Misleading EOBs

Most patients who are transported by ambulance have medical insurance that pays for this service as part of their medical benefits plan.

After a trip is submitted to an insurance provider, the insurance company provides the patient with an Explanation of Benefits [EOB] outlining the total charges, the amount covered by insurance, and any balance that the patient may owe SCCAD.

Often, the patient is responsible for a deductible or copay as defined by their specific insurance plan.  SCCAD does not have any control over what a patient’s insurance plan mandates they pay as a copay or deductible.  SCCAD must, however, attempt to collect any copay or deductible to receive the insurance payment.

Individual insurers are free to decide what portion of SCCAD’s ambulance charges they will cover, leaving the responsibility to pay any difference to the patients.  Some insurers will categorize this as an “Out of Network” charge.  This is somewhat of a misnomer, as most patients have no choice when it comes to who is available to provide emergency ambulance service to them in their time of need.  We have found that if our patients find themselves faced with this situation, a call to their insurance company explaining the emergency nature of the response and asking the insurer to reprocess the charges as “In Network” will usually correct the problem and pay the claim. 

Other insurers have taken a more deceptive approach claiming to have “Negotiated Discounts” on their EOBs and misstating the amount owed by the patient.  The SCCAD invoice and the EOB then show the patient responsibility as much different amounts, leading to confusion on what is really owed by the patient. 

We completely understand the confusion and frustration that occurs when a patient receives a bill significantly higher than what their EOB initially communicated.  In the example above, the charges were $1020.00 and the insurance company paid $564.64, leaving $455.36 as remaining amount that the patient owes.  However, the EOB falsely indicates that a negotiated discount further reduces the bill by $314.20, leaving only $114.16 owed by the patient. We’ve asked these deceptive insurers to cease these deceptive practices.

Insurance companies referring to discounts that do not exist is inaccurate and deceptive.  If you or a loved one have been impacted by this misleading practice, you can take action by filing a complaint to the Missouri Department of Insurance https://insurance.mo.gov/consumers/complaints/index.php

SCCAD has several programs in place to assist individuals that may be unable to pay their invoice in full.  For help with ambulance invoices, information on payment plans or filing a hardship request, please call 877-460-0583.