State solutions needed to solve ambulance surprise bills

Published 9:40 am Tuesday, December 20, 2022

RALEIGH – Over the last year, the newly enacted federal No Surprises Act protected 9 million insured people from surprise medical bills from out-of-network hospitals and air ambulances. But the new law does not protect patients from ground ambulance surprise bills.

Each year, millions of insured patients who use ambulances are at risk of receiving an expensive out-of-network balance bill from the ambulance company. To provide a closer look at the problem, the U.S. PIRG Education Fund released a new report, “EMERGENCY: the high cost of ambulance surprise bills,” on Tuesday.

“People in a medical emergency don’t have the ability or the time to consult a network directory to make sure they call an ambulance covered by their health plan,” said Katie Craig, NCPIRG Education Fund’s state director. “Too often, even patients with robust health insurance, find themselves owing hundreds of dollars in surprise bills from out-of-network ambulances.”

The report explains that ground ambulances transport approximately 3 million privately insured people to emergency rooms annually. Because ambulances have the highest out-of-network billing rate compared to other health care providers, 51% of patients who have an emergency ride in an ambulance are exposed to a potential surprise bill.

In at least seven states, more than two-thirds of emergency ground transports could result in a balance bill, which can be pricey for those already dealing with a medical emergency. Ambulance surprise bills carry a median out-of-pocket charge of $450. And in some states, the median patient charge is more than $1000.

“Ambulance surprise bills are driving patients into medical debt,” Craig said. “We’re sounding the siren that patients need relief from these high out-of-network charges.”

When Congress approved the No Surprises Act, it acknowledged that ground ambulance surprise bills were still a problem and called for the establishment of an Advisory Committee on Ground Ambulances and Patient Billing. The Advisory Committee is tasked with submitting “a report that includes recommendations with respect to disclosure of charges and fees for ground ambulance services and insurance coverage…and the prevention of balance billing to consumers.”

In the meantime, 10 states already have protections from these surprise bills, including Florida, Ohio, and Maryland. But no such protections have been implemented yet here in North Carolina.

Advocates from NCPIRG Education Fund say that just because your trip to the hospital was a surprise, doesn’t mean that your bill should be too and that is why the group is calling for state and federal action to address this issue and protect consumers from surprise ground ambulance medical bills.