While the No Surprises Act protects consumers from surprise medical bills in some emergency situations, it does not cover ground ambulance transportation—a gap that results in around $129 million in out-of-network charges each year, according to a new report from U.S. PIRG Education Trust, Ken Alltucker reports for USA Today.

The cost of surprise ambulance bills

According to the U.S. PIRG report, ambulance companies regularly bill consumers for out-of-network charges when their insurance plan's network does not cover a specific public or private ambulance company.

Even after an insurer covers their portion of the charges, roughly half of consumers are billed more, amounting to around $129 million in excess charges each year.

A Kaiser Family Foundation (KFF) report found that around 51% of emergency ambulance rides resulted in out-of-network charges, potentially exposing patients to surprise bills.

In a 2020 study, researchers found that the median cost for a surprise ambulance bill was $450. However, the median varied across states and regions. In Massachusetts and Minnesota, the median surprise bill was higher than $1,000, while California had the most expensive median at more than $1,200. 

In 2020, fire departments or other local government agencies provided almost two-thirds of ambulance rides, while private ambulance companies provided around 30% of rides, according to KFF.

In January 2022, Congress passed the No Surprises Act, which protects consumers from surprise bills incurred during an emergency or when they receive care from an out-of-network doctor at an in-network hospital. While the law protects consumers from air ambulance bills, it does not cover ground ambulance transportation. 

"Ground ambulances were excluded from the No Surprises Act, in part, because of the complex regulatory nature and large number of stakeholders," Alltucker writes. "Ambulance companies are usually regulated by states and local municipalities."

Currently, 10 states have laws to limit ambulances from billing patients more than the amount their insurance companies pay, including Colorado, Delaware, Florida, Illinois, Maine, Maryland, New York, Ohio, Vermont, and West Virginia. Still, those restrictions vary—and they only apply to state-regulated health insurance plans.

In addition, "[s]tate bans don't apply to most employer-provided health insurance plans, which are regulated under a Department of Labor law called the Employee Retirement Income Security Act," Alltucker writes.

"This was the big gap in the No Surprises Act and it should be closed," said Patricia Kelmar, senior director of health care campaigns at U.S. PIRG Education Fund. "Three million insured people every year are going in an ambulance for an emergency, and half of those folks are exposed to a surprise bill."

"That's why we really do need a federal law to make sure that all insured patients have protection from surprise bills," Kelmar added. 

Advocates call for protection against surprise ambulance bills

In January, a federal advisory committee created by the No Surprises Act will meet for the first time. The committee will have 180 days to establish detailed recommendations for fee disclosures and strategies to shield consumers from surprise bills. U.S. PIRG is encouraging Congress to amend the law to protect consumers from surprise ambulance bills.

According to an analysis by Blue Cross Blue Shield Association and AHIP the No Surprises Act prevented up to 9 million surprise medical bills from January to September.

Ultimately, consumer advocates argue that it is "unfair to stick patients with surprise bills" after a ground ambulance transport because they are not given the opportunity "to compare prices or seek a better deal during an emergency," Alltucker writes.

"When you call 911, you don't know what ambulance is going to come," said Eileen Appelbaum, co-director of the Center for Economic and Policy Research. (Alltucker, USA Today, 12/14)