Ambulance Services’ Feet Not Held to Fire About Surprise Billing

There is legislation afoot at the local, state, and the federal level that address hospitals and other providers, but nothing takes on ambulance companies.

There’s been a lot of attention about surprise billing by hospitals and other providers. And the outrage and outcry has been intense enough to spur legislative attempts to address the problem. As the New York Times reports, however, one stakeholder has gone noticeably unnoticed—ambulance services.

The late House Speaker Tip O’Neil famously said “all politics is local.” Apparently, so is the funding for many ambulance services and that’s what makes them politically difficult to bring to the table when it comes to surprise billing. Even though, as the Times reports, the ambulance companies are very quick to sic collection agencies on people.

Christopher Garmon, a health economist at the University of Missouri-Kansas City, tells the newspaper that “if you call 911 for an ambulance, it’s basically a coin flip whether or not that ambulance will be in or out of network.” According to Garmon, 51% of ground ambulance services result in out-of-network bills, compared to 19% for ED visits.

Shawn Baird, president-elect of the American Ambulance Association, tells the Times that “when we talk to our members of Congress, what we really emphasize is that we’re a little different from the other providers in the surprise billing discussion. We have a distinct, public process. The emergency room isn’t subject to any oversight of that kind.”

But the ambulance bills people receive can easily be in the thousands of dollars. Patient advocacy groups aren’t having much luck on this front. Chuck Bell, program director for advocacy at Consumers Union, who worked to pass a Florida surprise billing law in 2016, tells the Times that “you’re struggling with health plans, hospitals and doctors and other provider groups. At a certain point you don’t want to invite another big gorilla in the room to further widen the brawl.”

The Times reports that “of the five states that passed surprise billing regulations in 2019, only Colorado’s new law takes aim at ambulance billing—not by regulating it, but by forming a committee to study the issue.”