ComplaintsforApex Paramedics

• Initial Complaint

  10/08/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  On May 14, 2024 I went to ***************************** ER for stomach pain. Turns out I had a perforation in my stomach which was an emergency and could have proved fatal. Apex Paramedics was called by ********** to transport me to *******************************. I was never informed that it would not be covered by my insurance. I assumed since Longs Peak contacted **** that it was an emergency situation. If I had been informed that it would not be covered I could have had my son take me to *******************. **** never filed a claim with my insurance and they have refused to even though it was an emergency situation. The bill is $2470 which is excessive and I most certainly do not have the money to pay for. My insurance should pay for it.

  Business response

  10/09/2024

  Dear Ms. Lavigne,
  
  I do hope this response finds you much better!
  
  I do want to confirm for you that Apex Paramedics is not in-network with any commercial insurance company. To be the best of our knowledge, there are not any ground ambulance providers in the state of Colorado which are contracted with commercial insurance.
  
  I want to make sure you have all of the facts concerning what Apex Paramedics’ billing department did on your behalf. We firmly believe that your insurance should be covering this service, however, we cannot force them to. As an out-of-network provider, we are very limited in what we are allowed to do by your insurance company. We did file a claim with your insurance, Meritain Health (Aetna) for this service. Meritain Health did process our claim under claim number HV34X34, charging $938.79 to your deductible and discounting $1,522.01. We would be happy to help you file an appeal with your insurance company. The best way to get our help with this is to contact us directly. We can help you write the appeal letter and provide you with the documentation needed to prove how serious your condition was.
  
  We look forward to hearing from you!
  Phone – 720-486-0622
  Email – Billing@apexparamedics.com

• Initial Complaint

  07/30/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I am filing a formal complaint against Apex Paramedics for excessive billing practices, refusal to adjust service coding, and misleading statements regarding out-of-network charges.Details of the Incident:Procedure Codes: A0426 (ALS Non-emerg Base Rate) A0425 Billed Amount: $1,425.00 for A0426 $1,713.95 for A0425 Total: $3,138.95 Provider Discount: $1,009.99 for A0426 $1,081.00 for A0425 Total: $2,090.99 Insurance Covered Amount: $415.01 for A0426 $632.95 for A0425 Total: $1,047.96 Deductible Amount: $415.01 for A0426 $318.71 for A0425 Total: $733.72 Coinsurance Amount: $31.42 for A0425 Insurance Payment: $0.00 for A0426 $282.82 for A0425 Total: $282.82 Amount Owed According to EOB: $765.14 Issues:1. Excessive Billing:Apex Paramedics' demand of $2,856.13 significantly exceeds the $765.14 indicated by my insurance EOB.2. Refusal to ************** Code:Apex Paramedics has refused to change the billing code from "ALS Non-emerg Base Rate" (A0426) to "Emerg Rate," despite the service being an emergency. This prevents my insurance from covering the appropriate amount.3. Prohibition on Balance Billing:Colorado law prohibits out-of-network private ambulance services from balance billing patients beyond their in-network cost-sharing responsibilities (deductibles, coinsurance, or copayments). (Sources: ******************* of ******************************* hcpf.colorado.gov; ********-KFF Health System Tracker, healthsystemtracker.org)4. Lack of Transparency:There was no clear communication about the out-of-network status and potential financial implications prior to receiving the service.5. Balance Billing as Deceptive Trade Practice:Continued balance billing by providers is considered a deceptive trade practice under Colorado law. (Source: Colorado Consumer Health Initiative, cohealthinitiative.org)

  Business response

  08/12/2024

  Hello ****************************,
  
  I would like to start by apologizing for the length of time it has taken for me to reply to your complaint. I have reviewed all of the information available concerning your complaint and would like to start by providing some clarification concerning the processing of the claim. As an out of network provider, we bill commercial insurance as a courtesy to the patient.To the best of my knowledge, there are no ground ambulance providers in the state of ******** which are in-network with any commercial insurance companies.We are under no obligation to accept the amount your insurance processed to a provider discount. As a ground ambulance provider, we are allowed to balance bill the patient for the difference between what commercial insurance processed as their allowed amount and our billed amount. (Please note, Colorado law only applies to insurance policies which are under written in the state of ******** and only addresses ground ambulance providers in a very narrow window.  Federal law has excluded ground ambulance providers from the No Surprises Act.) After your insurance processed our claim,the balance left was $2,856.13. The amount we charge for our services comes from the proposed rate for ground ambulance providers in our state of 325% of ******** allowables. While the state is still in the process of debating this issue, we feel the proposed rate to be fair. During my review of the information concerning this run, I have determined that there is enough documentation to change our coding from non-emergent to emergent. I have submitted a corrected claim to your insurance company on 07/31/2024. Currently, we are waiting for your insurance company to finish processing the corrected claim. Once your insurance company finishes processing the corrected claim, we would appreciate the opportunity to discuss this matter with you further. 

  Customer response

  08/14/2024

  Thanks for getting back to me, and I appreciate your apology for the delay.

  I wanted to share that it would have been really helpful to know all of this information upfront, especially since I was already in the emergency room and needed to be transferred to another one. It's tough to be in that situation and then find out later about the balance billing. I really believe that ground ambulance services should work on becoming in-network to protect patients from these financial surprises.

