Analysis: Half of Emergency Ambulance Rides Lead to Out-of-Network Bills for Privately Insured Patients

About half of emergency ground ambulance rides result in an out-of-network charge for people with private health insurance, potentially leaving patients at risk of getting a surprise bill, a new KFF analysis for the Peterson-KFF Health System Tracker finds.

Congress last year enacted the “No Surprises Act,” which prohibits most surprise out-of-network bills when a patient receives out-of-network services during an emergency visit or at an in-network hospital without advance notice starting in 2022. However, the protections do not apply to ground ambulance services, and the law instead requires a federal advisory committee to study the issue and recommend options to protect patients from surprise bills.

The analysis estimates that ambulances transport about 3 million privately insured patients to emergency rooms each year, accounting for about 1 in 10 of all visits to hospital emergency rooms among privately insured patients. Local fire and rescue departments and other government agencies account for nearly two thirds (62%) of those rides.

The analysis examines 2018 claims data from large employer health plans and finds 51% of emergency ambulance rides and 39% of non-emergency rides include an out-of-network charge for the ambulance service.

In seven states – Washington, California, Florida, Colorado, Texas, Illinois, and Wisconsin – more than two thirds of emergency ground ambulance rides result in an out-of-network charge.

The analysis also examines several existing state and local laws that seek to protect consumers from unexpected or excessive bills for ground ambulance services, generally by limiting when and how much ambulance providers can bill patients for their services.

The analysis is available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.