Can you negotiate down large medical bills (ambulance rides)?

Life Hacking
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Long story short but I had surgery and a week later I had to visit the ER on a Sunday in the middle of the night.

Me, being the imbecile European that I am, called an ambulance as the bleeding wouldn’t stop for over an hour and, you know, it’s medical, it’s a potential emergency => call the paramedics/EMTs.

Little did I know that ambulance rides are:

  • very very very very expensive: 1500.- for a 10 minutes ride
  • very poorly reimbursed by the health insurance (if it’s an accident, whatever their definition is: 100% covered, if it was medically necessary it’s usually 50% up to 500.- per year covered, if it wasn’t medically necessary: 0% covered)
  • for you to figure out whether they’re medically necessary beforehand (everyone is a trained doctor, right?)

Yet another amazing feature of the health insurance industry here (can you tell I’m very bitter at this idiotic system?)

So anyway, when I got the bill, I called the hospital because I wanted to split it in several payments. And the finance person there asked me “how much can you pay?” – which made me wonder: do they expect people to negotiate these (obscenely high) emergency transportation bills? I mean, it’s a common thing to do in the US for instance where healthcare billing is as opaque, expensive, and potentially not covered like it is here.

Has anyone ever tried?

And also, learn from my discoveries: do not ever EVER EVER call an ambulance. It will bite you in the ass. Drag yourself to the hospital instead or whatever unless it’s a car crash (then apparently it’s automatically on the accident insurance, 100% covered no maximum). For anything else, take the bus, walk, crawl, whatever just no ambulance. Unless you had an extra month of rent worth of money that’s burning a hole in your pocket.

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Feel free to try but I don’t think this will work. Those prices are fixed by the City / Kanton since those are public services.

For the future you might want to consider completing your health insurance, transport coverage is usually packaged with other things that are pretty useful and not that expensive (I pay 12 chf a month for this with Assura which also includes correction glasses and some teeth insurance)

NB: As a Swiss national those kind of idiotic comments about how expensive things are here are not really well perceived. If you come to a country it is your responsibility to learn about the insurance system and what you may need to cover your ass. The healthcare system in this country is one of the most efficient in the world and although part of it relies on public funding it still requires private insurances. That’s one of the reasons why salaries are higher but unfortunately you cannot have both. I experienced France and trust me you are better off being in Switzerland even if you need to contribute with deductibles and extra coverage.

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I think this question was more to find out how much you can pay immediately and how much in installments, but you can always try to negotiate of course.

Those kind of expenses (literally emergencies) are the reason everyone should have an emergency fund.

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I agree with some previous posters. It is expensive, but not that expensive. You can totally handle it, just skip one monthly contribution to your portfolio. Considering that such an emergency will probably happen maximum twice in your life, what you pay is probably cheaper than paying an insurance covering such things for 40 years. It happened all of a sudden, that’s why it is not nice. But it is just volatility of expenses, and if you use insurance to damp it, long-term you are actually losing money. Insurance companies know how to calculate probabilities, and they also want to make money.

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In addition to it. In the tax declaration of the next year you can report the medical bills, I understand if this is above 10% of your income you have some kind of deduction.

Yes, there are somethings incredible expensive in this country, but as above mention there are always ways to mitigate the risk like having an optional coverage in your insurance.

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So did you have to pay the full or was part of it covered by basic health insurance?

You might want to consider getting a supplementary insurance to cover this. It is really quite cheap.

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So I don’t know yet if the insurance will pay any of it. They’re still thinking about it.

It’s either:

  • an accident => 100% of the bill paid, no deductible and no copay
  • medically necessary => some of it paid, typically 50% up to 500.- unless you have supplementary insurance
  • medically unnecessary => they pay none of it

My problem is that:

  • I’m not a doctor, I have no idea if it’s medically necessary (short of the very obvious, like a bruise or a very minor every day injury)
  • The definition for “accident” is very complicated and it can take a lot of arguing to decide whether something is an accident (“sudden and external” is the definition… good luck with that)
  • Having to try and decide all this in the heat of the moment while injured is really not something anyone should be expected to do, yet here we are
  • The price in some cantons is fixed (some in Romandie, the result is that a ride costs more like 200–500.- and yet everything works fine) and unregulated in others (where you get 1000.- or 1500.- for a short ride)
  • Insurance in general is extremely opaque: it’s hard to tell if (and how much) many things are going to cost you and whether they’ll be reimbursed or not.
  • Switzerland is expensive, yes but why is it so hard to obtain generic medicines that cost 5x or sometimes even 10x less than their branded version for instance?
  • Or why are medicine (any medicine) so much cheaper anywhere outside of Switzerland? These things aren’t made here, they’re imported and thus don’t cost 3x or 5x as much to make, yet we pay through the nose for them compared to the rest of the EU.
  • Some doctors (mostly psychiatrists) flat out refuse to take insurance even if insurance would otherwise cover it because it’s way too much hassle dealing with the paperwork, the billing codes, the issues… How is that efficient and effective at all?
  • It feels like the insurance system here mostly benefits insurance companies rather than the general population.

