The Skyrocketing Cost of Out-of-Network Ambulance Rides

Calling 911 is scary enough without worrying about a massive bill showing up a month later. Medical emergencies happen fast, and you rarely get to choose the ambulance company that responds to your call. This lack of choice leaves many patients vulnerable to staggering out-of-network charges. Understanding how these bills work and what protections exist can save you thousands of dollars.

The Loophole in the No Surprises Act

In 2022, the federal government enacted the No Surprises Act. This federal law stops hospitals and doctors from sending massive, unexpected bills for out-of-network emergency care. It even covers expensive air ambulance rides. However, lawmakers left out one major service: ground ambulances.

Ground ambulances account for the vast majority of medical transports in the United States. Because they are excluded from the federal law, private ambulance companies can still engage in balance billing. Balance billing happens when your insurance pays a portion of the transport fee, and the ambulance company bills you directly for the remaining balance. According to data from FAIR Health, the average charge for an advanced life support ground ambulance is over $1,200. In some rural areas or major cities, those bills can easily surpass $2,500.

Why Ground Ambulances Are So Expensive

The ambulance industry is heavily fragmented. When you call 911, the dispatcher might send a municipal fire department, a volunteer rescue squad, or a private, for-profit company like Global Medical Response or Falck.

Many local governments outsource emergency transport to these private corporations to save money on municipal budgets. Because these private companies often do not sign contracts with major health insurers like Cigna, Aetna, or UnitedHealthcare, they are legally considered out-of-network.

When they pick you up, they charge their own independent rates. If your insurance plan only covers $500 of a $2,000 ride, you are officially on the hook for the remaining $1,500.

State Laws That Offer Protection

Because the federal government has not fixed the ground ambulance loophole, several states have created their own laws to protect patients. As of 2024, around 14 states have banned out-of-network balance billing for ground ambulances.

California recently passed Assembly Bill 716, which took effect on January 1, 2024. This law strictly limits how much out-of-network ground ambulance providers can charge Californians. Similar laws exist in New York, Colorado, Texas, Florida, and Maryland.

If you live in one of these states, ambulance companies must limit your out-of-pocket costs to your standard in-network copay or deductible. If you receive a massive bill in a protected state, the ambulance company is likely violating state law.

How to Protect Yourself Before an Emergency

You cannot always predict a heart attack or a car accident. You can still take specific steps to lower your financial risk before an emergency happens.

• Look into local ambulance subscriptions: Many county fire departments and local EMS agencies offer an annual membership for a small fee. These typically cost between $50 and $100 a year. If you pay this fee, the agency will write off any out-of-pocket costs if they ever need to transport you.
• Explore private memberships: For wider coverage, private companies like MASA Medical Transport Solutions offer memberships that cover out-of-pocket emergency transport costs across all 50 states.
• Review your health insurance policy: Check your exact deductible and co-pay amounts for ground transport so you are not caught off guard. Knowing your coverage limits helps you prepare financially.

What to Do If You Get a Surprise Ambulance Bill

If a massive bill arrives in the mail from an ambulance provider, do not panic and do not pay it immediately. Follow a strict process to reduce or eliminate the cost.

First, call the billing department and request an itemized bill with specific billing codes. Errors are common. You might be charged for advanced life support when you only received basic transport.

Second, call your health insurance provider. File a formal appeal and explain that you had no choice in which ambulance picked you up during a 911 emergency. Insurers like Blue Cross Blue Shield or Humana will sometimes negotiate directly with the ambulance company to settle the claim.

Third, negotiate directly with the ambulance company. Tell them you cannot afford the balance. Many private companies, such as American Medical Response (AMR), have financial hardship programs. If you meet certain income thresholds, they may reduce your bill by 50 percent or more.

Finally, if you live in a state with surprise billing protections, file a formal complaint with your state insurance commissioner.

Frequently Asked Questions

Does the No Surprises Act cover ground ambulances? No. The No Surprises Act protects patients from unexpected out-of-network bills for emergency room visits and air ambulances. Ground ambulances were specifically excluded from this federal legislation.

Can I choose my ambulance company during an emergency? Generally, no. When you call 911, the local dispatcher sends the closest available unit. You cannot request an in-network ambulance company during a true medical emergency.

What exactly is balance billing? Balance billing occurs when a healthcare provider bills you for the difference between their total charge and the amount your insurance company paid. This usually happens when the provider is out-of-network and has no contracted rate with your insurer.