Cost of Ground Ambulance Services Saw 22% Increase Since 2017

The cost of emergency ground ambulance services increased by 22 percent from 2017 to 2020, giving advanced life support ambulance rides a price tag of more than $1,200, according to a white paper from FAIR Health.

Around three million privately insured patients receive ground ambulance rides to emergency departments every year. Patients generally do not have a say in their ambulance providers due to the nature of ambulatory services, which can lead to patients receiving care—and high medical bills—from an out-of-network provider.

While the No Surprises Act protects consumers against surprise medical bills for non-emergency and air ambulance services from out-of-network providers, the provisions do not apply to ground ambulance services.

To understand how the cost of ground ambulance services has changed over the past few years, FAIR Health analyzed claims data from its private insurance dataset. The results include claims from January 1, 2016, to June 30, 2021, that indicated emergency ground ambulance services.

Basic life support (BLS) services included care from a paramedic or emergency medical technician (EMT) for fractures, injuries, psychiatric patients, or medical and surgical patients who did not need cardiac monitoring or respiratory interventions. Advanced life support (ALS) services required a paramedic and higher-level EMTs and typically consisted of an invasive procedure, such as injections or limited surgical procedures.

The study results found that ALS ambulance services were more common than BLS services between 2016 and 2020. In addition, ALS services were more expensive than BLS services.

From 2017 to 2020, ALS ground ambulance services saw a 22.6 percent increase in the average charge amount, going from $1,042 to $1,277. The average amount health plans covered also increased by 56 percent, going from $486 in 2017 to $758 in 2020.

FAIR Health included Medicare reimbursement amounts in the report as a point of reference. Medicare reimbursement for ALS ambulance services saw a 5 percent increase between 2017 and 2020, going from $441 to $463.

While the cost of BLS ground ambulance services was lower than ALS services, they still saw a significant price increase over the last few years.

The average charge amount for BLS services increased by 17.5 percent, going from $800 in 2017 to $940 in 2020. The average allowed amount that health plans paid increased by 39.9 percent, from $373 in 2017 to $522 in 2020. Medicare reimbursement for BLS services saw a lower increase of 4.8 percent, going from $372 to $390.

The increasing prices of ambulance services are more likely to impact older individuals the most. Individuals 65 years and older were the most common group to receive emergency ground ambulance services every year during the study period.

Between 2016 and 2020, the most common diagnosis for which patients needed ambulance services was general signs and symptoms, including syncope and collapse, tremors, lack of coordination, and fever. The second most common reason for ambulance services was general signs and symptoms involving the circulatory and respiratory systems, including tachycardia, bradycardia, and heart palpitations.

In November 2021, the Biden administration and the Department of Health and Human Services (HHS) announced plans to address ground ambulance billing and its exclusion from the No Surprises Act.

The administration created the Ground Ambulance and Patient Billing (GAPB) Advisory Committee in which HHS and other federal departments would meet and discuss ground ambulance billing practices and how to protect patients from surprise bills.

A study from the University of Michigan found that 71 percent of patients in a national insurance plan received out-of-network bills for ground and air ambulance transportation between 2013 and 2017, with a median surprise bill of $450 for ground services.

A separate FAIR Health report found that the price of in-network air ambulance services has also been on the rise, increasing by 76 percent from 2017 to 2020.