A Connecticut man turned to NBC10 Boston Responds for help after an ambulance ride left him facing a bill of nearly $6,000, raising questions about why emergency transport can be so expensive, and what options patients have when costs spiral.
Stephen Wass was working on a construction site in Chelsea, Massachusetts when he suddenly felt chest pain and became lightheaded. Concerned about his health, he asked for an ambulance to be called.
“It was a three-mile ride and a $6,000 bill,” Wass said.
The invoice, reviewed by NBC10 Boston, shows Action Ambulance charged $6,343.41 for the emergency transport. Wass’ Tufts Health Plan initially covered just under $600, leaving him responsible for $5,745.25.
“Looking at that number right now, it makes my stomach turn,” he said. “Thinking about that hanging over my head—I’d still be paying it.”
Wass noted the cost of the ambulance ride was significantly higher than his hospital care.
“Mass General was almost half the cost of the ambulance ride,” he said.
You’re calling 911. You have no choice on who shows up. And obviously it’s a life-or-death situation in most cases. So how do you then say no?
Stephen Wass
Why the bill was so high
When Wass challenged the charge, he learned the ambulance company that transported him was out of network with his health insurance plan.
In an email to NBC10 Boston, a spokesperson for Point32Health—the parent company of Tufts Health Plan—explained:
“Point32Health is committed to ensuring our members access to care is not disrupted and we have long advocated for out of network protections for members during emergency situations at both the state and federal level. Mr. Wass was transported by a non-contracted ambulance company. Many ambulance providers do not contract with health plans for emergency services, and there is no upper limit on what ambulance providers can charge many health plan members.”
“It doesn’t seem right that they can make up their own rate,” said Wass. “You’re calling 911. You have no choice on who shows up. And obviously it’s a life-or-death situation in most cases. So how do you then say no?”
After NBC10 Boston Responds contacted both the ambulance company and the insurance provider, Wass’s claim was reprocessed. His bill dropped to about $30.
“I’m here and very lucky that I got help,” Wass said. “But on the other hand, I was still upset that they can continue to do this. And I’m sure there are other people that may not be as persistent to make those calls to try to find another way. And maybe they may have to choose between paying their heat bill or food bill and to pay an ambulance bill.”
Why ambulance bills are so complicated
Ambulance services in the U.S. are provided through a patchwork system. When you call 911, an ambulance might be responding from a municipal fire department or a private provider. That can range from hospital-based ambulance services to nonprofit public safety organizations to for-profit companies. There are almost as many ambulance services in Massachusetts — 314 — as there are municipalities — 351. Further complicating things, cities may have backup and mutual aid agreements with ambulance providers to respond when needed. So, it’s hard for the patient to know who is going to respond, let alone whether they have a contract with their health insurance provider.
The Massachusetts Attorney General’s office examined ambulance billing in a 2023 report. They found two- thirds (67%) of emergency transports they reviewed involved out-of-network providers, which often results in higher out-of-pocket costs for patients—called “balance billing.” They also found that some ambulance transfer rates are more than four times what Medicare would pay for the exact same service.
What ambulance companies and insurers say
“These prices, even though they appear to be shocking, are typically a result of the lower prices that government payers are reimbursing us. The number also reflects the cost to provide service as well,” said Michael Waronka, CEO of Action Ambulance, the company that responded to Wass’ emergency.
He points to insurance companies, saying their reimbursement rates often do not fully cover the cost of service.
“It’s a very common tactic amongst most of the commercial payers. And what we call it is repricing. They arbitrarily will reprice the invoice,” said Waronka. “And then what we have to do is work with the patient to go back and talk to the insurer through the patient to be able to get a higher level of reimbursement in the end from the insurer.”
Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, pointed back to ambulance companies.
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“The ambulance companies unfortunately have been emboldened not to take these rates for the most part,” said Pellegrini. “Now, we do have some third-party ambulance companies that are willing to contract on us at an appropriate rate, but others, I think, I hate to be so cynical, because it’s a needed service, I think they just think they can charge whatever they want and balance bill the patient, which is wrong.”
The attorney general’s report found nearly 75% of municipalities surveyed cite a need to “make up” for lower reimbursement rates from public payers, like Medicare, as a primary reason they do not contract with commercial health plans.
Meanwhile, patients like Wass are stuck in the middle.
What happens when you can’t afford to pay?
The AG’s office found nearly 31,000 accounts, totaling nearly $27.5 million, were sent to collections by four private providers in 2022.
Here’s what you should know if you get an ambulance bill.
The AG’s office also found that “consumers with sufficient time and health care literacy may have success in requesting their health plans re-process claims to eliminate the balance bill.”
That’s how we resolved Wass’ bill.
“There are options on the table for consumers to say, ‘Hey, I just can’t afford this,’” said Waronka. “And there are cases that we will just turn around and write that balance off, knowing that they’re experiencing some type of financial hardship at this point in their life.”
A gap in federal protections
The federal No Surprises Act, enacted in 2022, prohibits most surprise out-of-network billing. But it does not apply to ground ambulance services, largely because of the complexity of the system. Some states have taken up their own legislation, including New Hampshire, which this year banned ambulance balance billing.
In Massachusetts, Sen. Michael Moore is sponsoring a bill that aims to cap balance bills at $100.
“We talk all the time about improving or making sure people have access to health care. Don’t we have an obligation to make sure they have access to emergency health care without having to worry that you’re going to put yourself in financial bankruptcy or some sort of financial insecurity?” the Democrat from Worcester said.
What you can do if you receive a high ambulance bill:
Request an itemized bill to review for any errors or duplicate charges
Ask your insurer to reprocess the claim
Contact the ambulance company to negotiate a lower bill or ask about financial hardship programs
Seek help from consumer advocates