Why Are Ambulance Rides So Expensive?

Ideally, you’ll never need to ride in the back of an ambulance. But if it happens, here’s what you should know: Ambulance services are extremely expensive.

Rick Santoro learned that the hard way.

After receiving a two-mile transport in February, Santoro experienced sticker shock: His ride added up to $2,691.50. Though insurance covered most of it, Santoro had to pay $770.30 out of pocket, and he wondered if that was right. The bulk of the bill resulted from the fact he hadn’t yet hit his annual deductible, but it still seemed pricey, he said, given the brief care he received.

“I just want an answer,” Santoro said. “If I gotta pay the 700 bucks, I gotta pay … It will be a lesson learned for me.”

‘I Didn’t Feel Well’

In early February, Santoro, 60, was at an orthopedist’s office for a small procedure, an injection in his knee. Afterward, he passed out, but once he regained consciousness, he continued to feel ill.

His doctor suggested he go to the emergency room, and Santoro, uncertain why he was having issues, agreed. An ambulance took him two miles to the nearest hospital, and a few weeks later, the bill arrived. The short ride cost more than the subsequent emergency room visit, which he estimates lasted about two and a half hours. That bill was $200.

Why Are Ambulance Services So Expensive?

Santoro’s inquiry isn’t the first Credit.com has received about a pricey ambulance ride. As we’ve previously reported, there are many reasons medical transport services cost hundreds or thousands of dollars. It’s difficult to pin down an average amount for an ambulance bill, because costs vary so widely by location, services and contracts between providers and insurers. But the core expenses generally result from the same things.

“Labor, training, readiness, equipment — all these things factor into the equation,” said Alan Schwalberg, vice president of emergency medical services at Northwell Health Center in Syosset, New York, which provided the ambulance that transported Santoro. (Schwalberg said he couldn’t comment on a specific patient’s case but could speak generally about the cost of ambulance services at Northwell.)

“[Patients] can’t fathom how it’s so expensive,” he said. “They compare it to Uber, but it’s not Uber.”

People who receive ambulance transportation pay not only for the services they receive but also for what it costs for ambulances to be readily available in the service area, in addition to the cost of training people who provide medical services in the vehicle.

“There’s two people for every one patient, minimum,” which is a different standard of healthcare than you’d find in an emergency room, Schwalberg said. “It’s labor intensive.”

Equipment and staff must also meet local and state regulatory requirements, and the cost of such maintenance adds up. All that factors into the base charge, or what Schwalberg referred to as “loaded miles.”

On top of that, there’s a mileage charge, but that generally makes up a much smaller portion of the final bill. In Santoro’s case, the base charge was $2,480 and the mileage was $84. (The remaining $127.50 was a surcharge imposed by New York state.)

Part of what shocked Santoro is the fact that he received what he considered very little care: An EMT took his vitals and gave him oxygen, he said. But Schwalberg said Northwell doesn’t itemize medications and other care a patient may receive in an ambulance. Patients are charged for one of two types of care: basic life support or advanced life support.

Why Ambulance Costs Vary

While Schwalberg’s explanation gives insight into the high costs of ambulance transport, it’s really only applicable to Northwell Health Center on Long Island. As with many aspects of health care costs, base charges vary by provider, insurance coverage and location.

In Northwell’s case, ambulance rates were set after working with an outside consulting firm a few years ago, Schwalberg said. They compared prices throughout the region, determined the final rates, and then negotiated with insurance carriers what they would pay. They determined a patient’s final responsibility would rely not only on the type of insurance coverage they have but also on the terms their insurance carrier set with the provider.

For these reasons, it can be really difficult to know how much a health care service will end up costing you, unless you price it out with the provider and your insurer in advance. That’s something medical billing experts like Adria Goldman Gross recommend, but obviously that’s not an option in an emergency situation. In that case, Gross said you should be prepared to negotiate. (You can read more about how to avoid a high medical bill here.)

How to Handle a Massive Medical Bill

Gross said the first thing to do when you get a bill is check the medical billing codes to see if they match the services you received. (She recommends doing this with any bill, no matter the size, because errors are common.) If it’s wrong, that’s the first thing to challenge with the health care provider, but if it’s right, the next thing to do is research costs for similar procedures in your area. She said she uses the Medicare fee schedule as a benchmark.

Fair warning: While the fee schedule is publicly available, it’s not the easiest thing to read. If, based on those figures or other research, you feel like you’ve been overcharged, you can try to negotiate a lower bill. Again, this is easier said than done.

“Sometimes it could be one phone call, other times it could be 15 phone calls or it could be 20 phone calls, it depends,” Gross said. You’re in for a lot of work, she added, but if you really believe you’re being overcharged, it can be worth the fight.

Gross suggested arranging a monthly payment plan so your bill won’t be sent to collections while you pursue negotiations. (A collection account can seriously hurt your credit standing, though some newer credit scoring models won’t ding you for medical-bill collections. You can keep tabs on such things by getting your free credit report summary right here on Credit.com.)

“Say, ‘Look, I really feel that you’ve been paid the reasonable amount, and I really only owe you this much for the allowed amounts for your location,'” she said. Gross suggested working your way up the ladder and even calling the CEO of the hospital or an equivalent authority figure to make your case. If you truly can’t afford your bills, ask about repayment assistance. Schwalberg said Northwell offers such a program.

Having made several phone calls to the hospital to verify his bill, Santoro said he is on track to pay the full $770.30 in small monthly installments. He said he wishes he hadn’t taken the ambulance or at least knew how expensive it was going to be. Reflecting on the situation, he said he should have waited to see if he felt better or taken a car service instead of an ambulance, then acknowledged he isn’t sure how knowing the cost would have affected his decision at the time.

“Why can’t the guy that picks you up say to you, ‘This is going to be an expensive ride?'” Santoro said, seeming to replay the episode in his head. He added: “I don’t know what I would say. I just wanted to feel better.”

Image: FangXiaNuo