Taken for a ride
Navigating the cost of ground ambulance service
The last thing any of us think about as we get wheeled into an ambulance is whether the service is in-network and whether it’s covered by our health plan. If it’s not covered, this means the ambulance fee hasn’t been agreed upon in advance with your insurance company, so it’s an out-of-network service and the fee may be high. Sometimes, very high.
A recent study found the median out-of-network bill for a ground ambulance was $450. In some states, the average is more than $1,000.1 Keep in mind nearly 40% of all Americans don’t have the money to cover a $400 emergency expense.2
Ambulance services and balance billing
Although air ambulance services are included in the No Surprises Act — a law that prohibits balance billing for most out-of-network health care services — the Act doesn’t cover ground ambulance services.
FYI — balance billing occurs when health care providers bill patients for the difference between their charges and the amount paid by the patient's insurance company.
Ground ambulance services have the highest out-of-network billing rate of any medical specialty.3 In fact, 85% are out-of-network and can result in a balance bill.4
Most people are unprotected by state laws
Although many states have recognized the need to protect consumers from excessive bills for ground ambulance services, only 10 states currently provide some protection. They are Colorado, Delaware, Florida, Illinois, Maine, Maryland, New York, Ohio, Vermont and West Virginia.5
However, the laws in these states are limited to protecting only patients who are insured by a state-regulated health plan and don’t apply to most employer-sponsored plans.5
That means 60% of those who get their insurance coverage through a plan offered by their employer are left unprotected because those types of plans are exempt from state laws.6
Expanding the No Surprises Act
Clearly there’s a need for some kind of federal solution that includes ground ambulance services. But lawmakers have been reluctant to regulate them, citing the diversity of providers, complex layers of state and local regulation and a lack of information about what it costs to keep an ambulance stocked and running.3
Good news: There are ongoing discussions at the federal level aimed at establishing more comprehensive protections against surprise medical billing, including ground ambulance services.3
In fact, the No Surprises Act created an ambulance advisory committee, which will study patient billing and make formal recommendations. But it’s anyone’s guess as to if or when the Act will be revised to include ground ambulance service.
Experts at negotiating out-of-network bills
Meanwhile, what can you do if you get a balance bill from a ground ambulance service? Contacting both your insurance company and the ambulance provider may help you navigate the situation. Engaging in open communication, understanding billing details and seeking negotiation or assistance may lead to resolution and potentially reduce the financial impact.
Naviguard®, a UnitedHealthcare company, specializes in working with out-of-network providers on negotiating balance bills. We’re leaders in this field, with decades of experience understanding what out-of-network providers charge for services and when it may be excessive.
You may not be able to pick and choose which ambulance service to use, but with Naviguard, you’ll have experts on your side who have successfully resolved tens of thousands of balance bills.
RESOURCES
- What is out-of-network balance medical billing?
- How to negotiate a medical bill
- Learn how Naviguard can help employers reduce out-of-network health care costs
- Customer reviews about Naviguard services
REFERENCES
- Health Affairs article: “Most Patients Undergoing Ground And Air Ambulance Transportation Receive Sizable Out-Of-Network Bills"
- Fortune article: “‘Turbulence ahead’: nearly 4 in 10 Americans lack enough money to cover a $400 emergency expense, Fed survey shows”
- New York Times article: “Why Ambulances Are Exempt From the Surprise-Billing Ban”
- Herman, Bob. "Patients still have no protection against surprise ambulance bills. And there’s no solution in sight." STAT, 13 Feb. 2023.
- Alltucker, Ken. "Half of ambulance rides yield surprise medical bills. What's being done to protect people?" USA TODAY, 13 Apr. 2023.
- Association Health Plans. "What Is ERISA Health Insurance?" June 30, 2020.