As many as 1.5 million privately insured patients who are brought to an emergency room by an ambulance may be at risk of getting a surprise medical bill each year, according to new research published by the Kaiser Family Foundation. The research highlights the acute risk of surprise bills that many patients still face, despite the passage of the No Surprises Act, and is a reminder that more work needs to be done to protect patients who may require ground ambulance transport.
Key highlights from the research include:
- “We estimate that there were 29 million emergency room visits by privately insured patients in 2018. About 10% of these emergency room patients (3 million people) were brought to the emergency room by an ambulance.”
- “About half (51%) of emergency and 39% of non-emergency ground ambulance rides included an out-of-network charge for ambulance-related services that may put privately insured patients at risk of getting a surprise bill.”
- “In seven states (Washington, California, Florida, Colorado, Texas, Illinois, and Wisconsin), over two-thirds of emergency ambulance rides included an out-of-network charge for ambulance-related services that may pose a surprise bill risk.”
- “The No Surprises Act will prohibit most surprise bills, reducing out-of-pocket costs for emergency services and non-emergency services where the patient unintentionally sees an out-of-network provider. Congress did not include ground ambulances in the No Surprises Act reportedly because so many emergency medical transport services are operated by municipal and county governments, and therefore, may be subject to additional types of state and local regulation. Congress expressed interest in revisiting surprise billing for ground ambulances once it gathers more information.”
- “One-in-ten emergency room visits for privately insured patients begin with an ambulance ride. Similar to other studies, we find that about half of emergency ground ambulance rides for large group enrollees include an out-of-network charge for ambulance-related services that may put people at risk of getting surprise bills.”
- “Taken together, as many as 1.5 million privately insured patients who are brought to an emergency room by an ambulance may be at risk of getting a surprise medical bill each year.”
- “Where there is state or local regulation of ground ambulance billing practices, those laws may protect only certain types of ground ambulance rides. State laws protecting patients from surprise out-of-network ground ambulance bills do not apply to self-insured health plans.”
- “The regulation and delivery of ground ambulance services could present complexities beyond those involved in preventing other surprise medical bills. Yet, from the perspective of patients, ambulance rides are exactly the kinds of situations where they feel powerless to avoid surprise bills.”
To view the full research brief, click here.