Sheboygan family fights 'astronomical' ambulance bill

SHEBOYGAN, Wis. - When a common infection made it harder for their toddler to breathe, a Sheboygan family took him to an urgent care clinic. Its staff recommended overnight care and ordered an ambulance.

More than one year later, the family is still fighting a bill for the ambulance ride. As Contact 6 found out, patients in other states don’t have the same problem.

For the parents of Simon Nelson, the biggest scare of Halloween 2023 was a case of croup. Simon was 1-year-old at the time. 

"The urgent care (staff) was like, ‘it’s a breathing thing. You need to take him to the emergency room,’" recalled Sara Nelson, Simon’s mom. "They had spoken to a doctor and everyone was in agreement that he should be transferred."

Staff at Aurora Medical Center of Sheboygan County arranged the ground ambulance ride to Children’s Wisconsin.

Children’s Wisconsin discharged Simon the next day. Weeks later, the ambulance bill arrived.

Ryan Nelson, Simon’s dad, remembers his reaction.

"I looked at it and thought, "'This is crazy,'" said Nelson. "But, we’ll have it go through insurance and see what happens."

SIGN UP TODAY: Get daily headlines, breaking news emails from FOX6 News

Before insurance, the 58-mile ride cost the Nelsons $10,540. After insurance, it still cost them $6,921.66. That’s despite the bill being run through two insurance plans.

"We were in a unique situation where I had some insurance carry over from a previous job," Ryan Nelson explained.

In January 2022, the No Surprises Act brought sweeping consumer safeguards to medical billing. The law protects people in medical emergencies from out-of-network balance bills.

Ground ambulance rides are a notable exception to the law.

"You shouldn’t have to, in that moment, wonder, ‘am I going to be able to afford this care?’" said Ryan Nelson. "I’ve written to all our state and national representatives to question why that’s the case."

This year, Indiana Governor Eric Holcomb signed new legislation to stop Hoosiers from getting surprise bills from out-of-network ambulance providers. Ambulance providers must accept the patient’s in-network rate plus their deductible or copay, or 400% of the Medicare rate. The Indiana law takes effect in 2025.

Patricia Kelmar of the Public Interest Research Group (U.S. PIRG) said Indiana is among 18 states with laws that provide ground ambulance billing protections. Wisconsin is not among them.

"We have been working as a consumer advocacy organization to stop these surprise bills," said Kelmar. "The problem is growing because these bills are getting larger and larger."

Kelmar served on a federal task force created by the No Surprises Act called the Ground Ambulance and Patient Billing Advisory Committee. 

The committee’s final report states, "There was broad consensus among Committee members to recommend mandatory coverage of, and prohibition of balance billing for, ground ambulance emergency medical services when plans or issuers cover emergency services."

Kelmar says she supports a federal law.

"To make sure that everybody across the country, no matter what kind of insurance they have, is protected from a surprise ambulance bill," said Kelmar.

The Nelsons aren’t the first family to write to Contact 6 about surprise ambulance bills. In 2023, Contact 6 also heard from Christine Chialiva and Michael James. All three of their complaints accused one provider, Superior Ambulance, of overcharging.

"This is, like, an astronomical amount," said Sara Nelson.

Simon’s ride was classified as Specialty Care Transport (SCT), which is the highest level of care. In 2023, Contact 6 solicited base rates for SCT from other Wisconsin ambulance providers. LifeStar reported a base rate of $2,400. Orange Cross said it charged $1,915.48. Bell Ambulance reported $2,270. MMT said its base rate was $2,016.

Superior’s SCT base rate on bills sent to the Nelsons, Chialiva and James was $6,600.

"I can’t speak to charges by other ambulance providers," said Kim Godden of Superior Air - Ground Ambulance Service of Wisconsin.

Godden says Superior’s base rate reflects their overhead costs, medicine and technology, plus Superior’s response times for inter facility transportation.

"What’s unfortunate is not the size of the bill. It’s unfortunate that the insurance company didn’t cover the bill and the patient received the balance," said Godden.

The Better Business Bureau has more than 150 complaints about Superior Ambulance in three years. Its website warns consumers about a pattern of complaints alleging "high or excessive fees for transport." It also says consumers state their costs are not being covered by insurance.

Godden says Superior supports states passing similar legislation to Indiana’s.

"We are in the business or providing health care services to patients in their time of need. We are not in the business of chasing bills," said Godden.

As for the Nelsons, Superior Ambulance isn’t reducing their charge. Instead, it paused the family’s bill while it appeals to the insurance companies. Godden says the appeal is "to explain the level of care."

FREE DOWNLOAD: Get breaking news alerts in the FOX6 News app for iOS or Android

The Nelsons feel Superior has already been paid enough.

"I’m not against paying a medical bill, but this is just obscene and unreasonable," said Ryan Nelson.

Contact 6 reached out to both of the Nelson's insurance providers, Centivo and All Savers. AllSavers is part of UnitedHealthcare. Neither provided comment on the Nelson's bill.

Aurora Health Care told Contact 6, "We are not involved in establishing pricing for ambulance services or in their billing process."

Full Statement from Aurora

"We are not involved in establishing pricing for ambulance services or in their billing process. Because our patients’ safety is our highest priority, we contract with ambulance providers throughout Wisconsin to ensure adequate medical transport coverage, including critical care ambulances that are used to transfer very ill patients to facilities that can provide a higher level of care. These ambulances include professionals with advanced training and special equipment."

Reaction from senators

Contact 6 reached to Wisconsin Senators Ron Johnson and Tammy Baldwin for this report. Baldwin’s office sent a statement in response.

It’s disturbing to see hardworking families, like the Nelsons, slapped with a sky-high bill just for following orders and getting their son the care he needed," said Senator Baldwin. "No family should have to shoulder this burden, and that’s why I am working to cut health care costs, increase transparency, and connect more Wisconsinites with affordable, quality care."

Johnson’s office did not respond.