- The cost of being transported by ground ambulance has increased steadily over the past five years, according to a new report from nonprofit Fair Health, threatening patients with few protections from balance billing in disputes between insurers and ambulance providers.
- More ambulance trips are billing payers for advanced life support ( ALS), denoting a higher level of care (and reimbursement) than basic life support (BLS) services. Private insurers' average payments for those trips increased 56% between 2017 and 2020, from $486 to $758, according to the analysis. Before accounting for discounts negotiated with payers, the rate that ambulance operators charged for trips jumped 23% in the same time period and now average almost $1,300.
- However, the average reimbursement for advanced life support ambulance rides climbed by 5% for patients covered by Medicare, from $441 to $463, suggesting the government program is keeping a lid on rising costs.
Recent measures to curb rising healthcare prices often are focused on transparency with the hope patients will shop between services at different providers and choose the less-expensive option and one that's covered by their insurance. However, that's largely impossible when it comes to ambulance providers. Emergency medical dispatchers generally select the closest or best ambulance depending on a caller's location or the nature of the medical emergency, making it much more likely patients will receive care from a provider that doesn't contract with their health plan — and a potentially exorbitant out-of-network bill as a result.
It appears the problem is worsening.
Though average charges and allowed amounts increased for both advanced life support and basic life services from 2017 to 2020, pricier ALS services accounted for a much larger percentage of emergency ground ambulance claim lines in 2020, Fair Health found.
Such ALS services result in significantly higher reimbursement for ambulance providers. By comparison, costs for rides coded as supplying BLS services did increase, but at more manageable rates.
The average charge for BLS emergency ground ambulance services rose almost 18% from $800 to $940 between 2017 and 2020, according to the analysis. The average allowed amount for the same services rose 40%, from $373 to $522, during that period.
Meanwhile, the average Medicare amount for BLS services climbed almost 5%, from $372 to $390 — about the same percentage increase for ALS services in Medicare between 2017 and 2020.
The study's cost analysis was for base fees only and did not include any mileage fees, researchers said. The findings mirrored previous research on air ambulance cost trends, also conducted by Fair. That research found air ambulance charges soared for commercial insurers between 2017 and 2020, but the Medicare program appeared to tamp exponential cost growth.
The increasing prices have a wide implication on U.S. healthcare costs as an estimated three million privately insured patients are transported by ground ambulances to emergency rooms annually.
Though some state and local governments regulate ground ambulance surprise billing practices, no federal law currently protects patients from such unexpected bills. Ground ambulances aren't included in the No Surprises Act passed late 2020, which prohibits surprise out-of-network billing beginning in 2022. That leaves patients responsible for any extra charges in disputes between payers and ambulance providers.
One reason ambulances were excluded from that legislation is that ground ambulances are, among other complicating factors, operated by a variety of entities including local fire departments, rescue squads, hospitals and private companies, and are paid for in a variety of way. That makes it tricky to find a straightforward regulatory solution.
In November, the Biden administration set up a federal advisory committee, as mandated by No Surprises, to research and recommend ways to protect consumers from balance billing when using a ground ambulance.