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.

This analysis finds that 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. Overall ambulances transport about 3 million privately insured patients to emergency rooms each year. Local fire and rescue departments and other government agencies account for nearly two thirds of those rides.

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.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.