More than half of emergency ambulance rides could end with surprise medical bill

Photo: Ted Horowitz/Getty Images

Lawmakers are taking steps to prevent patients from receiving surprise medical bills, yet a major contributor to these unexpected expenses, ground ambulances, has yet to be addressed by Congress. 

Ambulances bring roughly three million people with private insurance to the emergency room each year, and more than half (51%) of these rides pose the risk of a surprise medical bill, according to new analysis from the Kaiser Family Foundation. 

The risk of surprise bills from an ambulance trip varies from state to state, according to the report. For example, in Washington, California, Florida, Colorado, Texas, Illinois and Wisconsin, more than two-thirds of emergency ambulance rides had an out-of-network charge in 2018. Meanwhile, in Alabama, Kentucky and Indiana, less than a quarter of emergency ambulance rides resulted in an out-of-network charge. 

These differences can be attributed to variances in state and local laws around ambulance billing, since there currently are no federal laws protecting patients from ground ambulance surprise bills, the report said. 

Of the emergency ambulance rides provided in 2020, nearly two-thirds (62%) were from local fire departments and other government agencies. The remaining portion was provided by private nonhospital ambulance companies (30%) and by ambulances owned by hospitals (8%).

WHY IT MATTERS

Surprise billing occurs when a patient sees an out-of-network provider during an emergency, or in a nonemergency case in which a patient sees an in-network provider but gets care from an out-of-network provider, such as an anesthesiologist.

When a patient receives out-of-network care, many times unknowingly, they may receive the balance of the bill, or the difference between full charges and what's been paid.

Previous research from the KFF found that two in three adults worry about unexpected medical bills and whether they'll be able to afford them, as they can cost thousands of dollars. 

Last December, Congress passed the No Surprises Act, which prohibits most surprise out-of-network billing for plan years beginning in 2022. Specifically, it requires plans to apply in-network cost sharing and prohibits out-of-network providers from balance billing on surprise medical bills. 

The act, however, does not apply for bills from ambulances – which is important, because as many as 1.5 million privately insured patients are brought to an emergency room by an ambulance and may be at risk of getting a surprise medical bill each year, according to KFF. 

Although the No Surprises Act doesn't address surprise ambulance bills, it does require that a federal advisory committee convene to review and recommend options to protect patients from them.

THE LARGER TREND

Health officials have called on Congress to end surprise medical billing for years. 

Part of the request includes increasing price transparency. The Centers for Medicare and Medicaid's final rule on the issue took effect at the beginning of this year. The rule requires hospitals, other healthcare providers and insurance companies to disclose their cash and negotiated contract prices to patients in an easy-to-access format

ON THE RECORD

"The regulation and delivery of ground ambulance services could present complexities beyond those involved in preventing other surprise medical bills," the KFF report said. "Yet, from the perspective of patients, ambulance rides are exactly the kinds of situations where they feel powerless to avoid surprise bills."
 

Twitter: @HackettMallory
Email the writer: mhackett@himss.org