At least one in five complaints about surprise medical bills involve ambulance rides, according to Consumers Union. And yet, very few states have laws regulating ambulance fees or prohibiting balance billing. This is largely because most of the nation’s ambulance companies are privately owned and not subject to state insurance laws, though some towns that hire private ambulance providers may regulate fees or prohibit balance billing.

That leaves patients vulnerable to out-of-network ambulance charges even if they have insurance. In fact, research published last year found that 79 percent of ground ambulance trips taken by patients with private insurance could result in an out-of-network bill. That’s much higher than the proportion of out-of-network charges from other physician specialists, such as ER doctors or anesthesiologists.

Many ambulance services reject insurers’ contracts to be in-network because they say insurance reimbursement rates are too low. That can lead to the kind of situation faced by Roswell couple Mike and Sherri Haga, who received a $2,438 ambulance bill for their toddler’s ride to the hospital. They said their call to AMR was transferred around the country and that no one would help them.

AMR did not respond to a request for comment from Atlanta News First. But the company did send the Hagas a letter that included a debt collection warning and a waiver they would have to sign if they were late in making payments on the bill. The couple says they declined to sign and called AMR again to ask if the company was willing to work with them on the bill. The company said it was awaiting word from its corporate office on the debt collection issue.

Ambulance companies often provide valuable services, but their high prices can put a strain on health insurance benefits. In the case of AMR, the federal government and state officials claim that the company billed Medicare and Medicaid for Advanced Life Support services, which require a paramedic on scene and in the ambulance and require a high level of monitoring, even when they were only providing Basic Life Support services (ambulance transport).

The Hagas’ case illustrates why patients need more than just a phone number to resolve their problems with an ambulance company. They need a contact at the company who can explain the level of service they were provided, review insurance information and create a patient account identifying all fees and charges. This is the function of the third party company that handles all communications, insurance claims and patient account billing for DCFEMS.

While there’s evidence of waste and fraud in the ambulance industry, most ambulance-related billing issues aren’t fraudulent. Instead, they are a symptom of a larger problem: Health care consumers are caught in a system that allows companies to charge thousands of dollars for a single trip and often leave patients with large out-of-network medical bills. It’s a system that needs to change.American Medical Response Billing