A new report says Arizonans who have a medical emergency and good health insurance could still find themselves with a costly "surprise" bill.

The federal "No Surprises Act" is supposed to protect people from the high costs of out-of-network medical services.

But it doesn't protect them from surprise ground ambulance costs - which Patricia Kelmar, senior director for Health Care Campaigns with the Arizona PIRG Education Fund, said is simply unfair.

The group's new report says when Arizonans call 911, dispatchers will send the closest ambulance - and there's a 50% chance it will be out-of-network and not covered by the patient's insurance.

Kelmar said the national average for that ambulance bill is $450 - but in Arizona, it's higher.

"Getting a bill of $586 or more is going to really set them back," said Kelmar, "and we know that ambulance bills are driving people into medical debt. So, we need to put the brakes on it."

While the report says changes are needed, it also acknowledges that ambulance services are necessary and providers should be paid an appropriate fee.

The report says ten states have already passed laws to protect patients from out-of-network ambulance bills - but they're limited to people who have state-regulated health plans, which translates to about 40% of their population - and Arizona isn't one of them.

Kelmar said most people get health insurance through their employer, and those plans are only required to follow federal law - not state law.

"The Arizona Legislature could certainly step forward and not wait for a federal solution," said Kelmar, "and at least put some surprise billing protections in place for people in Arizona from ground ambulances. And then, we can continue to fight for a federal solution."

She said that federal solution would mean protecting people with employer-sponsored insurance.

Kelmar said the most important thing is to get the medical attention you need, then work to negotiate what you can pay.

She added that some hospitals provide financial assistance, so ask to see if you qualify.

Air travelers could face fewer obstacles in securing a refund if their flight is canceled or changed under new federal rules announced Wednesday.

The moves are being praised by watchdog groups. The Department of Transportation said airlines are now required to promptly provide passengers with automatic cash refunds when they are owed one.

Teresa Murray, consumer watchdog director for the U.S. Public Interest Research Group, said some carriers have not adhered to standards, leaving passengers in a bind.

"They would drag their feet, and they would say, 'Well, you bought your ticket from a ticket agent, so we don't know where your money is. Or, here, have a voucher,'" Murray explained.

Amid higher complaint volumes, companies will be forced to act quickly. The new rules, which are being phased in, provide clearer definitions for travel disruptions, including delays of at least three hours on a domestic flight and six hours on international flights. A key industry group responded to the announcement by touting transparency efforts among carriers.

Murray acknowledged most people are not frequent flyers, and it is hard for them to keep up on all the least practices and policies among airlines.

"The average person only flies once every 18 months," Murray pointed out. "This will just bring transparency to that process and it kind of evens the playing field."

Murray added it could come in handy for Midwestern customers when a winter storm wreaks havoc on air travel. The new rules also require refunds for baggage fees when a piece of luggage is delayed by 12 hours or more for domestic flights. And there must be upfront disclosure on fees for first and second checked bags and carry-on bags.


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Wisconsin lawmakers recently debated reforms for payday loans. Efforts to protect consumers come amid new research about financial pain associated with cash advances offered through smartphone apps. The Center for Responsible Lending is out with findings that detail how "earned wage advances" from digital platforms come with extra costs disguised as things like tips. Traditional payday lenders are often criticized for charging excessive interest rates on loans that are usually around $500.

Lucia Constantine, a researcher with the Center for Responsible Lending, said customers are usually seeking smaller amounts from the apps, but she warns they can be just as costly.

"They are trapping consumers in a cycle of borrowing that is similar to that of a payday loan, " she said.

The report said after using these financial products, customers are seeing overdrafts on their checking accounts increase by 56% on average. Industry leaders deny they're barraging consumers with hidden fees, stressing that features such as suggested tips are optional. More broadly, a bipartisan payday loan reform bill in the Wisconsin Legislature failed to advance this month.

Constantine said like longstanding payday lenders, these cash advance apps can be hard to regulate. Meanwhile, she urged those in a bind to explore other options.

"[They should] try talking to their friends and family as a first source. The other option which I would recommend is reaching out to their credit union or banking institution to see if they can get some sort of small-dollar loan," she said.

She noted places such as credit unions typically provide more transparency on loan costs. According to the report, three-quarters of consumers took out at least one advance on the same day or day after a re-payment was posted.


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Food prices remain high, in Montana and across the country.

A new report by the Federal Trade Commission says the country's largest grocery companies are gouging consumers, by keeping prices artificially high.

Many grocers, retailers and wholesalers have consolidated to cut costs. Grocers continue to blame supply chain problems, even though regulators have said most of those issues have been resolved.

President of the advocacy group Farm Action, Angela Huffman, said retailers were doing more than making up for lost revenue during the pandemic-era supply chain disruptions - and the FTC report says they continue to do so.

"In 2021, the retailer revenues, they rose to more than 6% higher than their total costs, and that those profits are still going up," said Huffman. "So, in the first nine months of 2023, the profits increased to 7%."

At nearly 6.5%, Montana had the nation's ninth-highest grocery price increase in 2023.

The FTC data show Amazon, Kroger and WalMart each gained market share during and after the pandemic - while profits continued to rise.

Other large retailers and wholesalers have consolidated, which they say gives them more buying power and the ability to pass those savings on to customers.

Huffman said that isn't what's happening, and calls on regulators to fine the grocers, or more.

"This would be kind of the farthest extent of what they could do, but go so far as breaking them up," said Huffman. "In years past, they broke up the telephone companies and the railroads and, you know, that would be the ideal outcome for us, is to take away their excessive power."

Huffman also points to a 150% increase in egg prices in 2023, which producers blamed on the avian flu. The FTC says the disease did not justify the drastic price hike.