I personally think all this is the result of making health insurance mandatory (which is a good thing) but leaving up to private insurers to influence the laws and charge whatever they want.

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If you were bleeding - it’s obviously at least point 2 from your list.

Did you speak to the insurance re. any coverage from their end?
(You said you spoke to the hospital re. payment)

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I wish it was so simple. We’ll see what they say, for now they refuse to say anything. It shouldn’t be like that, ambulances are medical expenses and the insurers should be mandated to cover the costs without exception. Maybe that’d also help the cost of ambulance transport go back down to reasonable amounts.

If the dispatcher thinks an ambulance is necessary then that should be it. But nope, it has to be a gamble anyway.

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So you want even higher health insurance premiums? How many times in your lifetime do you think you need an ambulance? Ambulance should only be called in severe cases in my opinion and there I agree with you that the costs should be covered in full but not if calling the ambulance was unreasonable (without knowing what your case has exactly been).

I think you are overreacting a little bit here.

When I was a young adult I also had to pay about 1000.- for a seven minute ambulance ride. Whatever as long as you are healthy and you learned how high the costs are I think you just have to bite the bullet.

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I wonder what effect these high costs of ambulance have an on the amount of people who fail to call the ambulance when actually needed because they fear the bill. Such phenomenon, if existing, must affect more poor/FIRE people compared to the average person.

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Well in the US you have the phenomenon of people calling Uber instead of an ambulance…

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Yes, completely agree. Nobody should turn away from medical help because of the costs.

I think the problem is that with normal medical help you know your fixed costs based on premiums+franchise+10% part up until 700.-.

In the case of the ambulance or rescue missions for example the cost can almost be unlimited which can be a problem.

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You gotta think about the bigger picture here.
People who reached the maximum of the Franchise or definitely after reaching the maximum of the Selbstbehalt will call the ambulance for other reasons than emergencies.
I think you will agree that this wouldn‘t be feasible?

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I don’t think this is true.

There are many countries (I’d say all of the EU) where ambulance rides are “free” in the sense that the patient doesn’t get the bill for them.

Last I checked, taxis were still in business. It’s not like people call ambulances because they’re free instead of taxis… why would it be any different here?

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15 posts were split to a new topic: Health insurance policy

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According to a belgian show I watch, some people call the ambulance for nothing, and the dispatchers refuse to send them

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Which is also a very reasonable solution to a real problem. Much better than charging through the nose.

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Whataboutism? 20 chars

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I recall an ad campaign in the UK a few years back, where they tried to raise awareness for the societal impact frivolous call outs for ambulance had. From a newspaper article: “People have dialled 999 because of a split condom, a nose bleed, a finger trapped in a door, a sore throat and toothache”…

I would agree that 1’500 CHF seems high and might make somebody hesitate getting help, when it may well turn out to have been urgent. On the other hand, making it completely free / always fully insured would leave it too open for abuse. Leaves us with the question of what the fair cost should be?

Also, you call them out on corporate greed and excessive profits, but I’m not sure I would want to start an ambulance business. What would it take as minimum to serve your 10 minute drive?

  • Assuming the 10 minutes drive was 1-way, total use time was probably close to 30 minutes (get in, get there, load passenger, get back, get out). Add 15 minutes for staff to disinfect & restock any items used. Total down time = 45 minutes.
  • If we want to cater to the more trivial end, we probably need at least a second ambulance ready to go if a more urgent call comes in during those 45 minutes. To allow for repairs, upgrading equipment, etc. maybe consider a third ambulance to ensure there are always two ready to go.
  • Per ambulance a team of two people, driver & paramedic. 24 hours standby @ 2 ambulance @ 3 shifts = 12 people. Possibly needs 4 shifts to ensure sufficient rest time and need to cover weekends as well, let’s make the total 18 people. Also need to train people, cover for vacation, sick leave, maternity leave… New total maybe 22 people? Add some admin & cleaning & car/equipment maintenance… New total 24 people?

I don’t know… Maybe 1’500 CHF is on the high end, but I don’t think I’m going to invest any time soon.

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