Only 14 states prevent surprise ambulance bills
What is the problem?
Each year, three million individuals with private insurance are transported to emergency rooms by ground ambulances, with 51% facing the potential for surprise or balance billing. Surprise billing occurs when a patient is billed for an out-of-network service that became involved with their care without their knowledge or choice.
Why is it important?
The out-of-network billing rate for ambulances adds up to $129 million annually in surprise bills for insured patients. Although 85% of ground emergency ambulance rides are reported as out-of-network, they were not included in the No Surprises Act (NSA) congress passed in 2020. Based on distance traveled, level of medical care provided, use of specialized equipment, and type of ambulance used, basic life support or advanced life support, ambulance rides in the U.S. average between $300 and $2500.
What is the solution?
To protect consumers against out-of-network charges Washington state has introduced HB 2285 / SB 5986. The bill requires out-of-network ground ambulance providers to ensure consumers pay no more than the cost sharing amount, treating services as in-network with the maximum out-of-pocket obligation. As of October 2023, the following states: Arkansas, Colorado, California, Delaware, Florida, Illinois, Louisiana, Maine, Maryland, New York, Ohio, Texas, Vermont, and West Virginia, have enacted legislation to protect against out-of-network surprise ambulance billings. Two common state approaches to protect against surprise billings are reimbursing ground ambulance services at a set local rate or at the lower of a fixed percentage of Medicare service rates.