The ambulance bill the Seattle man received is not uncommon. Consumer Reports (CR) has collected hundreds of stories about ambulance billing problems. Most often, the problem involves insurance companies and ambulance services not agreeing on fair reimbursement rates for ambulance rides. Insurers often present an all-or-nothing proposition to ambulance services, forcing them into accepting contracts with unsustainably low reimbursement rates.

Medicare and private insurers typically negotiate rates with ambulance providers to ensure they’re getting a reasonable return on their investments. But for some reasons, the negotiating process doesn’t always work. That leaves ambulance companies that don’t sign up for the insurance networks free to balance bill—and many consumers wind up on the hook for out-of-network bills that aren’t negotiated.

Ambulance services charge by the mile and for each service, like providing oxygen. Depending on billing practices, charges can range from zero to thousands of dollars. Forty years ago, most ambulances were run by local governments or volunteer fire departments using taxpayer money, but today more than half are owned by for-profit companies that are often backed by venture capital firms. Ambulance services must still make a profit, but they’re relying on fewer and fewer Medicare transports. A recent GAO report found that most ambulance services make only a small profit on Medicare transports and are losing money overall.

Unlike doctors and hospitals, most ambulance services are not required to be in-network with insurance plans. And although the No Surprises Act, a law that went into effect last year in 2022, requires health insurers to negotiate rates with ambulance providers and prohibits them from charging out-of-network patients more than in-network customers, it excludes ground ambulance services. That loophole allows for the kinds of surprise medical bills Mike and Ella Hawkins experienced, when they were hit with a $2,438 bill after an ambulance ride to the hospital to get treatment for Ella’s seizures.

While the Hawkins have been able to get their insurance company to negotiate the final bill, they’re still facing the original ambulance-company balance bill from AMR, which is out of network with their health plan. They’re frustrated that they can’t get a straight answer from AMR customer service about what the company is asking them to pay.

The Hawkins say the ambulance-company call centers are often in other countries. When they’ve tried to call a company number provided on their bill, they’re rerouted to call center locations in Arizona and California before being transferred to someone in the Philippines. Then, they’re told to wait while the phone line gets connected to a supervisor. The call takes over an hour, and when it ends, the rep says the bill will be sent to collections. doxo enables secure bill payment on your behalf and is not an affiliate of or endorsed by American Medical Response. American Medical Response Billing