Nearly six in 10 ground ambulance claims were out-of-network last year, putting patients at significant risk of surprise bills, FAIR Health reported Thursday.
The federal No Surprises Act provides consumer protections against unexpected charges from air ambulance providers but does not cover ground ambulance services. Last year, 59.4% of ground ambulance trips were out of network, according to a FAIR Health analysis of private health insurance claims data.
“Surprise or balance bills occur frequently with ground ambulance services, FAIR Health President Robin Gelburd said in a statement. “Patients often have no control over whether to use a ground ambulance or which ground ambulance provider to use.”
Moreover, the ambulance industry is characterized by complex ownership and operational structures that involve individual hospitals, local governments and private companies, which complicates rate setting and contracting, according to the report. States such as Colorado, Illinois, Maryland and New York have laws regulating ground ambulance billing that aim to limit patient exposure to large costs, according to FAIR Health.
FAIR Health analyzed more than 16 million ground ambulance claims from 2018 to 2022 and reported a slight decline over that time in the share of out-of-network claims, from 63.7% to 59.4%.
In addition. FAIR Health reported that in-network ground ambulance charges were highest in Utah, where they averaged $28.35 per mile, and lowest in Florida, where the average was $5.79 per mile.