It was a route he’d taken thousands of times on his bicycle. The weather was clear and bright. Then the unexpected happened.
Randy Henderson’s handlebars got caught on the side of a fence on a bridge along MacGregor Boulevard and down he went into the pavement.
Henderson, who was Mayor of the city at the time, said he was in the worst pain of his life. But when a good samaritan showed up and offered to call 911, he protested.
“I said if you call 9-1-1 and they call an ambulance it’s going to be $5,000 and my house is right over there,” said Henderson, recounting the story about a year later. Henderson said he found out about that ambulances weren’t in-network when a family member had to take a short ride to a hospital a few years before his bicycle mishap.
Lee County EMS ground ambulances are not in-network on any commercial insurance providers. The same is true in Collier and Charlotte counties as well.
Tiffany Drake, a medical billing supervisor for a Fort Myers orthopedic practice, said despite her profession she was still caught by surprise when she got a $45,000 air ambulance bill.
In 2016, her husband had to be airlifted to the hospital after a motorcycle crash. He died a few days later.
A week into being a widow, she found herself on the phone arguing over that air ambulance bill.
“I’d probably have to claim bankruptcy to be honest there’s no way that I could afford $45,000,” said Drake, who was eventually able to get insurance to cover the bill by arguing that it was an emergency situation.
Federal legislation that passed in the last year makes it illegal for air ambulances to bill an out of network price. But, the 2020 law fell short of covering ground ambulances.
In Florida, there is some protection for people on an HMO plan, but that is only if your plan actually originates in the state of Florida. County EMS is also obligated by law to take Medicare, Medicaid, and Tricare.
Drake said she would not have known to call and ask for insurance to consider covering the bill if it weren’t for her decades of experience in medical billing.
“I would think most people don’t know that. All that kind of information is just not handed to you in a booklet that says for this kind of scenario this is what you do,” she said.
COST OF CARE: Read more stories in the WINK News Cost of Care Series