Comment by xp84
2 days ago
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 <insert details> 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.
But isn't the California law requiring the insurance company to act as a sin-eater here? They seem to be the only people you were frustrated with, even though they are not the ones who charged you $1000.
They had the duty to pay and they try to trick every one of their customers into not realizing that, so that's why I'm only mad at them.
I acknowledge that the CA law is forcing them to, in the mechanism the article covers, causing them to subsidize other people's care, and this is happening in many areas of healthcare too.
Though those costs are surely accounted for when they set their premiums, which for 2025 amounted to just over $32,000 for my family.
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?
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> isn't the California law requiring the insurance company to act as a sin-eater here?
American healthcare providers have done a pretty good job at transferring PR liability to insurers. Cost inflation, in America, is mostly a problem at the provider level.