It’s never a good thing when you, or a loved one, needs an ambulance. Whether it’s a car accident or a heart attack, it’s usually a scary event that prompts you to call 911. EMTs save our lives. But at what cost? Why are ambulance rides so expensive?

I know from personal experience that when the ambulance arrives, their presence is comforting. You know they will provide on-site help and if needed, quickly get you (or your loved one) to a hospital.

But what if your ambulance ride leaves you with a bill for thousands of dollars that your insurance company won’t pay? It’s happening more and more across the US as the business model of ambulance service has evolved.

You have no say about which ambulance company shows up.

When you call 911, or a bystander, or police officer calls on your behalf, the dispatcher determines which ambulance crew is sent, either an ambulance from the fire department, or a privately-owned ambulance company that has a contract with the town. In some towns, they use a combination of service providers, public and private. You have no control over who is coming to help you.

Why does this matter?

Your costs depend on the type of ambulance and your insurance coverage. Unsurprisingly, a January 2023 report states that private-sector ambulances come with significantly higher costs, as compared to public-sector ambulances.

And if the ambulance is out-of-network (which is the case for 85% of emergency ambulance rides), your insurance company may not cover any of the bill! Therefore, chances are you will get a large bill, perhaps even several thousand dollars, if you ever need an ambulance.

Additionally, these private ambulance companies can decide which hospital to take you to, even if the hospital is out-of-network for you, which can lead to significantly higher hospital bills as well.

Why do ambulance rides cost much more than years ago?

Forty years ago ambulances were usually free for patients, with services provided by volunteers or by the town fire department. It’s a different story today. In general, towns and cities now charge for ambulance services. And many ambulance companies are owned by private companies and even venture capital firms.

These for-profit ambulance companies, which have contracts with towns and cities, usually charge by the mile and may even charge for each service, such as providing oxygen. Additionally, you might get a bigger bill if a paramedic is involved (as opposed to an EMT), even if you didn’t need that higher level of care.

And the bills for air ambulances can be astronomical.

Why are the bills getting even higher?

According to a February, 2022 report by FAIR Health, ambulance costs rose significantly between 2016-2020. Their analysis found that:

Ambulance companies have increased the percentage of trips billed as advanced life support (ALS) instead of basic life support (BLS). For example, in 2020, 51.5% of emergency ground ambulance claims were associated with ALS compared to 48.5% associated with BLS.
From 2017 to 2020, average charges and allowed amounts increased for ALS and BLS emergency ground ambulance transport:
- For ALS emergency ground ambulance service, the average charge increased 22.6%, from an average of $1,042 in 2017 to $1,277 in 2020.
- For BLS emergency ground ambulance services, the average increased 17.5% from $800 in 2017 to $940 in 2020.

Why do patients get stuck with high ambulance bills?

Health insurance companies have pricing agreements with all types of providers, including ambulances, hospitals and doctors. These agreements set a maximum cost for services, which is generally significantly lower than the “list” price. Your policy type dictates the portion you must pay.

When a private ambulance company and an insurance company cannot agree on a pricing structure, the ambulance company cannot be a part of the insurer’s network. If you use an ambulance that is out-of-network for your health insurance, you can be responsible for exorbitant full-price bills at “list” price.

Importantly, there are currently no federal laws protecting people from “surprise” bills from out-of-network ground ambulance providers. Moreover, a study published in April 2020 found that 71% of all ambulance rides involved potentially surprising bills for patients insured by a large national insurance plan.

However, some states and local governments regulate ground ambulance billing, but these laws may not apply to every health plan or ambulance company in your area. Unfortunately, if your insurance coverage is through a self-funded plan by your employer, local regulations will not protect you.

How high are these bills?

These bills can be thousands of dollars for ground ambulances. But you likely won’t have to pay the entire bill.

If you use an out-of-network ambulance company, you will receive an invoice for the “balance bill” – the difference between the in-network rate and the out-of-network rate, as negotiated by your insurance company. The average out-of-pocket charge for balance bills is $450, although in some states the average is closer to $1,000.

Moreover, bills for air ambulances can reach tens of thousands of dollars.

Can’t the government prevent these high ambulance bills?

Although there are 21 states with laws to protect people from surprising medical bills, these laws largely ignore ground ambulance rides.

The type of health insurance matters as well. Employer-sponsored, self-funded plans cover 61% of people with insurance. Interestingly, only federal laws, not state laws, apply to people in that category. So even if state laws protected patients from high ambulance bills, these laws wouldn’t protect the majority of insured patients.

There are some towns who have contracts with ambulance companies that regulate fees and/or prohibit balance billing. You can call your town to learn its policy.

What can you do to avoid ambulance rides that are too expensive?

Unfortunately, not too much, but you can try to get your bill reduced.

Firstly, find out which ambulance provider you used, and speak to your insurance company to see if they cover services from that particular company. You can file an appeal, which can be time-intensive and overwhelming. However, it can be worth it if the ambulance company and your insurer can reach an agreement.

If you need an ambulance, you must call 911. You can’t “shop around”. And you might be away from home in a different town or state when an emergency arises.

You should of course use an ambulance for a medical emergency. But you should also know that you can refuse ambulance transport if you are 18+ years old and mentally competent. For minor ailments like sprained ankles, it might make sense to ask a loved one to take you or call a ride sharing service.

Want to read more about why ambulance rides so expensive?

Read The Washington Post article to see stories of patients stuck with unexpected, expensive ambulance bills.

Learn more…

Ambulance rides are not the only expensive part of healthcare. Read these blog posts to learn more about money related matters:

NOTE: I updated this post on 3-1-23.

Why are Ambulance Rides so Expensive?