Ground Ambulance Billing

Ground ambulance billing is the one large piece of emergency care the No Surprises Act left out. When Congress banned surprise bills in 2022, it covered emergency rooms, air ambulances, and out-of-network doctors at in-network hospitals, but ground ambulance was set aside for a federal advisory committee to study. So an ambulance ride is still billed the old way: the ambulance company charges its rate, your plan pays what it considers allowed, and you can be billed for the difference. Most ambulance services are run by cities, counties, fire departments, or private companies that never signed a contract with your plan, so most rides are out of network.

The numbers: a 2023 study of commercial claims found about half of ground ambulance rides for insured patients produced an out-of-network bill, with a median surprise bill of around $450 and some above $1,500. Charges run from $600 to more than $3,000 for a basic-life-support ride plus a per-mile fee. Because a patient in an ambulance is in no position to shop, the argument for protection is obvious, and 18 states have passed their own ground ambulance balance-billing laws, Texas among them for state-regulated plans in 2023. The federal advisory committee recommended in 2024 that Congress close the gap. Self-funded ERISA plans are not covered by the state laws unless the employer opts in.

The takeaway: if you get an ambulance bill for more than your plan paid, do not pay it yet. Ask the plan to reprocess it at the in-network rate, ask the ambulance company for their Medicare rate, and if your plan is state-regulated in Texas, remind both sides of the 2023 law.