American Medical Response Billing
Over the past three years, Consumers Union has collected more than 700 stories of surprise medical bills. Of those, more than a quarter involved ambulance rides, the organization says. “It’s a massive problem,” said Betsy Imholz, special projects director for the group. Ambulance services are not regulated by the government, unlike hospitals and doctors’ offices. Instead, many are run by private companies or volunteer fire departments and rescue squads, and they can set their own fees — which aren’t negotiated with insurers like a doctor’s office visit would be.
The federal Medicare and Medicaid programs do regulate fees, but those rules don’t cover private insurance. So patients who rely on private insurance are left with a patchwork of local rules and procedures, including some that allow for surprise billing. “The fact is, these are small, local services that operate on razor-thin margins,” says Brian Werfel, a consultant to the American Ambulance Association. “The cost of a ride can vary dramatically from one town to the next.”
Werfel adds that very few states have laws that limit ambulance charges or ban balance billing, and those that do don’t extend to ground ambulance rides. That’s because most of the nation’s ambulance rides are to or from a hospital, and hospitals are regulated by state law. So the only way to stop balance billing for ground ambulance trips is for state insurance regulators or lawmakers to change regulations, he says.
In recent months, two states have passed laws similar to the No Surprises Act, which prohibits out-of-network doctors from charging insured patients more than in-network rates. But those laws don’t include ground ambulances, which can leave patients with thousands of dollars in unanticipated bills, according to a Kaiser Health News review of 350 consumer complaints in 32 states.
Almost all of the complaints reviewed by KHN involve surprise ambulance bills, but that doesn’t mean all of them are unfair or illegal. Some may be based on misunderstandings between patients and their ambulance services. Others, such as the case of a Seattle man who took his wife to a hospital in an ambulance, resulted from data entry errors.
One way to avoid surprises is to consider joining an ambulance service’s membership program. The annual fee — which can range from $30 to $75 a year — covers all the company’s transport costs for your specific address and ride type. It’s worth checking whether your area has an ambulance service with a membership program, but it’s probably not a good fit for most people who don’t anticipate needing an ambulance often.
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