Testing the “NO SURPRISE ACT”

Way back in 2019 I started writing a comprehensive guide to the various “Helicopter Insurance” options available, detailing the Pros and Cons of each. Last September I finished that with an update that pretty much changed the entire reason behind the post itself. That was the No Surprise Act that became law in 2022.

Last Wednesday, (3/18/26) I was riding my mountain bike on my usual daily route. It’s a 10 mile loop, 1,000 ft climb, and takes me right about an hour. It was a beautiful morning and I was feeling pretty good. I was cresting a small hill on a fire trail. I had my bell on and it was dinging on every small bump. A hiker ahead of me heard the bell and turned to look. I gave him a hand signal that I was going to pass him on the right and did just that. Twenty yards later my front tire either got into sand or slid in gravel and tucked, throwing me violently over the bars.

I think I first hit on the right side of my helmet and my shoulder, and then tumbled a bunch more, finally coming to rest on my left side. I could hear somebody grunting and groaning in pain. Turns out, it was me. The hiker was soon at my side, asking me if I was ok.

I was not.

I told him to call 911 which he did. He had it on speaker phone as I could hear the dispatcher. He gave the dispatcher my description, what happened and that he was in Lime Ridge. I could hear dispatch asking for better specifics of where he was within Lime Ridge and he just didn’t know. He didn’t know the trail name and why would he, right?

I reached for my phone in my back pocket but it wasn’t there. I asked the hiker if he could find it. He searched in the grass for a bit and handed it to me. I opened my What 3 Words app and held my phone up to him and told him to read these “3 words” to the Dispatcher. I never looked at my screen but this is about where it all happened so it really could have been these 3 words:

I heard the Dispatcher say, “Gotcha! I’ve got your location. Help is on the way!“

I’ll say it again – get this App on your phone and put it on the Home Screen where you can find it easily. It’s free and might even save your bacon some day!
https://what3words.com/products/what3words-app

I then called my wife and gave her a quick SITREP. She called Travis and Em, gave them my location to go get the bike. She has full tracking on my via Google and Strava when I ride. Next she called Dispatch through the her direct line and informed them that I was hers, not that I expect they would have treated me in any other way.

Moments later I could hear sirens approaching. Quite a few. In our area most every medical call is going to be a local Engine crew and an Ambulance. That should be just two sirens. For whatever reason I heard a few more than that. After the fact, I saw that they had a lot more than that including a Battalion Chief, a Wildland Engine, an ATV, and the HELICOPTER (STARR) in the picture above!

The lead Paramedic and the entire crew did a fabulous job assessing my damage. They asked all the questions, checked all the things. They put me in a cervical collar and helped me get to my feet. I was maybe 50 yards from the parking lot and if I could walk they wouldn’t need special equipment. Luckily a Park Ranger came by just at that time and so I sat in his cab and hitched a very slow, very bumpy ride to the waiting ambulance.

I saw the BC and another engine leaving as we got to the parking lot. I’m sure that a lot of the originally assigned units were quickly cleared as soon as they knew my location. The Helicopter probably never took off.

As I was getting set up in the back of the Ambulance, Emily poked her head in and said Hi Dad! Best family ever!

I told her what happened and what I thought I had broken (collarbone and ribs). It wasn’t her first rodeo either.

I could see Travis behind her talking to the guys from Station 8. They had offered to bring the bike back to the station. Best support system ever! Best Son in Law ever too!

Because of my condition and location it was a Code 3 to John Muir’s Trauma Center. It was 4.1 miles, 2 left hand turns and we made it in about 11 Minutes. In the back of the Ambulance and on the rather bumpy road, the Paramedic put an IV in my left arm and started a bag. Perfectly and effortlessly. Practice makes perfect! Best IV Ever!

