If you’ve ever needed an ambulance, you’ve probably been in awe of the speed and skill of the paramedics. But after the ride, your thoughts likely turned to the bill: How much did that call really cost? For patients with private insurance, it’s a common problem. Ground ambulance providers don’t have to be in-network with your insurer, which means you could get hit with a bill for the portion of the trip that went over what your insurance company paid — a practice known as balance billing. In fact, one study found that more than half a million ambulance rides took place in 2014 where the patient was out-of-network with their provider.
Unlike air ambulances, which are required to be in-network for Medicare and private insurers, almost all ground ambulance companies operate as independent contractors, and the majority of them are not part of a network of hospitals. That’s why some of them choose not to sign up for an insurance network, and patients can be hit with out-of-network charges for a ride that went over what their insurer paid. It’s a “huge issue,” says Betsy Imholz, special projects director for Consumers Union, which has collected hundreds of stories from people who got surprise bills. “They are often stuck in the middle, being billed by both their ambulance service and their health care provider.”
A lot of those out-of-network charges are legitimate. But in some cases, the ambulance services are overcharging because of a lack of transparency around what’s actually happening behind the scenes. That’s particularly true for emergency-level transports, which typically take you from a scene to the hospital, where you’re seen by doctors.
There are a number of ways to fight these bills, starting with a phone call to your insurance company. The Patient Advocate Foundation has a helpful step-by-step guide for doing just that. If that doesn’t work, consider a formal appeal. Your state’s insurance regulator or your attorney general may have a consumer protection division you can turn to for help.
Other options include asking the provider to lower the bill or offering a payment plan. If that doesn’t work, you can file a complaint with your state insurance department or attorney general.
Some people may want to look into ambulance membership programs, which are offered by companies and fire departments. For an annual fee, you can use their ambulances for free and never get a surprise bill (as long as you live in the group’s service area). But it’s important to note that these programs may not fully cover every situation that would require an ambulance, so they’re not a magic bullet. And they’re not an option for everyone, because many people still need to be transported to the hospital by ambulance. American Medical Response Billing