A ground ambulance is road transport by an emergency medical service, as distinct from an air ambulance. The distinction is a billing one rather than a clinical one, and it exists because of a gap in federal law.
The No Surprises Act, in force since 2022, ended most out-of-network surprise billing: the emergency room physician who does not take your plan, the out-of-network anaesthesiologist at an in-network hospital, and air ambulances. Ground ambulances were left out, with a federal advisory committee created to study the question instead. So an out-of-network ground ambulance can still bill a patient for the difference between what it charged and what the plan paid, unless a state law closes the gap. Roughly two dozen states have written one.
The unfairness people feel about these bills is structural rather than imagined: nobody compares ambulance networks during an emergency, and in most of New York City you cannot request a particular service anyway.
In New York: state law provides protections for emergency services, and disputes over what is owed go through the independent dispute resolution process run by the Department of Financial Services, which settles the amount between the provider and the plan rather than leaving the patient in the middle. An uninsured patient may file an IDR application themselves for a bill for emergency services in New York they believe is excessive. Which law reaches your bill depends on your plan type: fully insured plans are regulated by New York, while self-funded employer plans fall under federal law, where the ground ambulance gap remains open. Separately, New York’s medical debt credit reporting ban names ambulance services explicitly, so an unpaid ambulance bill should not be sitting on a credit report.
Also called: ambulance balance bill, EMS transport. Full guide: Ambulance bills in New York and how to dispute one.
More in Glossary of health coverage and billing terms
- Coinsurance — Your percentage share of a bill after the deductible — 20% of a $4,000 procedure is $800.
- Out-of-pocket maximum — The out-of-pocket maximum caps your cost sharing for covered in-network care each plan year. What counts toward it, what never does, and the New York rules.
- Network (in-network and out-of-network) — The set of doctors and hospitals your plan has contracted with. Outside it, you pay much more.
This page explains how the system works. It is not medical advice. More.