At the Hospital I was put in as a “Bravo Level” patient in Trauma Bay 25. I was transferred over to their hospital bed and 6 to 8 professionals rushed into the room and jumped into action. Trauma shears cut away everything I was wearing but my socks. I had not been undressed that fast since that one time I walked into the Swedish Women’s Bikini Contest. (not)

Someone started a second IV on my right arm. This time it was not as seamless as the left arm – for whatever reason. Quite a few tries, different locations, and one audible ‘ooops’ and he had it finally in correctly. NOT the best IV ever!

DID YOU KNOW… No matter how good of a job the guy in the field does, the hospital staff will always put in their own line, ALWAYS. It’s a liability. The IV that was put in “in the field” may not have been sterile and that’s ok. It was never it’s focus. Job #1 is to make sure you are alive when you get to the hospital and in the right event they’ll need to push different drugs into your body fast – germs are not important at that point. The Hospital however has the ability to insert in a sterile environment and that’s why they always will.

Back to me on the table… I was fielding questions from all over. “What’s your date of birth?”, “Can you wiggle your toes?”, “Are you on any medications?”, “Squeeze my hands as tight as you can“.

Side Note: That last question is how we found out I broke a finger.
“Ouch!” said I when I made a fist.

I heard someone say, “Ok Michael, we’re going to roll you onto your side…” I offered to help, but there was a quick “No we got it – ON THREE…” and then next thing I knew I was screaming in pain. White. Hot. Stabbing. Pain.

Multiple X-rays were taken right there in the room. Next it was a CT scan from the waist up. Then things slowed down while we waited for results and the wife was let in to see me.

With the results back it was time to get me cleaned up and head home. Wyatt was the ER Tech assigned to me and he recognized me from the Bicycle Shop years before. He got me all cleaned up, got me a pair of sweats and a t-shirt to wear, and put my right arm in a sling. He and Nurse Sam then tried to get me to stand. On the first attempt the sling was too high and forcing my shoulder into a pain point. I turned white and they sat me back on the gurney.

Twenty minutes later I had drained the IV Bag and we took off the sling. I was able to stand much better and that’s when we discovered I had a broken a toe. Remember, I still had my socks on and nobody really looked down that far.

Through all of this, my biggest pain was in my shoulder. I thought for sure I had broken my collarbone and maybe a few ribs but the CT scan said otherwise. I honestly could not believe it. I felt the pain, the looseness and even heard bones crunching yet staff repeatedly told me there was no break.

John Muir Hospital was not my health care provider and they wanted me to follow up with mine (Kaiser) as soon as possible. My wife booked an appointment on the phone for Friday, while we were still in the trauma room.

I had started my ride from my driveway at 9:32 AM, crashed around 10:05, called 911 at 10:11, called my wife at 10:28, transported at 10:45 AM, arrived at 11:00 AM and discharged at 3:30 PM.

On Friday (3/20/26) I saw a Doctor at Kaiser who was more interested in my pinky than my collarbone. I had had it “Buddy Taped” since John Muir. Apparently, that wasn’t good enough as I left Kaiser that day with this.

Seriously. There’s an actual cast running from my two fingers all the way up to my wrist. An hour after I got home it was off and I went back to Buddy Tape. I was referred to Orthopedics for follow up and on Monday (3/23/26) I saw another Doctor who said the Buddy Tape was just fine for the next 3 weeks.

He explained in depth all about my collarbone. I had a very unusual dislocation of the Sternoclavicular joint. That’s where the Clavicle connects to the Sternum.

My clavicle had torn off the sternum and was now sitting a few inches higher and more towards the middle. It’s actually putting a little pressure on my airway and esophagus making it hard to swallow. He suggested softer meals and nothing big and crunchy for a while.

I told him I had something similar happen and tore two ribs off my sternum a couple of years ago. They naturally went back into place. He suggested that this might not happen – but we’ll see. Apparently, I have great bones but weak cartilage! (kidding) I have appointments with both him and my regular physician in a couple weeks.

