Surprise ambulance bills take patients for a ride

“This experience has scared me off from calling an ambulance unless someone is bleeding out in front of me," said a Connecticut student about their ambulance billing experience.

Ground ambulance speeding down the street, lights flashing
Alex Sherman

In a medical emergency, a ton of thoughts race through your head. Will I be OK? How long do I have to make it to the hospital? One question that probably isn’t on your mind is What if the ambulance taking me to the hospital is out of network? Unfortunately, if the answer is “yes,” you could be on the hook for an expensive surprise bill. 

After an insurance company pays its out-of-network rate for emergency transportation, the ambulance company sends a bill to the patient for the remaining balance. The trouble is that in an emergency, patients call 9-1-1 and don’t get to decide which ambulance will respond. 

In December 2020, the federal government passed the No Surprises Act, which will protect patients from most surprise bills, including air ambulances — but not regular ground ambulance bills. Lawmakers cited the complexity of the ambulance system as a primary reason why they omitted that category from the new federal law. Yet, Congress included surprise air ambulance bills, despite that system’s similar complexity

That loophole puts Americans in 42 states at risk of incurring surprise ambulance bills. Eight states have laws that protect patients from them.  Each of these laws requires that patients only have to pay the amount they would have paid if the ambulance had been in-network. 

It’s crucial to rectify this situation soon. Ambulance trips are a common source of surprise billing; 51 percent of emergency ground ambulance rides and 39 percent of non-emergency rides result in a surprise bill. On average, those surprise bills cost patients $450 and often cost far more.  

One Connecticut student’s story helps to shed light on the problem. In April 2020, while studying for their graduate degree, the student (who asked us to remain anonymous) visited their university’s Mental Health and Counseling Department. Just 10 minutes into their first appointment, their therapist decided to involuntarily admit them to the emergency room and called an ambulance to drive them. The therapist said that the university’s mental health department would completely cover the cost of the ambulance ride. The student was admitted and the hospital kept them for four days. Six months later, they received a $4,000 bill from the ambulance company.  Even though the student had no choice in taking the ambulance, their insurance company denied the claim, as the insurance plan did not include coverage for a mental health emergency.  By the time they received the bill, the ambulance company was just days away from sending it to a collection agency.  

They could not afford this unexpected $4,000 expense. After several unsuccessful attempts to talk to someone at the University Mental Health Department about the therapist’s promise to pay for the ambulance, they had to ask their father to take care of the bill. While they feel fortunate to have a generous father with the means to cover the $4000, they still feel the effects of this experience today. This ordeal contributed heavily to the student being unable to finish their degree, because it compounded the stress of a recent move, working two jobs and going through a divorce. 

Summing up their experience, they said, 

“This experience has scared me off from calling an ambulance unless someone is bleeding out in front of me. I had no say in the care I received, and was stuck with a substantial bill that my therapist lied about covering. I feel privileged that my family was able to help me pay the bill, but I felt completely on my own.”

To prevent more nightmare ambulance billing scenarios with far-reaching repercussions, Americans need both state and federal governments to take further action. We’ve already seen one landmark law to protect patients from most surprise medical bills. Surprise ground ambulance bills should be the next step forward. 


Photo by Jonnica Hill on Unsplash


Alex Sherman