Darcy, what's the deal? Las Vegas man questions ambulance ride not fully covered by health insurance

LAS VEGAS (KTNV) — If you're having a medical emergency and need an ambulance, the last thing on your mind is insurance.

However, not asking questions up front could lead to you paying more out of pocket. So, what's the deal?

This all began with a pup named Reavo, who got his name from his owners' love of the Vegas Golden Knights and former right winger Ryan Reaves. Reavo's not "in the dog house" for what he did, but his actions cost his owners big bucks.

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David Burns and his wife went on vacation in February, leaving behind Reavo and their two other Boston terriers. When they got back, Reavo was a little over-excited to show David some love.

"Reavo decided he would stretch out on my leg and claw me all the way down, and we had forgotten to clip his claws," David explained. "He tore a nice gash in my leg here."

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That sent David to an after-hours clinic, where the gash was butterflied. But as he was getting ready for work the next day...

"I heard a pop, and I looked down, and it looked like someone had stuck a straw or syringe and my blood was shooting out about this far, all over the place. And it was all over the bathroom, and I pounded on the wall and I said 'Laurie, you need to call an ambulance!'"

His wife, Laurie, did call 911. Two ambulances showed up to his house, and one took him to the hospital.

"They did some special stitches on my leg and got me stabilized and then I was able to come home," David said.

David has health insurance through Anthem Blue Cross Blue Shield. He tells me it's typically good coverage, so he was shocked after getting a nearly $1,500 bill for that ambulance ride.

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"I was surprised to see I was out-of-network. I thought, 'Out-of-network? What does that mean?' My wife works with insurance all the time and she said, well, because you're not in the right area, they're not going to cover all of that bill. I said well, if I am having an emergency and I call for an ambulance, how am I supposed to know that the ambulance is in my network?" David said. "I said I've got to do something about it, so that's when I decided to call you."

We took David's concerns to Anthem Blue Cross Blue Shield, asking them what's the deal with this out-of-network ambulance ride.

We found emergency room and hospital bills have some legal protections. Under the federal No Surprises Act, patients can't be charged out-of-network rates for most care at in-network facilities and they have to tell you your out-of-pocket costs up front.

In an emergency, you won't get a cost estimate before treatment. However, you can't be hit with surprise bills for out-of-network emergency care. You're only responsible for your normal in-network costs.

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Ambulance rides are different.

Many ambulance providers are out-of-network, which can leave patients on the hook for much of the bill.

"Did you know there was such a thing as an in- or out-of-network ambulance?" I asked David.

"I had no idea," David said. "I did not know that...And then you just wonder, Darcy, how many other people in this area have experienced the same thing?"

Here's the deal: The pricey ambulance ride comes from what's called a balance bill.

Ambulance companies often don't have contracts with health plans and operate independently from hospitals. Like other healthcare providers, they can charge you for the part of the bill your health plan didn't pay.

Clark County officials have set flat rates for ambulance rides, but you can also be charged mileage for how long it takes to get to the nearest hospital.

You can read that document below.

Obviously, in an emergency, getting care right away takes priority. However, you can mitigate the shock of a big bill by closely reading your insurance company's explanation of benefits, which outlines what you do and don't pay. If something doesn't look right, industry officials say to contact your insurance company — which David did but said it didn't make a difference, and he had to pay the bill.

"You can't fight big insurance. You can't take them on," David said. "I'm just one of these little people here, that if you try to take on an insurance company, they'll bury you."

A state legislative commission, the Nevada Commission on Minority Affairs, is working on a bill for the next session that would expand how EMS calls can be handled and reimbursed.

Current policy only reimburses ambulance providers for transport to a hospital, which officials say creates a financial incentive to take patients to a hospital even if they don't need emergency care.

The new bill would create partial reimbursement for providing care while not taking patients to a hospital. Similar models are already in place in Texas, West Virginia, and Colorado.