Most Americans believe their health insurance will fully cover the cost of emergency medical transport. However, this assumption often leads to unexpected bills and financial stress. For example, a 2024 study by the Journal of the American Medical Association found that more than half of emergency ground ambulance rides involved out-of-network providers, which often resulted in higher out-of-pocket costs for patients. To better understand why these unexpected costs occur, it’s important to take a closer look at what insurance actually does — and doesn’t — cover when it comes to emergency transport.
The fine print on emergency transport coverage
Most health plans provide at least some coverage for emergency transport when it’s “medically necessary,” but:
Medical urgency doesn’t always guarantee approval
Insurers may deny claims if they determine a ride wasn’t medically necessary, even in emergency situations. Additionally, the mode of transport can be challenged — for example, air transport may be deemed not medically necessary by your insurer if they conclude ground transportation would have been sufficient.
Not all ambulances are covered equally
If the ambulance provider is out of network, health insurance may cover only part of the cost, depending upon your specific insurance plan.
Out-of-network billing
Out-of-network billing refers to a situation where a healthcare provider, such as a doctor, ambulance services, or hospital, does not have a contract with your insurance company to provide services at pre-negotiated rates. When you receive care from an out-of-network provider, your insurance company may cover less of the cost, and you could be responsible for a larger portion of the bill.
Air transport is a gray area
Many air ambulance services operate independently and are not part of major insurance networks. However, under the No Surprises Act (NSA), which took effect in 2022, most air ambulance transports are required to be treated as in-network for billing purposes—regardless of whether the provider is formally in-network. This provision was designed to protect patients from unexpected, often exorbitant, out-of-network charges.
Unfortunately, loopholes still exist. For example, if the insurer determines that the flight was not medically necessary, they may deny coverage entirely, leaving the patient responsible for the full cost. In some cases, disputes between insurers and providers may go through the Independent Dispute Resolution (IDR) process, which can delay final billing outcomes. Additionally, patients may unintentionally waive their NSA protections by signing certain service agreements or forms, especially in non-emergent scenarios. These factors can still result in significant out-of-pocket expenses.
High deductibles and co-pays
With high-deductible health plans on the rise, many Americans pay thousands before coverage kicks in. According to recent research from Kaiser Family Foundation, the average deductible for single coverage in an high-deductible health plan is $2,944, while for family coverage the average is $6,080. High-deductible health plans can come with both risks and benefits, depending upon your personal health and budget. Opting for these types of plans can mean lower premiums and access to a Health Savings Account (HSA) to put aside pre-tax money for medical expenses, though it’s worth noting that federal law requires the statutory minimum deductibles be met before supplemental benefits can apply. Overall, choosing a high-deductible plan could also mean higher out-of-pocket costs and unexpected expenses for emergencies.
Aren’t there legal protections?
While many people primarily rely on their selected health insurance plan for financial protection, there are some legal protections offered to help consumers, yet they have limits.
Federal No Surprises Act applies to emergency air transport only
Excluding ground ambulance billing from the No Surprises Act created a significant gap in consumer protections. The NSA was designed to shield patients from surprise medical bills, particularly for out-of-network emergency care and air ambulance services. However, ground ambulance charges were not included in the law — largely due to the complex patchwork of local, municipal, and private ambulance providers and varying state regulations. As a result, patients can still face unexpected and often high bills if the ground ambulance service used is out of network or not fully covered by their primary insurance plan.
While the No Surprises Act offers some protections, The Commonwealth Fund has noted that many states are now enacting additional legislation to supplement the NSA.
State protection? Not always guaranteed
Some states have implemented mandates that require health insurers to pay a minimum amount to out-of-network providers, especially in situations where patients receive emergency care or services at in-network facilities from out-of-network practitioners. These laws aim to protect patients from surprise medical bills and ensure fair compensation for providers who are not part of an insurer’s network. The Commonwealth Fund provides a helpful map to help the insured determine the type of protection their state offers.
What you can do
The most important thing you can do to preserve your finances from surprise emergency medical transport billing is add supplemental protection. There are many types of supplemental protection available with optional policies that help pay costs not fully covered by standard health insurance. Common types include accident insurance, which helps with expenses from injuries; critical illness coverage, which pays a lump sum for serious diagnoses like cancer or stroke; and hospital indemnity plans, which provide set daily payments during hospital stays. Some plans, like supplemental health or disability insurance, help with out-of-pocket costs or lost income, offering added financial protection during unexpected health events. However, all of these types of supplemental plans often provide limited coverage for emergency transport.
MASA offers comprehensive emergency medical transport memberships that protect you from out-of-pocket costs for both ground or air ambulance services, plus access to expert coordination services to help manage some specialized post-emergency logistics, depending upon your plan. With MASA, you gain peace of mind knowing you have financial protection you can count on when it matters most.
MASA case study:
$94,000 air transport bill
MASA member Claire experienced a severe injury that required emergency air transport. Afterwards, she received an air ambulance statement for $94,000. Claire’s primary insurance and ambulance provider could not agree on rates for the service, so her bill was sent to NSA’s independent dispute resolution (IDR) process. IDR required Claire’s primary insurance to pay an adjusted rate of $92,000. Claire was then obligated to pay her cost-sharing amount based on the new adjusted rate, which resulted in an out-of-pocket exposure of over $2,000. Claire submitted her bill to MASA, leaving her with $0 out-of-pocket.
There are other things you can do to protect yourself. It’s important to:
- Understand your policy
Carefully review your health plan and ask your insurer:- What’s covered for emergency vs. non-emergency transport?
- What are the in-network vs. out-of-network differences for ground and air ambulance services?
- Appeal denied claims
If a claim is denied, you have the right to appeal and some states have consumers assistance programs that offer help with insurance billing problems, free of charge.
Rely on protection you can trust
Emergency transport is a vital service and the first step in critical care, however without sufficient coverage, it can also become a major financial burden. Traditional health insurance often doesn’t provide the blanket coverage many expect. By gaining a greater understanding of how your traditional insurance works and opting for MASA membership, you protect yourself from unexpected emergency transport bills and ensure that a life-saving ride doesn’t turn into a long-term financial burden.
