Seventy-one percent of all ambulance rides involve a potential surprise bill or in other words an out of network charge. For ground rides in an ambulance that surprise bill has been a median of $450. If you have to use an air ambulance, you could be on the hook for a median surprise bill of a whopping $21,698! Prior to the pandemic Congress was addressing the regularity with which ambulances were taking you for a ride, but that effort has not yet resolved the problem.
Congress put in a three year fight to control surprise billing by doctors that proved to be effective, the same is not true for ambulances and hospitals. Ambulances account for 51% of all out-of-network bills, emergency rooms 19% and elective inpatient services 9%. While Congress and States continue to fight hospital surprise billing, predominantly driven by anesthesiologists, they aren’t making any effort or inroads on controlling ambulance surprise charges.
Air Ambulances have successfully used the Airline Deregulation Act of 1978 as a legal loophole to prevent state policy makers from policing their industry. This 1978 Act was passed to deregulate the airline industry and “to promote efficiency, innovation and low prices in the airline industry through maximum reliance on competitive market forces and on actual and potential competition.” It opened up air travel to the masses through this deregulation but the air ambulances have used it as an argument why their pricing can’t be regulated. The leading air ambulance companies deliberately remain out of network with most insurers, thus avoiding any constraints on their charges and balance billing practices. These companies thrive on the ability to impose chares on unknowing patients. As these industry profits have ballooned the number of air ambulance providers have grown from 1100 in 2007 to 1400 in 2018.
Ground ambulance pricing is typically set by local and municipal governments which is why the federal government has a hands-off approach to the problem. Local governments generally finance their ambulance services through a mix of user fees and taxes. Prices vary from $2600 plus $42 for each mile traveled in the San Francisco Bay area to $550 plus $11.25 per mile in a county in Florida. In Bucks County, Pennsylvania the emergency medical service gets 78% of its revenue from ambulance billing and the rest of the budget comes from taxes raised by local cities and fund-raising drives. Shawn Baird, president-elect of the American Ambulance Association, “We have a distinct, public process.” Patient advocates contend that public oversight doesn’t seem to be protecting patients who often face surprise bills and forceful collection tactics from ambulance providers. The good news? Medicare pays a set base rate of around $225 in addition to a mileage fee and forbids the companies to send patients additional bills.
Five states passed laws in 2019 to restrict surprise billing in hospitals and doctor’s offices. Ground ambulances have been left out of every bill. As Christopher Garmon, a health economist at the University of Missouri-Kansas City said, “If you call 911 for an ambulance, it’s basically a coin flip whether or not that ambulance will be in or out of network.”