Omaha sends heart patient bill for remainder of ambulance ride costs

Published: May. 5, 2021 at 10:36 PM CDT
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OMAHA, Neb. (WOWT) - In the panic of a life-and-death emergency, most wouldn’t worry about the cost of an ambulance. But there is a charge for a rescue squad and some health insurance policies may not cover the entire bill.

Now, one patient owes the city money, even though he has full coverage.

“I was walking to my house and started feeling lightheaded,” heart patient Randall Sedlak said. “I knew something was really wrong.”

A history of heart problems had Sedlak worried that his time was up. During an episode a few months ago, he called 9-1-1, and an Omaha Fire and Rescue squad quickly arrived to transport him to a hospital.

Fortunately, his medical emergency didn’t turn out to be serious, but Sedlak said his blood-pressure skyrocketed when he went to the mailbox and found a bill from the City of Omaha for the rescue call because his insurance didn’t pay it all.

The city charged him $985 for the call, but Bright HealthCare insurance won’t pay that much, leaving Sedlak with a nearly-$400 bill to cover.

“But I had already met my out-of-pocket prior to the call to 9-1-1, so I knew I should covered at 100%. so of course, I’m going to call 9-1-1 and get immediate help,” he said.

But Bright Healthcare doesn’t have a contract with Omaha, so a rescue squad call is out-of-network, and the insurance carrier will only pay 60%.

“I’m going to be afraid to call 9-1-1 for medical transportation if I think I need to get to the ER quickly,” Sedlak said. “I’m going to be knocking on my neighbors’ doors.”

But friends and family might not get you to the right hospital.

“Survivability literally drops by the minute,” Nebraska Medicine ER Dr. Eric Ernest said. “If you end up at the wrong hospital and are needing an advanced procedure that’s not available at that hospital and we end up transferring you, all those minutes in between is killing off part of the brain.”

Omaha’s rescue squad billing service processes about 600 charges a month, and most insurance companies don’t pay the full amount for some since the city isn’t a participating provider.

“Most agencies are willing to work with people in terms of payment plans,” Dr. Ernest said. “I’m not going to call someone for their service if I can’t pay for their service.”

The city does have a hardship program designed to be fair and consistent with rescue patients who have trouble paying the charges.

Sedlak said he expected Bright insurance would cover the entire bill for his transportation to the ER rather than leave him with a financial emergency.

“I paid for insurance,” he said. “I just want what I got coming — no more; no less.”

A Bright HealthCare representative confirmed that Sedlak qualified for full coverage of a medical emergency. He said an appeal has been filed with the company for not paying Omaha’s full rate, and the claim has been resubmitted.

Sedlak said he bought the policy through the Affordable Care Act, so 6 News contacted the federal agency that oversees the program, but they can’t comment.

A complaint has also been filed with the Nebraska Department of Insurance.

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