Prices can vary significantly between private, public ambulance services
About 28% of emergency trips in a ground ambulance resulted in a potential surprise bill in an analysis of commercial insurance claims reported in Health Affairs.
The No Surprises Act protects consumers from many types of surprise medical bills – but not if they need an ambulance.
About 28% of emergency trips in a ground ambulance resulted in a potential surprise bill in an analysis of commercial insurance claims reported in Health Affairs. Between 2014 and 2017, approximately 85% of emergency transports were considered out of network, although two-thirds of those trips were paid in full by insurers.
Researchers found significant price differences among ambulance service ownership types. Potential surprise bills from private ground ambulances, the most common type of emergency transport, were more than 50% higher than those from the public-sector ambulances in 2017.
“Our analysis illustrates that being transported by a private-sector ambulance in an emergency comes with substantially higher allowed amounts, patient cost sharing and potential surprise bills compared with being transported by a public-sector ambulance,” the report says. “Further, allowed amounts and cost sharing tended to be higher for private equity or publicly traded company-owned ambulances than other private-sector ambulances.
“These findings highlight substantial patient liability and important differences in pricing and billing patterns between public- and private-sector ground ambulance organizations.”
Ground ambulances were left out of federal legislation outlawing surprise bills because many are operated by public agencies that feared the law would affect their ability to continue offering services. In emergencies, patients typically are not able to choose an ambulance provider that is in network, potentially exposing them to surprise medical bills.
Public ambulances were more likely to be out of network and to have their charges paid in full by the insurer compared with ambulances operated by publicly traded and private-equity groups. On the other hand, privately run ground ambulances were able to command higher prices, patient cost sharing and higher potential surprise bills, the analysis of claims found.
Related: ERISA Industry Committee disappointed with final surprise medical billing regulations
The research results “imply that a law similar to the No Surprises Act can more easily be crafted to generally benefit, or at least not harm, public-sector ambulance revenues without increasing federal deficits — an outcome likely to be important to lawmakers,” the report concludes.