It’s time to end ambulance surprise billing
Expert advisory committee released report for Congressional solutions to end ambulance surprise billing.
We’ve been working to end surprise billing from out-of-network providers for years. And we’ve made some progress. Over 1 million surprise bills have been prevented EVERY MONTH since the implementation of the No Surprises Act in 2022. That’s a lot of money that now remains in the bank accounts of patients.
But our work isn’t done. Why?
In most situations and in most states, a ground ambulance is still allowed to send a surprise balance bill if it doesn’t have an in-network contract with the patient’s insurance.
What is a surprise bill?
Although many medical bills are surprising, “surprise billing” is a shorthand for bills that out-of-network providers send to patients, for the balance of a medical bill that their health insurance doesn’t cover. Patients cannot avoid these bills because they come from providers that the patient doesn’t choose. While the No Surprises Act protects patients from surprise bills from out-of-network emergency room doctors and service, anesthesiologists, radiologists, and air ambulances, there are still situations where patients might receive a surprise bill, such as ground ambulances, some urgent care centers, or labs located within a physician’s office.
Ground ambulances were not included in the No Surprises Act patient protections. That’s why we still need to solve this billing problem. Patients are stuck with whatever ambulance is ordered for them by the 9-1-1 dispatcher or ordered by the hospital. And there’s a 50% chance that people in the U.S. will be transported to a hospital by an out-of-network ambulance. That ride could result in a balance bill of hundreds or thousands of dollars.
Why were ambulances left out of the No Surprises Act?
Ambulances across the country are operated differently throughout the country. Some are run by or contracted by municipalities or counties; some are operated by local hospital; others are privately run (either family/small businesses or private-equity owned). Finding a solution wasn’t going to be so clear cut, so within the No Surprises Act, Congress created the Ground Ambulance and Patient Billing Advisory Committee to study the issue and make recommendations. PIRG’s health care campaigns senior director, Patricia Kelmar, was appointed as the only consumer representative on the committee. And we fought hard to have the patient voice heard among the many industry voices which were also appointed.
PIRG believes the solution to surprise billing must include two elements:
- Individual patient protection: Protect the patient from the out-of-network balance bill. Patients cannot avoid these providers and should not have to pay extra just because the provider chosen for them is not part of their insurance network.
- System cost-containment: Ensure the provider gets paid a reasonable rate by our health plans but insurers should not have to absorb overpriced charges from out of network providers. Those over-charges can easily be passed on to all insured beneficiaries, rising costs for everyone.
What did the Ground Ambulance and Patient Billing Advisory Committee recommend?
In November 2023, after six months of reviewing data and discussing solutions, the Advisory Committee voted on a series of recommendations. And on March 29, 2024, the recommendations were issued as part of a full report to Congress.
Individual patient protections:
PIRG was able to convince the Advisory Committee to recommend strong patient protections.
- Ban on balance billing for both 911 and interfacility emergency transportation
- Ambulances can’t bill the patient until after they run it through the patient’s insurance
- Patients co-pay amount is capped to an amount that doesn’t deter them from calling the ambulance when they need one.
- The No Surprises Help Desk will handle consumer questions and complaints
System cost-containment:
PIRG felt the recommendations could have included stronger cost-saving solutions.
The Advisory Committee recommendation says insurers must pay out-of-network charges based on any rates that are set by the local municipality or county. (If there is no locally set rate available, then Congress would establish a set payment based on some percent of Medicare rates).
Our preferred solution for paying out-of-network ambulances:
Insurers should be required to pay rates high enough to cover costs of 24 hour ambulance systems in every community – but not much more.
Our concern with relying on locally set ambulance rates:
Municipalities might set overly generous ambulance rates to fill local budget gaps. Local leaders might happily allow ambulance to charge high rates to the “big insurer”. But when insurers pay more, we all pay more.
An important guardrail:
The Advisory Committee does recommend a mandate that all locally set ambulance rates are collected by each state and made public. Transparency gives us the tools to identify outliers and set us up for reform in the coming years.
Now it’s time for Congress to pass a law to protect all patients from ambulance surprise bills.
Until then, if you live in one of these states and are insured in a state-regulated health plan, you may be protected.
LEARN MORE
We gathered a group of experts to talk about the Advisory Committee recommendations that were included in the report that was sent to Congress. Listen to that robust discussion. We thank the panelists for their generous time.
MODERATOR: Dr. Ritu Sahni, M.D., M.P.H., Medical Director for Clackamas County EMS and Washington County EMS
SPEAKERS:
- Patricia Kelmar, J.D., Senior Director, Health Care Campaigns, U.S. PIRG Education Fund
- Asbel Montes, Chair of the federal Ground Ambulance & Patient Billing Advisory Committee
- Jane Beyer, J.D., Sr. Health Policy Advisor, Washington State Office of Insurance Commissioner
WEBINAR Ambulance emergency: Time to remedy ambulance surprise billing
Topics
Authors
Patricia Kelmar
Senior Director, Health Care Campaigns, U.S. PIRG Education Fund
Patricia directs the health care campaign work for U.S. PIRG and provides support to our state offices for state-based health initiatives. Her prior roles include senior policy advisor at NJ Health Care Quality Institute, associate state director at AARP New Jersey and consumer advocate at NJPIRG. She was appointed to the Ground Ambulance and Patient Billing Advisory Committee in 2022 and works with patient advocates across the U.S. Patricia enjoys walking along the Potomac River and sharing her love of books with friends and family around the world.