Dive Brief:
- Many Americans are still exposed to the potential for a surprise medical bill from an out-of-network ambulance ride, a research report published in Health Affairs found. About 28% of emergency trips in a ground ambulance resulted in a potential surprise bill, according to the research that analyzed commercial insurance claims.
- About 85% of emergency transports were deemed out of network between 2014 and 2017, researchers found. But two-thirds of those trips are paid in full by insurers, eliminating the risk of a surprise bill.
- The report shows the difference in pricing by ground ambulance ownership and how that affects patients’ financial exposure.
Dive Insight:
Surprise bills are banned in most cases thanks to legislation that went into effect last year.
But ground ambulances escaped enforcement and can legally still send surprise bills to patients.
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 are typically not able to choose an ambulance provider that is in network, potentially exposing them to surprise medical bills.
A surprise bill is when an insurer may only pay some — or none — of an out-of-network bill. The remaining balances sent to patients can be a significant sum.
Researchers struck out to analyze the prevalence of surprise bills for emergency and nonemergency ambulance rides and the impact ownership had on the potential for surprise 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.
Potential surprise bills from private ground ambulances for the most common type of emergency transport were more than 50% higher than those from the public-sector ambulances in 2017, the report found.
Given the high prevalence for a potential surprise bill, protections like those afforded to consumers in the No Surprises Act may be necessary for both emergency and nonemergency transports, the authors said.
The price differences by ownership “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 authors said.
