Emergency medical services (EMS) in the United States are a significant financial concern due to high costs. When calling 911 for an ambulance, the service is almost always subject to a charge, but the final amount a patient pays varies dramatically. This variability stems from complex billing practices, insurance coverage rules, and the specific medical interventions required. Understanding the factors that generate the bill and how insurance processes the claim is the first step in navigating this unexpected expense.
Factors Determining the Ambulance Bill
The ambulance bill is determined by the level of medical care administered, categorized primarily as Basic Life Support (BLS) or Advanced Life Support (ALS). BLS is staffed by Emergency Medical Technicians (EMTs) who provide essential care, such as oxygen administration and basic wound care. ALS service is billed at a higher rate because it is staffed by paramedics trained to perform more invasive procedures and deliver medications. These advanced interventions include IV line insertion, cardiac monitoring, and advanced airway management.
Base Rates and Mileage
The national average cost for a BLS ride is around $940, while an ALS ride averages about $1,277, though costs can be significantly higher depending on the provider and location. In addition to this base rate, a per-mile charge is added for the distance traveled with the patient. Mileage rates vary widely, sometimes ranging from $10 to $50 per mile. The ownership structure also influences pricing, as private companies, hospital-based services, and municipal fire departments each set their own fee schedules. Specific supplies used, such as specialized bandages or administered medications, are also itemized and contribute to the total cost.
Charges When No Transport Occurs
A charge often applies if EMS arrives but the patient does not require transport to a hospital. Many jurisdictions apply a distinct fee for “treatment-on-scene” or “medical assessment,” even if the patient refuses the ride or the crew determines transport is unnecessary. This charge compensates for the personnel time, vehicle deployment, and medical supplies used.
This service is often documented using a specific billing code, such as A0998, which designates a response and treatment without transport. While this fee is generally lower than a full transport bill, it can still represent a substantial amount. Even if a patient refuses transport, services rendered up to that point—such as an initial assessment or stabilization—will usually result in a billable event.
Insurance Coverage and Out-of-Pocket Costs
Health insurance, whether private or government-sponsored like Medicare and Medicaid, plays a large role in determining the patient’s final cost. Medicare Part B, for instance, covers 80% of the approved amount for medically necessary ambulance transport after the patient meets their annual deductible. The remaining 20% is the patient’s coinsurance responsibility.
For those with private insurance, the final out-of-pocket cost is determined by the plan’s deductible, copayments, and coinsurance amounts. A major issue is whether the ambulance provider is “in-network” or “out-of-network.” Since patients cannot choose the responding ambulance, it is common for the service to be out-of-network.
This often leads to “balance billing,” where the patient is billed for the difference between the provider’s total charge and the amount the insurance company pays. Although the federal No Surprises Act protects consumers from surprise billing in many emergency situations, the law does not currently apply to ground ambulance services. However, some states have enacted their own protections to shield patients from balance billing for ground ambulance transports.
Options for Managing High Ambulance Costs
Receiving an unexpectedly high ambulance bill does not mean the full amount must be paid immediately, and patients have several options for recourse. The first step is to request an itemized bill from the provider to review all charges, looking for potential errors or duplicate fees.
Ambulance providers are often willing to negotiate the total bill, particularly with patients who lack insurance or have high out-of-pocket costs. By contacting the billing department and explaining financial hardship, consumers can often secure a significant discount. Many EMS providers and affiliated hospitals also offer financial hardship programs or charity care, which can provide free or discounted services based on the patient’s income level. Patients can also appeal the insurer’s decision if they believe the payment was calculated incorrectly after the bill has been processed.