Dive Brief:
- Out-of-network ground ambulance rides made up a larger percentage of total claim lines than in-network rides between 2018 to 2022, exposing patients to a higher risk of surprise bills, according to an analysis by Fair Health.
- Out-of-network rides made up almost 64% of all ground ambulance claim lines in 2018, decreasing slightly to over 59% in 2022.
- Advanced life support (ALS) services, which provide a higher level of care than basic life support (BLS), comprised a larger share of ground ambulance claims than basic life support services from 2018 to 2022 — another factor that could drive up costs, the research found. About 51% to 52% of ground ambulance claim lines were associated with ALS during the study period.
Dive Insight:
Patients frequently face surprise bills — unexpected bills from care inadvertently received from an out-of-network provider — after a ground ambulance trip, as many critically ill or injured people have no control over which service to use.
About 28% of emergency trips in a ground ambulance resulted in a potential surprise bill between 2014 and 2017, according to research published early this year in Health Affairs.
Patients often have relatively few protections against ground ambulance surprise billing. While some state and local governments have moved to regulate the practice, laws might not apply to all health plans or ambulance providers, leaving some patients still at risk.
States with the highest average allowed amounts for ground ambulance mileage last year were Utah, Wyoming and California at $28.35, $24.29 and $20.63 per statute mile, respectively. The lowest average amounts were in Florida at $5.79, Maine at $7.55 and North Carolina at $7.66.
The federal No Surprises Act, which was passed in 2020 and went into effect last year, created an independent dispute resolution process where insurers and providers can hash out billing issues, but the law doesn’t apply to ground ambulances.
Earlier this summer, a group advising Congress on surprise billing after emergency transport argued the IDR process wouldn’t work well for ground ambulances, which are often publicly funded and could lack resources to dispute claims.
