No-surprise emergency rule changes have a glaring exception: ambulance rides

Beginning in 2022, even if you end up in an emergency room and you find out later that no one on the medical team was not in your insurer's approved network, you won't be stuck holding the bill for getting health care.

Congress has finally outlawed "surprise" billing that has left patients with higher costs when they didn't have the foresight to figure out in the middle of an emergency if everyone working on their case was in their insurance network.

The No Surprises Act also prohibits those out-of-network emergency health care providers from going after patients for the difference between what an insurer paid them and what they actually billed. That all-too-common practice is known as balance billing.

But there's one big caveat to this good news: The federal law does not cover ambulance rides to the hospital, except for air-ambulance transport.

New research from Health System Tracker, a joint project of the Peterson Center on Healthcare and the Kaiser Family Foundation, found that more than half of all emergency ambulance rides in 2018 ended up being out-of-network. Separate academic research published last year estimated that the median cost of surprise bills for out-of-network emergency ambulance rides is $450. In high-cost areas such as New York City, it can be at least double that amount. Often, much more.

While 51% of all ambulance rides in 2018 triggered an out-of-network charge, your odds of having financial insult added to injury are far higher in many states.

Why didn't Congress protect ambulance rides? It's complicated.

The result: In a searing emergency situation, the reality is that you are in no position to advance shop for in-network transport. About all you can do is pressure your congressional reps to focus on that promised study of the problem.

That said, keep in mind that if you find yourself needing nonemergency ambulance transport, you have more control. For instance, if you are being transported from one facility to another, say from a hospital to rehab, you might have the time — if not the energy — to contact your health insurer and ask what in-network options you have for your ambulance ride.

Yet, the reality is that this is just another reason why having a bulked-up emergency savings fund can be so important for your financial health.