Do You Have to Pay for a 911 Ambulance?

911 ambulance services generate a bill. Ambulance services are provided by various entities, such as municipal fire departments, private companies, and hospitals. Providers incur costs for personnel, equipment, and medical care during transport.

The Cost of Ambulance Services

Ambulance costs vary by base rate, mileage, and medical supplies or procedures. The average cost for an ambulance ride can range from $500 to over $3,500 without insurance, averaging around $940 for basic services and $1,300 for advanced services. Air ambulance services, less common, can cost tens of thousands, averaging $24,507 for airplanes and $30,446 for helicopters.

Level of care significantly impacts the bill. Basic Life Support (BLS) services provide basic emergency care, including controlling bleeding, CPR, or assisting with minor burns or fractures. BLS ambulances are staffed by Emergency Medical Technicians (EMTs) and focus on non-invasive techniques. The average cost for a BLS ambulance ride can range from $500 to $2,000 without insurance.

Advanced Life Support (ALS) services provide complex medical interventions, including administering medications, performing advanced airway management, or providing cardiac care. ALS ambulances are staffed by paramedics who provide intravenous therapy, cardiac monitoring, and other advanced procedures. The cost for an ALS ambulance ride is higher, ranging from $850 to $3,500 without insurance. An average billed cost is $1,463 for ALS ground ambulance services.

Mileage charges are a common component of an ambulance bill. Charges range from $6 to $70 per mile, often $15 to $30, depending on location. Distance to the nearest appropriate medical facility can increase costs, especially in rural areas. Medical supplies used during transport, such as oxygen, bandages, or IV fluids, contribute to the charge. Procedures like intubation or administering medications also add to the bill. Costs are also influenced by whether transport is emergency or non-emergency.

Who Pays for Ambulance Services

Insurance plans and government programs determine ambulance bill responsibility. Most health insurance plans (private, employer-sponsored, marketplace) cover ambulance services, but coverage varies. Patients pay deductibles, co-pays, and co-insurance as outlined in their policy. Out-of-pocket costs with insurance average $250 to $1,500, but can range from $0 to $5,000 depending on the plan and location.

Medicare, through Part B, covers emergency ambulance services when medically necessary. This means an ambulance must be the only safe transport method, and the trip must be for a Medicare-covered service or return from such care. After meeting the Part B deductible ($257 in 2025), beneficiaries pay 20% of the Medicare-approved amount for ambulance services. Medicare may also cover medically necessary non-emergency transport in limited situations, such as when a doctor provides a written order certifying other transport methods would jeopardize health, or for repetitive transports like dialysis.

Medicaid also covers ambulance transportation for eligible enrollees, requiring that the service be medically necessary and provided by state-licensed providers. For non-emergency ambulance services, Medicaid requires a doctor’s statement indicating the necessity of the service. Some state Medicaid programs may have specific exclusions, such as not covering certain “911 non-emergency” services, allowing providers to bill beneficiaries directly if informed beforehand.

Individuals may be responsible for the full cost of an ambulance ride in situations where they lack insurance coverage, the ambulance provider is out-of-network, or the services are deemed not medically necessary by their insurer. The No Surprises Act, enacted in 2022, protects insured consumers from surprise out-of-network charges for emergency air ambulance services, but it generally does not cover ground ambulance transport. This means patients can still face substantial “balance billing,” where they are charged the difference between the provider’s bill and what their insurance covers, especially if the ambulance company does not have a contract with their insurer.

Managing Ambulance Bills

Managing an ambulance bill involves several steps. The first step involves reviewing the bill carefully for accuracy, checking dates of service, services rendered, and the charges applied. Billing errors or duplicate charges are possible, and identifying these can help in disputing the bill. It is also important to compare the ambulance bill with the Explanation of Benefits (EOB) received from the insurance company to understand what was covered and what remains the patient’s responsibility.

Submitting claims to insurance is handled by the ambulance service provider, but patients should confirm this. If a claim is denied, patients have the right to appeal the decision. An internal appeal can be filed with the health plan, often within six months of the denial, providing additional information or a letter from the healthcare provider explaining the medical necessity of the transport. If the internal appeal is unsuccessful, an external review by an independent organization may be an option.

Negotiating directly with the ambulance service provider can be an effective strategy, especially if facing financial hardship. Many providers are willing to discuss reduced payments or set up manageable payment plans. It is often beneficial to ask for an itemized statement and inquire about their policy on negotiating bills or offering discounts for prompt payment.

For individuals who cannot afford to pay their bills, several options for financial assistance exist. Many ambulance service providers and hospitals offer financial assistance programs, sometimes referred to as “charity care,” which provide free or discounted care based on income eligibility criteria. These programs are designed to help uninsured or underinsured individuals, or those experiencing catastrophic financial circumstances. Information on eligibility and application procedures for such programs can be obtained directly from the provider or hospital.