DENVER — If you ever have to call 911 and take an ambulance, the last thing you want to worry about is a bill. But many Coloradans who have been in that situation are being hit with surprise bills that are not covered by the federal law known as the No Surprises Act.
"I have stage 4 cancer, and then I was diagnosed with a seizure disorder," said Alvin Gordy, who had a seizure in his doctor's office last July and was taken by ambulance to Swedish Hospital next door. "It's on the same campus. The buildings are connected by walkways. They could have actually put me in a wheelchair or even strapped me down on a gurney and just wheeled me. It's a three-minute walk."
At first, the Gordys were not worried because they have insurance with Cigna, and the explanation of benefits was clear.
"It says here [that] what I owe [is] zero!" said Mary Gordy, who thought the matter would be settled until bills continued to come from Northglenn Ambulance, charging more than $1,900 for the short ride.
"It's a .1 mile (528 feet) ride, and this is what they are charging," said Gordy. "This is just salt in the wound. It's just it's too much. We've hit our limit."
Emails sent to the Gordys state it is because of "balance billing" that they are seeing a surprise bill, which occurs when there is a difference between what providers charge and what insurance will pay. The provider bills the patient for the difference.
While in many cases, balance billing is illegal in Colorado and across the country, there are some gaps in the protections.
"There's this gaping hole that continues to catch consumers off guard," said Adam Fox with the Colorado Consumer Health Initiative.
He said Colorado law only protects customers with state-regulated plans, and Gordy's Cigna plan is based out of state.
Federally, ambulances are not covered by the No Surprises Act that went into effect last year and prevents surprise medical billing. A federal committee has convened to consider changes and recommendations to cover this gap.
"This is an issue that we really want to see addressed, and if it's not addressed at the federal level, we're going to do what we can at the state level to close this gap," said Fox.
In a statement to Contact Denver7 Northglenn Ambulance's CEO Rick Lindsey wrote, "I would refer you to all of the regulations by Colorado Division of Insurance and Federal requirements on balanced billing. Northglenn Ambulance follows all current balance billing regulations."
So what can you do if you're caught in the middle?
CCHI has a consumer assistance program to work with consumers on balance billing and other medical issues, and Fox recommended consumers work with their insurance companies to try to get them to pay more to ambulance providers, potentially by filing an appeal or a complaint.
Meanwhile, Mary Gordy said that after months of negotiating with Cigna and Northglenn, the ambulance bill was lowered to $1,700. After Contact Denver7 reached out, the Gordys tell them Cigna confirmed they are negotiating with Northglenn Ambulance once again.
In a statement to Contact Denver7, a Cigna Healthcare Spokesperson wrote: “People deserve protection and peace of mind when it comes to their health, which is why we work with providers to reduce situations where a person receives an unexpected bill for health services. We work hard to resolve issues related to surprise bills for our customers whenever possible.”
"I've got that wait-and-see attitude now," said Alvin Gordy. "Because I really want to get a break from this. But so far, we just have to see."
Editor's note: Contact7 seeks out audience tips and feedback to help people in need, resolve problems and hold the powerful accountable. If you know of a community need our call center could address, or have a story idea for our investigative team to pursue, please email us at email@example.com or call (303) 832-7777. Find more Contact7 stories here.