In some cases, patients find themselves facing large, unexpected bills from ambulance companies. A common reason is that the ambulance service isn’t in-network with their health insurance plan. But many states — including New York and Ohio — have banned this practice, called balance billing, for ground ambulance services. And a 2022 federal law that protects air ambulance costs also applies to some ground ambulance services, though not all state and local fire departments and volunteer ambulance squads are covered.
The ambulance industry says insurers don’t pay enough to cover the cost of keeping ambulance crews available around-the-clock, 365 days a year. And that’s especially true for ambulance trips that don’t result in a hospital visit. “In about a third of the cases where an ambulance crew responds to a call, they don’t take anyone to a hospital,” Fitch says. “So they’re not reimbursed for the trip.”
Ambulances don’t turn down private insurance network contracts out of greed, experts say. Instead, they often are forced to do so because Medicare and Medicaid reimburse EMS providers at rates well below their costs. And these low reimbursements put pressure on insurers to strong-arm ambulance services into accepting their network contract terms.
A recent study found that over half of a million ambulance trips taken by people with private insurance resulted in a surprise bill. And a separate study found that more than 26% of those bills included out-of-network charges.
Some of the most troubling incidents reviewed by Kaiser Health News involve people who were charged thousands of dollars for a single ambulance trip. Others found themselves tangled in the system without any clear way to resolve their situation.
One of the most recent examples involves a retired police officer in Georgia who got a $20,000 bill for an ambulance ride that took him from one hospital to another — for a minor injury. He had no idea the ride was out-of-network and ended up paying $2,800 to settle his bill.
When he called to complain, the phone was answered by someone in Arizona, then California, and then the Philippines before being disconnected. “I felt like I was being scammed,” Mike Haga says.
What can you do if you get a surprise ambulance bill?
First, try negotiating with the provider. If that doesn’t work, file an appeal with your insurer using this guide from the Patient Advocate Foundation. And consider contacting your state insurance regulator or attorney general.
Some of the newest legislation addresses this issue by requiring that ambulance services disclose their charges upfront and allow you to choose whether you want the service. This could help prevent surprises — but it will take time to implement and could be difficult for small, rural communities. And, finally, it’s worth noting that Medicare and Medicaid have their own rules that prohibit balance billing and require that EMS providers offer in-network rates for all covered ambulance services. This may ease some of the pressure on insurers and EMS providers to balance bill. American Medical Response Billing