Investigation

Surprise Ambulance Bills: A Consumer’s Guide

Q: What’s a surprise ambulance bill?

When the ambulance service that picks you up is out-of-network, your insurer pays what it considers fair. And then — surprise! — the ambulance service sends you a bill for the rest.

Q: What can I do if I get one?

  • Ask your insurance company to pay more.
  • Call the ambulance service’s billing department. Do they have a financial assistance program? Can they offer you a discount or a monthly payment plan?
  • File a complaint with your state insurance commissioner’s office, state attorney general’s office or the Better Business Bureau.
  • Ask a consumer advocacy group to help you negotiate down the bill.

Q: Can I avoid these bills ahead of time?

Possibly, if it’s not an emergency. First, ask your insurance company: Which ambulance companies are in-network? What do you pay for in-network and out-of-network ambulance rides? If you’re on Medicare or Medicaid, you should be protected from surprise bills, though there are exceptions.

At the hospital

If you’re at a hospital and need to travel by ambulance to a nursing home or another facility, you may have time to identify an in-network ambulance company. Ask which ambulance services the hospital works with and if any take your insurance. Even if the hospital is in-network, don’t assume the ambulance will be.

911 calls

  • You can’t pick which ambulance service responds to an emergency call. But if you want to be proactive, you can figure out the likely scenario where you live.
  • Ask your local fire department which ambulance service responds to 911 calls in your town. Is it a government service, a company hired by the government or a combination?
  • Ask if the fire department regulates ambulance charges. Does it have a policy protecting you from a surprise bill, also called a “balance bill”?
  • If a private company serves your area, ask the company what its policies are.
  • If there are no local rules protecting you, your state insurance commissioner’s office can tell you if state law protects you from surprise bills. Keep in mind these state protections don’t apply if you have a self-funded, employer-sponsored insurance plan, which is common if you work at a large company.

Q: When I call 911, can I choose where the ambulance takes me?

Possibly. Most ambulances will take you to the “closest appropriate facility,” but protocols vary from town to town. If you’re not in dire condition, the ambulance crew may agree to take you to your preferred hospital. If you’re on Medicare, you may have to pay for the extra miles. If you’re set on going to a particular hospital, ask if they’ll take you there before you get in.

Sources: American Ambulance Association; USC-Schaeffer Initiative; Medliminal

KHN’s coverage of end-of-life and serious illness issues is supported in part by the Gordon and Betty Moore Foundation.

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