TOOELE, Utah — When the bill first showed up in the mail, Robyne and Michael Gallacher assumed it was an error.
The ambulance provider that had transported the couple’s 2-month-old son to Primary Children’s Hospital in Salt Lake City several weeks before was saying that their insurance had paid only a small portion of the cost for that 35-mile ride from Tooele.
Now, the company was coming after them for the rest – about $2,900.
“First thing we thought is like, ‘insurance made a mistake,” Michael Gallacher recalled in a recent interview with FOX 13 News. “‘Like, they didn’t process it right. No, we hit our max out of pocket. Something’s wrong. There’s some kind of miscommunication between the provider and our insurance.’”
But when they called their insurance to reprocess the bill, they learned that the ambulance they’d taken was out-of-network – and that there weren’t any in-network providers in all of Tooele County. So even though their insurance paid for the approximately $13,000 in costs for their son’s medical care and overnight monitoring, they could be held responsible for the ride between hospitals.
The federal No Surprises Act, which took effect in 2022, protects patients from most out-of-network emergency medical costs, including air ambulances. But the bill excluded ground ambulances – even though patients don’t have control over which company responds in a crisis and most emergency transport services don't contract with insurance.
“About 50% of the time the patient is going to be transported by an out-of-network ambulance," notes Patricia Kelmar, the senior director of health care campaigns with the health research organization PIRG. “And what that means is your insurer will pay some amount towards that bill, but that ambulance has then the ability to send you a balance bill. We often call it a ‘surprise bill."
In 2022, patients ended up spending around $129 million on these surprise ground ambulance costs, according to PIRG’s research.
Congress opted to exclude ground ambulances from the No Surprises Act in part due to the complicated mix of models for providing these services across the country, from private businesses to government entities and hospitals or fire departments. Instead, Washington leaders created a committee to study the issue and provide ideas on how to best create a national solution to protect consumers who take ground ambulances.
Kelmar served on that committee and said she’s hopeful lawmakers will act sometime this year, after the group sent its recommendations last March.
“However, Congress has a lot on its plate and we need to be able to raise attention to this issue,” she said. “Patients need immediate relief. This is a really hard situation to be in, to know that calling 911 might expose you to a really large ambulance bill. So we need to solve it.”
After experiencing the consequences of this federal exception firsthand, Michael Gallacher said he was frustrated to learn that lawmakers had left patients who need ground ambulances unprotected from surprise bills for so long.
“I mean, it sets people up to have to choose between physical suffering or financial suffering,” he said. “And that should not be a choice on the table. It’s like you need help, you need help.”
"WE FELT LIKE THERE'S NO HOPE"
The day the Gallachers needed help, they assumed their visit to the hospital would be a relatively straightforward one.
They had decided to take their newborn, Alden, in to see the doctor out of an abundance of caution after he bumped his head, leading to “a pretty big goose egg.”
"We’d already hit our max out of pocket,” Michael Gallacher said. “We figured we’ll just play it safe. Get him checked out.”
But at the hospital, the little bump started to feel like a bigger deal. The doctors were concerned he had a small skull fracture and recommended he be sent to Primary Children’s for additional monitoring.
They made it “feel very urgent,” Robyne Gallacher said. “And so my mind and thoughts were just everywhere. And wondering, like, how long he was going to be at Primary Children’s Hospital and what that was going to look like and what the long-term outlook was going to be.”
She climbed in the ambulance with her son and stayed with him overnight. By the next morning, “he was fine,” Michael Gallacher recounted, and the doctors sent him home with a clean bill of health.
They got the invoice for the ambulance in the mail a few weeks later.
After a series of back and forth, the couple was eventually able to get their insurance to cover the bill at an in-network rate. But that still didn’t cover the entire cost, so the ambulance company came back to them again – this time threatening to send them to collections for the $1,600 left on the bill.
“Multiple times we felt like there’s no hope," Michael Gallacher said. “I mean, we try to budget correctly and live within our means, but any unexpected bill in the thousands, no matter what it’s damaging.”
Kelmar said she hears similar stories from patients across the country who are struggling to pay high ambulance bills – often while they’re still recovering from an unexpected health emergency. Paying off these costs, she said, can take some families years.
“These are situations that set you back emotionally and health-wise,” she said. “And then to, on top of that, have to face a $2,000 ambulance bill, it’s just really dramatic.”
VIDEO BELOW: Patricia Kelmar with PIRG explains the long-term impacts surprise ambulance bills can have on consumers
FIGHTING A BALANCE BILL
While there are no federal protections against surprise billing for ground ambulances, Kelmar said there are steps consumers can take to mitigate the financial impact of high charges.
She recommended patients start by contacting their insurer to ask if the company can pay more toward the bill. They can also ask the policyholder’s human resources department at work to negotiate with the provider.
If neither of those options work, Kelmar recommends patients go directly to the ambulance provider. Sometimes an ambulance company will offer consumers a discount in exchange for a sizable payment toward a bill.
“It takes a lot of courage to call up the company that saved your life or got you the care that you needed when you needed it and fight a bill,” she said.
But while all these steps can take a lot of time and effort, Kelmar said it’s often worth if “it finances are a real concern.”
The Gallachers were eventually able to get their bill down to $0, after asking Robyne Gallacher’s HR department to approach the insurance company.
“Because there’s a business relationship there,” Michael Gallacher said he felt the insurance provider was more willing to listen than when they were trying to tackle the issue on their own.
The whole process took them about a year. And while the couple is glad to have that financial burden off their backs, they said they’ve also had to deal with some “non-economic losses.”
“The stress, the mental load, the lost time,” Michael Gallacher said. “Anxiety, just fighting it and fighting it and just not getting the help.”
PIRG's research has shown that “almost half of U.S. adults hesitate to seek out care” because of worries about unexpected bills, and the ground ambulance billing committee also raised concerns about consumer reluctance to call for help “for fear of unknown out-of-pocket costs.”
With no in-network ambulance in Tooele County – and knowing that an emergency transport would likely mean another expensive bill and another long fight – the couple now count themselves among that group.
The next time they face a health crisis, Michael Gallacher said his plan is to bypass 911 and instead “call our neighbors” and ask them for a ride to the hospital.
“And multiple people we’ve crossed paths with that have had similar experiences share the same feelings, that they don’t trust taking the ground ambulance,” he said. “And they’ll either call a friend, take a taxi or an Uber or hitch a ride to watch out for themselves financially.”
VIDEO BELOW: Patricia Kelmar with PIRG explains how consumers can fight their ground ambulance bills