- Slightly more than half of emergency ground ambulance rides resulted in an out-of-network bill, according to a new analysis from the Kaiser Family Foundation.
- In seven states — Washington, California, Florida, Colorado, Texas, Illinois and Wisconsin — more than two-thirds of emergency ambulance rides resulted in out-of-network billing.
- Congress' ban on surprise bills kicks into effect next year, but ambulances are exempt from the legislation, meaning patients will still be on the hook for those pricey, unexpected bills.
Tamping down on surprise bills, which occur when a patient unknowingly receives care from an out-of-network provider or facility, was one of the hottest health policy discussions in Washington before the coronavirus slammed onto the scene. It's a pervasive issue: Previous research from KFF found that among large group health plan enrollees, one in five emergency room visits and one in six admissions to an in-network hospital led to a surprise medical bill.
In December last year, Congress passed the No Surprises Act, which prohibits surprise out-of-network billing beginning in 2022. The legislation requires plans to apply in-network cost sharing to surprise medical bills and prohibits out-of-network providers from balance billing patients for the unexpected costs.
However, the law doesn't apply to ground ambulances, though it did call for an advisory committee to review options for restricting surprise ambulance bills. Critics said at the time it was a notable oversight, as a large proportion of emergency rides result in surprise bills.
The new KFF analysis adds credence to that perspective. Researchers found ambulances bring on average 3 million privately insured people to an ER each year, and just over half of those rides posed a risk of a surprise bill. Using data from 2018, KFF found 51% of emergency ground ambulance rides and 39% of non-emergency ground ambulance rides included an out-of-network charge.
In the absence of sweeping federal protections, a number of states and local governments have stepped up to try to regulate patient billing, though they can't touch the self-funded employer plans that cover roughly two-thirds of U.S. workers. Many states protect patients from getting a ground ambulance surprise bill if they're covered by fully-insured plans, though many regulations only apply to a subset of ambulance companies, KFF said.
Researchers stressed additional protections are needed, given as many as 1.5 million privately insured patients brought to an ER by an ambulance could be at risk for a surprise bill.
"The regulation and delivery of ground ambulance services could present complexities beyond those involved in preventing other surprise medical bills," the report reads. "Yet, from the perspective of patients, ambulance rides are exactly the kinds of situations where they feel powerless to avoid surprise bills."