Couple Contacts NBC 5 Responds with Balance Billing Issue

In a life-threatening situation, you'll do anything to keep your family safe, but a North Texas couple said they're still dealing with bills for three ambulance trips after such an incident last year.

Doctors can be in network or out of network and you pay more when they're out of network. This also applies to ambulance companies and, depending on  your insurance, your local private or city ambulance may not be fully covered.

Debi Waldrop is fighting to recover from a heart blockage and then bleeding in her brain last fall.

"When I found her, she was just laying on her side and she had completely lost the use of anything on the left side of her body," Debi's husband Jeff Waldrop said.

An ambulance ride from the City of McKinney saved her life. It cost $975, but Jeff said he wasn't thinking about that.

"I didn't pay any attention to it until I started getting bills from ambulance company and I went, 'What's this? Why wasn't that covered?'" he said.

The Waldrops' insurance paid their in-network price, even though the City of McKinney was out of network. Even so, there was a balance of $461, which the Waldrops were billed.

In recovery, Debi Waldrop needed two non-emergency transports from Careflite. Each cost about $1,600, which was more than the emergency trips. Blue Cross Blue Shield covered about $446 and the Waldrops were billed the balance of $1,135 dollars for each.

Jeff said he was told there was no in-network ambulance at the time of care. The Texas Department of Insurance told us BCBS does not have ambulance providers in their provider lists for 2015.

But Blue Cross Blue Shield said its network did include one ambulance service. The insurer told us:

"At Blue Cross and Blue Shield of Texas, we work hard to expand our number of in-network providers... We share the concern over some health care providers, like private ambulance services, billing people excessively. Regrettably, some of these companies have little or no economic incentive to negotiate lower, contracted rates."

But one of the ambulance providers told us his company is in a tough spot.

"CareFlite doesn't make the choice of what insurance the patient has," Jim Swartz said. "Blue Cross has all kinds of different rates. We could do the same trip and get paid 100 percent on other Blue Cross plans."

As for charging more than McKinney, Swartz said a private non-profit company like his must charge more, in part, because there is no taxpayer to help foot the bill.

"We have the system where Medicaid pays this. And Medicare pays this. And the VA pays this. And the commercial insurance something like this. And the people over here pay nothing," he said. "We have to collect every dollar we can."

Still, that's cold comfort for the Waldrops who are on the hook for a total of about $2,700.

"Ultimately, I think that what ought to happen again is that the insurance company ought to get with the ambulance provider and they work out something exclusive of me," Jeff said.

CareFlite is currently appealing the case to the Texas Department of Insurance.

"CareFlite is confident that Blue Cross will, as a result of this appeal, pay this claim properly," the company's CEO said.

Your best protection is checking your policy right now to see if you have ambulance coverage and who your in-network provider is, if you have one.

Some private ambulance companies, like CareFlite, sell memberships that cover its services. You can also try to negotiate your bill with the providers, and your insurance company.

The Texas Department of Insurance does mediate balance billing issues with doctors, but not ambulance bills. Still, you can file a complaint.

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