WENDOVER, Utah — When someone dials 911 in the small, western Utah community of Wendover, the first responders who answer the call for help know they’re at least 120 miles from the nearest hospital.
There’s no backup in the roughly 900-square-mile area that Wendover Ambulance covers on the border of Utah and Nevada. So the EMTs who respond in crisis have to rely “on what they know and their partner and what they can do” as they work to stabilize patients and get them to safety, said Lauara Lisk, an advanced EMT and the company's owner.
Lisk has been working in Wendover under these high-stakes conditions for the last four decades. In that time, she’s responded to calls by family and friends in the small community and seen firsthand the difference a first responder can make when life is on the line.
“I’m passionate about the EMS here in Wendover,” she said in a recent interview with FOX 13 News. “I’ve been an EMT for 42 years and I’ve owned the company for 37. And so I’ve just seen it grow. I’ve seen the struggles and it’s just… what I do. And I enjoy it.”
But providing ambulance services in a rural community – especially as a private company that doesn’t collect taxpayer dollars – also brings with it financial challenges, Lisk said.
Her company has to pay for everything from staff to equipment and supplies “on the amount that we collect for the services we provide,” she said – something that can be tricky when insurance won’t cover the full costs of an ambulance ride.
Since many policies don’t contract with ambulance providers at all, that’s a common occurrence. About half of all emergency rides across the country are considered out of network, according to the health research organization PIRG.
When insurance won’t pay for the full cost of a transport, Lisk says Wendover Ambulance has no choice but to send a bill for the unpaid amount directly to the patient. It’s a practice commonly known as “balance” or “surprise billing.”
“Bottom line is if I’m not able to bill for the difference between what the insurance will allow and what we bill, then we will not have enough revenue to stay in business,” she said.
The federal No Surprises Act, which took effect in 2022, safeguards patients from balance billing for most emergency medical services, including medical helicopters or airplanes. But those protections don’t extend to ground services – leaving many consumers vulnerable to high ambulance costs. PIRG estimates that consumers spend around $129 million on these emergency transports each year.
These surprise bills have been a source of frustration for patients across the country, especially since they don’t have control over whether the company that responds in a crisis is in their insurance network.
“Because of that glitch in the law – or it’s an engineered flaw in the law – you’re on the hook and then you have to fend for yourself,” said Michael Gallacher, who received a $2,900 surprise bill for his 2-month-old son’s ambulance ride even after the family paid their $10,000 out-of-pocket maximum for the year.
VIDEO BELOW: Lauara Lisk with Wendover Ambulance discusses the costs of providing ambulance services
'A good first step’
While Congress hasn’t taken action, 18 states have stepped up to provide some limited protections for patients who take ground ambulances.
Utah isn’t one of them. But state lawmakers are currently weighing a bill that would prohibit ambulance providers in the state from balance billing.
"It’s fair especially to the consumer, because if the state’s going to set a rate then everybody needs to abide by that rate,” said Rep. Cory Maloy, the bill’s sponsor, in a recent interview.
Patricia Kelmar, the senior director of health care campaigns with PIRG, said state laws are “a good step.” But because they typically only safeguard those with state-regulated insurance plans, “it won’t protect everybody.”
"To really protect all people in a state from ambulance surprise bills, we need federal protections,” she said, adding that she’s hopeful Congress will take action on the issue later this year.
After they spent the last year fighting their ground ambulance bill down to $0, Robyne and Michael Gallacher said they’re supportive of even limited efforts to protect patients.
“I think it’s a good first step for sure,” Robyne Gallacher said of a state ban on balance billing. “Because nothing’s going to change unless something changes.”
Lisk recognizes that the bill would benefit consumers, who pay expensive premiums for health insurance only to find themselves caught in the middle of “providers who want to be paid for the services” and insurance companies that don’t want to pay the full bill.
But she worries that the legislation would quickly put her out of business.
If Wendover Ambulance couldn’t bill patients directly for costs uncovered by insurance, “I think longshot it would probably be, like, maybe six months,” she said.
Maloy, R-Lehi, said his legislation, HB301, would prohibit balance billing across the board and noted that “all of the insurance providers are going to have to abide by that.”
However, Lisk doubts legislators can require national providers to pay the rates set by the state for ambulance providers. And she worries she’ll be the one left with the balance.
“I don’t think they’ll have any luck requiring these large companies to adhere to the base rates,” she said. “If they did, then it would be a lot easier and I think I and maybe others would agree that it would be a good deal.”
VIDEO BELOW: Lauara Lisk with Wendover Ambulance explains how she works with customers facing high bills
‘High’ rates in Utah
In addition to prohibiting balance billing, HB301 would also implement a slight increase in the base rates providers can charge.
Those rates, which are established by the state, are currently set as follows:
- EMT ground ambulance: $1,176.11 per transport
- Advanced EMT ground ambulance: $1,552.68 per transport
- Paramedic ground ambulance: $2,270.22 per transport
- Paramedic on-board (paramedic not employed by the licensed ambulance provider): $2,270.22 per transport
A 5% increase to these rates, Maloy says, would account for the costs of supplies, which ambulance providers say insurance often won’t cover.
The bill doesn't address ambulance mileage rates, which are added onto the base rate and are currently set at $42.24.
Kelmar said Utah is “unique” in setting rates statewide – something that can be advantageous for patients, since they can easily figure out the maximum amount a provider can charge for an ambulance “and hold them to that.”
But she notes that a recent audit raised concerns about Utah’s prices, finding that they “appear to be high compared to other states.”
The audit also found the state’s rate-setting process “lacks clear guidelines or standards,” in part due to insufficient financial data.
“The audit raised some really good questions,” Kelmar said. “Are the ambulances providing adequate and correct information about their costs and expenses? That’s informing what the rate is for the state. And the state should do a better job of really evaluating cost to price.”
Since the audit, Lisk said the Utah Bureau of Emergency Medical Services has been training ambulance providers to improve their financial reporting, and she opposes the effort to set new rates while the process to determine fair costs is ongoing.
“It would be counterproductive for the state to through this bill set some rates that we don’t know if that’s going to be correct or not based on what the audit has required,” she said.
Maloy, however, said he doesn’t think his bill would “stop or hinder that work.”
As the legislative session continues, Lisk says she’ll be watching to see how the bill moves forward. She said she ultimately hopes to see a solution that protects patients and also keeps her in business.
“I think the insurance companies have to pony up," she argues. “Because the consumers are struggling. The providers are struggling. And they’re not doing so bad. So I think that’s really where the crux of this is.”