For those keeping track at home…

• Nondisplaced oblique fracture of the fifth proximal phalangeal neck. (Broken Pinky Toe)
• Closed nondisplaced fracture of the middle phalanx of fifth finger on right hand (Broken Pinky Finger)
• Inferiorly positioned left clavicular head in relation to the right clavicular head possibly related to left sternoclavicular joint subluxation (Dislocated Collarbone at the Sternum)

Back to TESTING THE NO SURPRISE ACT

The law states pretty clearly that

The No Surprises Act protects you from a large balance bills and surprise costs related to emergency medical care if you have insurance. You’re only responsible for your deductible, co-pay or coinsurance, just as you would be with any other healthcare service.

I didn’t get the Helicopter ride that would have really tested this out, just the 4 mile Ambulance ride but even so I know that runs in the thousands of dollars. I took a very similar ambulance ride for $5,000 maybe 8 or 9 years ago before this law came into effect.

When the dust had settled in the trauma room, someone from John Muir came in and got all my vital billing information. They knew I was Kaiser, looked up my co-pay and collected the $150 for an ER visit there on the spot. That’s right in line with my Kaiser plan. So far, each follow up appointment has been no charge – also in line with my plan.

Billing sometimes takes months to shake out so I’ll update this as time goes by.

Side Note: As I was brought in they slapped a wrist band on me. As I was taken to CT or a new person came in, they would scan the tag and ask my full name and date of birth for verification. I think initially they just fill in the fields with garbage to get the band printed and then can update with the real full name, DOB and so on as they get it.

I’m not at all sure what an Ice Cream Trauma is but I look good for 185 years old!

UPDATE 4/1/26:

Checking in on my current billing at Kaiser I can see the CT Scan done at John Muir was covered.

However I see that there’s a balance due on the Ambulance Ride.

I’ll have to check into that further. At least it’s not another $5,000 taxi ride like last time.

And as for the Level II Trauma event at John Muir I see it’s still pending

Oh! I found a link to download all my summary of costs as an xls. It shows much more detail. I cut out the columns that didn’t matter.

If it’s correct, it looks like my Trauma II Visit was billed at a cool $64,k and I’ll be paying less than the cost for a new set of tires!

UPDATE 4/9/26:

Billing was indeed updated and it looks like my $64,k Trauma visit to John Muir Hospital did indeed cost me just the $150 Emergency Co-Pay it says on my Kaiser Card!

33 Different line items were billed and I pay $150? I’m ok with that!

I’m still not sure about the $250 Ambulance ride, but even if that is correct it’s still miles away from the thousands I was billed last time!

UPDATE 4/27/26:

I checked with Kaiser about that $250 charge for the Ambulance ride. It’s specifically states in my health plan that I have a $250 Copay for Emergency Ambulance Services so it’s absolutely correct.

The final tally for my ‘event’ was just $400 ($150 + 250). Oh and I’m still doing followups with my Kaiser specialists and since they are also being labelled as ‘follow ups’ – there’s no cost to me.

The other day I rode to where the crash happened. It’s been a month. I think I know what happened.

When I came upon the hiker, he was on the left side of this trail. That’s normally our regular MTB line. It’s hard packed and solid. But since he was there and unsure where to go, I told him I was going to pass on the right side. It’s hard to see in this picture but it’s a bit higher on the right side and has a drainage gully running down the middle.

There’s a slight turn to the right in this section and it was just after I passed him that I tucked the front wheel and went over the bars.

This picture below is looking back up the trail from where I had come and you can see that there’s also a bit of loose gravel/dirt – not at all like the hard packed other side of the trail.

The tip of the arrow is probably where my tire started to slide and the the front wheel tucked.

One month later my collarbone is still misplaced and hanging out over my air pipe. Doctors don’t know if it’ll go back to where it is supposed to and if it will ever attach itself back to my sternum. As of right now, no surgery is planned.

Yes, that lump is the end of my Clavicle!