Health Insurance Print

Excuse Me, Mr. Paramedic: Which Way to the Nearest In-Network Hospital?

By: Elizabeth Biondo, Esq.

You’re sitting at home one night and you suddenly feel a shooting pain down your left shoulder and pressure in your chest. You suspect you are having a heart attack, and you know you need an ambulance. Right now your main focus is on, well, not dying. Far from your mind: the cost of that ambulance ride and resulting hospital stay. That is, until you get the bill.

The cost of emergency ambulance transport can vary from a few hundred to a few thousand dollars depending on where you are located and the amount of advanced lifesaving support you need. And what if the hospital to which you are taken is not within your insurance network? How much is your treatment going to cost you? Which begs the question: can you direct the ambulance to a hospital that is in your network?

The short answer: it depends. Most parts of the country have protocols to help paramedics decide where to go. Obviously, if you are unconscious or otherwise unable to express your wishes, the EMTs or paramedics are obligated to take you to the nearest hospital that is most capable of dealing with your medical issue. For example, if you are having a heart attack, the ambulance will take you to the closest hospital with the expertise for treating a cardiac event, though this may not necessarily be the closest hospital geographically. Accident victims will be taken to the nearest hospital with a trauma center. This improves your chances of survival. Who can argue with that logic?

If you are able to express your wishes, an ambulance might take you to the hospital of your choice so long as it doesn’t take the ambulance too far out of its service area. But again, this depends on where you are located. For example, some towns will assign ambulances to specific zones. Those ambulances must take you to the hospital within their zones. And again: your health is the number one priority. So conscious or not, paramedics will not honor your request if it jeopardizes your health and safety. Sorry, not sorry.

While you can’t anticipate emergencies, there are things you can do to prepare for them. Make sure to learn in advance which local hospitals are within your insurance network. That way, if possible, you can try to direct the ambulance to an in-network facility. Worth a shot, right? If you wind up at an out-of-network hospital, contact your insurance carrier as soon as possible after you are admitted. You may be able to negotiate an in-network fee. Once you have been admitted and evaluated, you might be able to be transferred to another hospital if this can be done safely.