U.S. Ground Ambulance Surprise Billing Protections Lag Behind Federal Law

Surprise billing for ground ambulance rides remains a significant concern in the U.S. healthcare system, as the federal No Surprises Act does not extend its protections to these services. Patients often face substantial out-of-network bills for ground ambulance services, which they cannot choose due to emergency circumstances.

This gap has prompted at least 20 states, including Utah and North Dakota, to implement state-level legislation aimed at curbing surprise bills for ground ambulance rides by setting minimum insurer reimbursement rates. However, these efforts face opposition from insurers and concerns that higher mandated payments could increase overall health insurance premiums for consumers. The federal No Surprises Act, enacted in 2020, protects patients from balance billing for air ambulances and other emergency services but excludes ground ambulance services, citing the complexity of varying business models and insufficient cost data. The advisory committee formed by Congress recommended patient protection from being stuck in disputes between providers and payers. States are limited in reach since many employer-sponsored health plans are self-funded and not state-regulated, fueling calls for federal legislation to close the coverage gap. In Colorado, a bill intended to expand protection against surprise billing was vetoed by the governor over concerns about premium increases, despite bipartisan legislative support.

Lobbying efforts by major insurers have influenced such outcomes by highlighting potential cost impacts on premiums. Industry groups argue mandated payments may reduce insurers' ability to negotiate fair prices, potentially driving up costs. The debate continues as policymakers seek to balance protecting patients from surprise costs without imposing unsustainable financial burdens on the health insurance market. Ground ambulance billing practices exemplify broader issues in the healthcare payment system associated with medical debt, access to care, and payer/provider negotiation dynamics.