to consider that pure fantasy.
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The insurer is being forced to act as an insurer, by paying the $1000 they're supposed to cover.
Did they know they were supposed to cover it, or did the provider make a billing error? Even if there's no error, why is a government-run ambulance service making this the patient's problem, if the law says that they definitely have to pay? Why did it cost $1000 anyway, is that a reasonable price?
> why is a government-run ambulance service making this the patient's problem
Whether government or private, they just want their money, and the insurance companies shrewdly avoid conversations where they might have to actually pay money. Plus, the ambulance guys probably have barely any documentation they could submit to prove that it was a "real" emergency, without which the $1000 would be the correct bill for me.
Insurance company's "genius" here is just remaining quiet and saying nothing, guaranteeing the average person will either get sent to collections by the ambulance, cut a deal with the ambulance, sell their plasma and subsist on ramen to afford it, or charge it on a credit card. And none of those involve the insurance sociopaths at all.
The article really proves that a "network" doesn't even make sense for this particular service. The insane part to me is that the insurance companies are allowed to pretend it does, and that they even have any "network" and impose the in/out of network distinction at all.
It's like if your Internet service came with "unlimited data" but when you read the fine print everything is pay-per-MB besides one single unpopular website.
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Cabulance - "wheelchair transport", often staffed by a EMR (emergency medical responder, a lower level than EMT). Someone who needs assistance and support getting where they're going, but is not in need of or likely to need medical treatment or support during the trip. And they are reimbursed, or actually generally billed to insurance.
Oh, ok. When I posted that I genuinely thought they wanted people to call Ubers, etc. This is less terrifying, thank you for clarifying!
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…
Was this Cigna? Same thing happened to me in SF in the same timeframe. It took 5 times of me calling and explaining that they can’t charge it as out of network before they adjusted it.
It could have been Cigna -- I've cycled between probably every possible insurer during my career. Dirtbags, the lot of them.
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…
> I immediately filed a complaint with the insurance company's California regulator (at the time it was the Dept of Insurance for this one, but it seems most or all now are under the Department of Managed Health Care) since insurance companies are by law obligated to pay at the in-network rate in the case of an emergency (which presumably is why you call an ambulance in the first place). Within 2 weeks I received a l…
What percentage of patients are likely to be taking ANY action that leads to insurance paying? Either spending (as someone else shared) 5 phone calls trying to convince them, or knowing what regulator to file a complaint with - those are the only options. All other options involve someone else eating that cost. I bet less than 10% get them to pay, so the fine should start at $10,000 - and escalate if they show no improvement.
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Lots of policy in the US is hacking around the lizard brain idea of "We cannot have nice things because someone who doesn't deserve it might get it." My favorite example is universal school breakfast and lunch. Without fail, someone will argue that some kids don't deserve it. It doesn't matter that all of the data shows it is more economically efficient and the benefits to kids is overwhelming.
You essentially described the Republican and Libertarian perspectives in the US. The Republicans seem to see it as immoral to potentially give a few people support they don't need even if that means that most of the people who need the support actually get it. And, instead, they believe that having an inconsistent array of private interests will somehow be more able to service an enormous population than having an or…
Good news is that if you want the democratic party to become the party of labor, now is the absolutely best time to have a real impact in your community.
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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.
I.e. I was responding to the original "in 'most of the world' EMS quality is ass.", trying to say that you only get that outcome if you compare apples and oranges (developed vs developing)
8-10 minutes in urban areas is pretty much universal (for the developed world). Rural areas are where differences come in, and even there standards for the developed world are somewhat on the same level.
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> The average ambulance transport costs $2,673 to provide I think this ignores the 400 pound gorilla in the room. Why does an ambulance transport cost thousands for the operator? This is a short trip in an automobile, essentially a fancy uber ride. At first one might say that's flippant - obviously ambulances are specialized vehicles, and you have paramedics, and they need to get to locations quickly, and so forth, b…
Replying to myself as a followup: https://digitechcomputer.com/costs-of-ems-readiness/ Looks like of the $1954 they estimate for a transport (already quite a bit below TFAs $2673), $1582 is salary. Given that we established the crew in the ambulance are taking home about $140 per transport between them, this seems bonkers. Capital, medical supplies, and fleet maintenance are a whopping 6% of the "cost".
For that, $1500 seems pretty reasonable. In a place like the US, labor costs often dominate the total cost of many goods and services.
And remember, you have to pay the staff while they are sitting there waiting for a call that may never come. According to the OP's article, the ideal utilization is 30-50%, because you don't want a situation where there's a surge in requests and you don't have an available ambulance. So you're paying people to sit around and wait for a call, and, under normal conditions, you'll have 50-70% of that pool of people not ending up needing to take calls at all.
Also your article includes under salaries:
> Regular, overtime, vacation, and holiday pay for all EMS staff, including EMTs, paramedics, chiefs, 911 call technicians, dispatchers, and support staff
That's not just the 2-3 people on the ambulance during trips. That's a lot more people required to make the entire system work.