Thirty years ago in the United States, ambulance services to transport patients to hospitals were generally free, provided as a municipal service or by volunteers, and funded by taxpayers. Today, the U.S. healthcare system and most ambulance services operate on a commercial basis, leading to a sharp rise in medical costs. Therefore, after immigrating to the United States, it is necessary to understand the relevant systems and their implementation in your local area.
Although ambulances are usually summoned by bystanders or 911 dispatchers, the bill is almost always sent to the patient. These costs and insurance coverage vary widely, ranging from free to tens of thousands of dollars. Jay Fitch, president of Fitch and Associates, the nation's largest emergency medical services consulting firm, stated, "Many patients' health insurance does not cover this expense, and the number of patients paying for ambulance services out-of-pocket continues to rise." More importantly, because ambulance companies typically only receive 30% to 40% of the total billed amount, they often charge more to patients who have health insurance or the ability to pay. The variation in charges is partly due to the fact that ambulance services are operated by different entities, including fire departments, hospitals, private companies, and volunteer groups. Some services are covered by insurance, while others are not. For example, 23-year-old Milas broke three teeth while working as a swimming instructor. She took an ambulance to Scripps Memorial Hospital in La Jolla, California. A week later, she received a bill for the 15-minute trip: $1,772.42. In a telephone interview, she said, "We only traveled 9 miles, and there were no life-threatening injuries. I absolutely did not need emergency treatment."
Various health insurance plans have different assessments of ambulance service coverage, and many plans attempt to determine whether the service was truly necessary—whether it was a genuine "emergency." This assessment can be highly subjective. Regardless of the patient's condition, some insurance plans will cover the cost if the ambulance's destination is the emergency room, though some may require hospital admission records as evidence of an emergency. Susan Pisano, a spokeswoman for the industry group America’s Health Insurance Plans, said, "Insurance companies will generally pay for this expense, provided you have a reasonable belief that a situation has arisen that seriously threatens your life or health."
If an ambulance is summoned via 911, the dispatcher will send an ambulance based on proximity. Most ambulance companies base their service fees on the technical level of the emergency team, rather than the medical needs of the patient being treated. Emergency teams capable of providing advanced life support charge more than those with only basic first-aid training. The distance the ambulance travels is not the primary factor, though a small mileage fee is also included. If friends or family accompany the injured patient in the ambulance, some companies may even charge an additional fee of several hundred dollars.