SALT LAKE CITY — Utah patients and health care advocates are celebrating after Gov. Spencer Cox signed a bill last week banning surprise billing for ground ambulances — making Utah the 19th state to implement such protections.
The new law — which received support from both ambulance companies and insurance providers during this year’s legislative session — will also include a slight increase in the statewide base rate for ambulance services to cover supply costs.
“I think if everybody does what they’re supposed to do with the spirit of this law, it should work out very, very well for everybody,” said Rep. Cory Maloy, R-Lehi and the bill’s sponsor, in a recent interview with FOX 13 News.
About half of all ambulance rides across the country are considered out of network, according to the health research organization PIRG, so insurance companies often refuse to pay the full cost for services. When that happens, an ambulance provider will often send a bill for the unpaid amount directly to the patient, in a practice commonly known as “balance” or “surprise billing.”
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 ambulance rides, leaving consumers in places without state protections particularly vulnerable to high ambulance costs. PIRG estimates that consumers spend around $129 million on these emergency transports each year.
These so-called surprise bills have been a source of frustration for patients across the country – especially because they don’t have control over whether the company that responds in a crisis is in their insurance network.
"And in most communities, even across the country, there's really only one 911 ambulance,” noted Patricia Kelmar, PIRG’s senior director of health care campaigns.
'We drove ourselves’
That’s what happened to Robyne and Michael Gallacher, a Tooele couple who faced a surprise $2,900 bill for an out-of-network ambulance ride their then 2-month-old son took to Salt Lake City – even though they’d already hit their out-of-pocket maximum for the year.
“We have the No Surprises Act. But when we were going through our experience, we didn’t know that excluded ground ambulances,” said Robyne Gallacher.
The Gallachers were ultimately able to negotiate their balance down to $0, after about a year of battling their bill. But they decided they wouldn’t let the same thing happen to them again.
That resolve was tested a few weeks ago, when their 3-year-old daughter, Lyla, swallowed a small button battery – something they quickly realized was more serious than they first thought.
“Within an hour, it can burn a hole in your esophagus and be fatal,” Michael Gallacher said. “So I’m like, ‘Oh, we might have an hour to get somewhere.’”
But remembering their previous experience — and knowing the ambulance that would come for them would be out of network – they decided it would be better to rush their daughter to the hospital themselves.
“We followed our plan,” Robyne Gallacher said. “We just, we drove ourselves.”
Fortunately, an X-ray at the hospital revealed that the battery had moved out of their daughter’s esophagus and into her stomach, so she didn’t need emergency surgery. All they had to do was wait for it to pass through her system.
Now that there are new protections for patients, the Gallachers say they’re hopeful other families won’t have to make these kinds of calculations moving forward.
“I was thinking about the infuriating back-and-forth battles we had to do with the ambulance provider and the insurance, the emails, the phone calls, that hopefully other people won’t have to go through now,” Michael Gallacher said of their previous medical emergency.
The new bill also means they may make a different decision about whether to call 911 the next time their family faces an urgent medical crisis.
“It definitely makes us feel more protected if we had to – if we really had an emergency that we had to take care of,” Robyne Gallacher said.
'Tell your friends and neighbors’
With the new protections for patients set to take effect early next month, both Maloy and Kelmar encouraged Utahns to understand their rights – and their responsibilities – in an emergency before they need to call an ambulance.
“Because it's a new law, you should be aware of it,” Kelmar said. “You should tell your friends and neighbors and know that you should not be getting a surprise ambulance bill for out-of-network charges.”
But while the law bans balance billing — when an ambulance charges a patient for the difference between the full cost of the ride and what his or her insurance would cover — it's important to know that the new law doesn’t mean someone with insurance will never owe anything for an ambulance ride.
"It will really kind of depend on how their policy is set up with their providers and their contracted individual subscribers,” Maloy noted.
For example, in an 80/20 coinsurance plan — in which an insurance company covers 80% of costs after the patient meets their deductible — an ambulance company could still come back to the patient for 20% of the costs of the ride.
But regardless of the details of their individual health plan, Maloy noted that patients can’t be charged more than the maximum rates the state has set for ambulance services.
A of May 7, the new statewide ambulance rates will be set as follows:
- EMT ground ambulance: $1,234.92 per transport
- Advanced EMT ground ambulance: $1,630.31 per transport
- Paramedic ground ambulance or paramedic on board: $2,383.72 per transport
The new law doesn't address ambulance mileage rates, which are added onto the base rate and are currently set at $42.24.
If patients have concerns about their ambulance bills after the new law takes effect, Maloy recommended they talk first with their insurance provider.
Kelmar noted that state laws are often limited in scope, safeguarding only those with a state-regulated plan. But, as with setting rates for ambulance costs statewide, Utah’s solution to the balance billing problem “is unique across the country,” she said.
“It's actually stating in the law what the ambulances can charge to insurers,” she said.
And while Kelmar said she has some questions about how the bill will be implemented among large national insurance providers, she said it’s clear that “the patient protection is there.”
Maloy said he heard support mostly from local insurance companies during debate of the bill. But he said he expects larger providers to also abide by the state’s new rules for ambulances.
"The expectation for this law and most laws in Utah is if they’re doing business in Utah, they need to abide by Utah’s laws,” he said. “And so pretty confident that that’s what will happen. And if they don’t, we’ll have to see what we need to do to fix that.”