Woman charged $1K for ambulance ride; insurance pays after Ch. 9 gets involved

CHARLOTTE — The average cost of ambulance ride is over $1,000, which can be too great of an expense for some families.

One woman told Channel 9′s Gina Esposito her insurance covered her hospital bill but not her ambulance ride, so Esposito investigated and helped get that bill paid.

Tera Long is a prime example of someone who relies on an ambulance. She is diagnosed with cluster seizures and therefore, cannot drive. She couldn’t understand why her insurance wouldn’t pay for her trip to the hospital.

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MEDIC, Mecklenburg County’s EMS agency, sent Long the bill after she took the ambulance to the hospital last August. She had recently been diagnosed and believed she was having an episode. Weeks later, she found out her insurance paid for the hospital visit, but not the ambulance ride.

“I called MEDIC immediately and I say, ‘my deductible is maxed out. Why do I have this $1,500 MEDIC bill?’ They said, ‘we will have it reviewed and see if we can change this,’” Long said.

That review involved how MEDIC coded her ambulance ride. The trip was coded as a “medical observation,” which is not covered until Long’s insurance.

For months, she kept getting bills as she fought to change the code. Last week, she reached out to Esposito for help. Esposito asked for her account number and sent that over to MEDIC, asking for the status of Long’s claim.

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Within days, Long got an email from MEDIC saying “your claim is 100% paid by BCBS.” Esposito went back to talk to her again.

“I don’t think I could have gotten this resolved on my own, I believe that it took you to get resolution,” Long told Esposito.

When MEDIC told her the claim would be covered, she questioned whether it was true. Esposito urged MEDIC to be transparent and the agency sent this timeline:

Long’s insurance denied the claim in October.
Long appealed in November and submitted documentation showing her medical condition.
On Feb. 3, MEDIC performed a coding review.
On Feb. 4, the code changed and the claim was resubmitted.

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Long wasn’t told that the claim went through until Feb. 11 -- the same day Esposito started asking MEDIC about the case.

“When you got involved, the PR specialist wrote me and told me she was going to keep me updated,” Long said. “I didn’t know where I was in the process. That helped me a lot.”

MEDIC uses dozens of codes to classify ambulance rides. The code is dependent on the medical emergency.

Blue Cross Blue Shield said an observation code is typically used when no medical treatment is needed. In this case, Long’s medical documentation was key to getting the insurance code changed.

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