Better Solutions for Healthcare

Health System Tracker: Ground ambulance rides and potential for surprise billing

By Krutika Amin, Karen Pollitz, Gary Claxton, Matthew Rae, and Cynthia Cox

June 24, 2021

In December 2020, Congress passed the “No Surprises Act,” which prohibits most surprise out-of-network billing for plan years beginning in 2022. Surprise bills occur when a patient receives care from an out-of-network provider or facility during an emergency visit or while receiving non-emergency care at an in-network hospital or facility. In these cases, patients may face balance billing from the out-of-network provider for the difference between the provider’s charged amount and the plan’s allowed amount for that service. Additionally, patients may have higher plan cost sharing for out-of-network services. We have previously found that among large group health plan enrollees, 1 in 5 emergency room visits and 1 in 6 in-network hospital admissions potentially led to a surprise medical bill.

The No Surprises Act requires plans to apply in-network cost sharing and prohibits out-of-network providers from balance billing on surprise medical bills. Additional details on the No Surprises Act are available here. The law’s protections, however, do not apply to bills for ground ambulances, which Congress put off pending further study. The No Surprises Act requires the Departments of Labor, Health and Human Services, and Treasury to appoint an advisory committee that will review and recommend options to protect patients from ground ambulance surprise bills.

This brief describes ambulance use, ownership type, the share of ground ambulance rides with a potential for surprise bills, and state or local policies aimed at reducing surprise bills for ground ambulances. Key findings include:

  • Ambulances bring 3 million privately insured people to an emergency room each year.
  • Local fire departments and other government agencies provide nearly two-thirds (62%) of emergency ground ambulance rides.
  • About half (51%) of emergency and 39% of non-emergency ground ambulance rides included an out-of-network charge for ambulance-related services that may put privately insured patients at risk of getting a surprise bill.
  • In seven states (Washington, California, Florida, Colorado, Texas, Illinois, and Wisconsin), over two-thirds of emergency ambulance rides included an out-of-network charge for ambulance-related services that may pose a surprise bill risk.