Do not take the insurance company’s calculation of “usual and customary” charges at face value. They have an incentive to make a lowball calculation, often based on the Medicare fee schedule.
Pursuing underpaid insurance claims does NOT involve putting the patient in collections. It simply means holding the insurance company to account to pay their fair share. EMS providers have better options than simply balance billing patients.
Many EMS agencies show 100% collections on a claim and are still underpaid, due to the application of "usual and customary" adjustments. Providers may be owed tens of thousands or hundreds of thousands of dollars, yet show $0 in balances for these claims.
Some underpaid insurance claims can be recovered for the ambulance provider for up to six years.
Appealing an insurance underpayment is usually not effective in recovering the underpayment. Other pre-legal and legal recovery tools are required.
Successfully suing an insurance company for underpaid ambulance claims does NOT mean that they will pay the correct rate in the future. You need a continuous recovery solution.
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