  Honestly, it doesnt seem right to balance bill someone in this kind of situation. Were already dealing with a lot, and adding financial stress on top of that is really hard, even with insurance. I think the emergent code should have been used from the start since I was in the ** and had no choice but to use your service for the transfer due to the diagnosis.

  Ill keep an eye out for the reprocessed claim and would be happy to talk more about it once everything is sorted out.

  Thanks again,

   

  Elied

• Initial Complaint

  09/12/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  3/8/23 Apex Paramedics provided medical transportation. Details pertaining to ******** and the ****** ******** Advantage plan I have were provided. This transportation should have been covered 100%. Apex Paramedics continues to try to collect $460.15, likely to double collect on a bill as they do not expect the customer will be the wiser.

  Business response

  09/14/2023

  Hello,

  This ambulance run was denied by ****** ******** Advantage plan. We would be happy to bill regular ********, but do not have that information on file. If you would like contact our office at ************, Monday-Friday 8am-5pm, and provide that information, we would be happy to bill ********. 

  Thank you,

  *****************************

  Customer response

  09/21/2023

  APEX Paramedics had ALL the ********* ******, Hospice, etc., information both verbally thru various phone calls and in writing but instead chose to send threatening collection letters out. Why? Probably trying to double-collect like the scum company they are! We contacted ******* and they informed us that they have had problems with APEX and on more than just ****************************** case. Additionally, Hospice noted that APEX knows an invoice would never be sent out to a client on Hospice and Hospice would contact APEX to correct the issue. Hospice contacted them and the problem, that should never have been an issue in the first place is now resolved.

• Initial Complaint

  08/31/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Balance billing practices employed by this company. Insurance pays a set price for the service they provide and apex balance bills the rest. If I had ****************** apex paramedics would be in violation of the surprise billing law. I have employer based insurance and apex takes advantage of their customers.

  Business response

  09/14/2023

  Hello,

  Please know, we do follow both Federal and State law for our billing practices. A person being eligible for ******** and surprise billing are not connected. As we are not contracted with any commercial insurance, we are not under any obligation to accept how commercial insurance processes a claim. As we are not contracted with commercial insurance, we do bill commercial insurance as a courtesy to the patient. The patient is ultimately responsible for how their insurance processes the claim and for the balance between their insurance payment and the balance. We are within our rights as a ground ambulance provider to seek reimbursement for the service provided. 

  Based upon the information provided by the person filing the complaint, I am unable to find a person with this name/address in our system to provide more detailed information. The patient is welcome to contact our billing department Monday-Friday from 8am-5pm to review their account.

   

  Thank you,

  *****************************

• Initial Complaint

  07/21/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Hello, re claim # ********A650H. My wife ****** was rushed by public ambulance on 12/30/22 to a stand-alone ** in ******, ********. At approximately 3:00 AM on 12/31 the ** decided she needed to be transported and admitted to a nearby hospital. They arranged for a private ambulance, Apex Paramedics, to take her. I followed in my car- she was not considered stabilized, so I was not allowed to take her myself in my car. I was not consulted about the selection of which private ambulance company to use, and we did not agree to any waivers with them. They billed ********** $1809. ********** says the allowable in-network charge was $643.88, and paid 100% of it (as we were over our annual out-of-pocket ***** Subsequently, Apex Paramedics invoiced me for the out-of-network balance of $1165.12. I contacted them to explain that my understanding is that surprise balance billing from a private ground ambulance is illegal in ********. The billing specialist claims that I am incorrect. I signed a form authorizing Apex to negotiate with my insurer directly for additional payment, but I'm not going to pay this bill myself. This sort of surprise billing is unconscionable. My wife was not stable, and the ** contacted Apex to transport her to a hospital for admission. We had no choice in the selection of the ambulance provider. If we had, we would have insisted on an in-network ambulance. Attempting to charge this exorbitant amount is deceptive. I believe that Apex should accept whatever amount they receive from my insurer as full (and fair) payment for services rendered. Thanks

  Business response

  08/16/2023

  The patient was transported in a non-emergent situation as 911 was not activated and our response time was 40 minutes after receiving the request for transportation. If the patients condition had been unstable at the time the decision to move the patient to another facility was made, 911 would have been activated by the facility. Instead, non-emergent transportation was called to provide the patient with needed medical supervision during the transportation between facilities. While Apex Paramedics is a private ambulance company, because the patient was moved in a non-emergent situation, the ******** surprise and balance billing laws do not apply in this situation. Furthermore, the ******** law only applies to insurance companies which are written in the *****************. This patients insurance was written in ********. Because the insurance was written in ********, by default, we follow the Federal Surprise billing law which has excluded ground ambulance completely. Because we do not have a contract with the patients insurance, we are under no obligation to accept their processing of $1,165.12 as experimental, investigational or unproven. We have received authorization to appeal on the patients behalf with their insurance. We have started that process, submitting an appeal to the patients insurance, on 08/04/2023, via paper and **** mail. In general, we allow 30 days for an insurance company to process our appeal. During that time,the patient will not receive a statement from us. 

  Attached are all of the ******** regulations and the Federal regulation. If Apex Paramedics wanted to be generous and apply the Code of ******** Regulations 4-2-66 (page 571), we would accept 325% of the ******** allowable rate which is $1,420.70.

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