• Karan R Chhabra, Keegan McGuire, Kyle H Sheetz, John W Scott, Ushapoorna Nuliyalu, and Andrew M Ryan.
• Karan R. Chhabra ( kchhabra@bwh. harvard. edu ) is a National Clinician Scholar at the Center for Healthcare Outcomes and Policy in the University of Michigan Institute for Healthcare Policy and Innovation, in Ann Arbor, and a house officer in the Department of Surgery at Brigham and Women's Hospital, in Boston, Massachusetts.
• Health Aff (Millwood). 2020 May 1; 39 (5): 777-782.

Abstract"Surprise" out-of-network bills have come under close scrutiny, and while ambulance transportation is known to be a large component of the problem, its impact is poorly understood. We measured the prevalence and financial impact of out-of-network billing in ground and air ambulance transportation. For members of a large national insurance plan in 2013-17, 71 percent of all ambulance rides involved potential surprise bills. For both ground and air ambulances, out-of-network charges were substantially greater than in-network prices, resulting in median potential surprise bills of $450 for ground transportation and $21,698 for air transportation. Though out-of-network air ambulance bills were larger, out-of-network ground ambulance bills were more common, with an aggregate impact of $129 million per year. Out-of-network air ambulance bills averaged $91 million per year, rising from $41 million in 2013 to $143 million in 2017. Federal proposals to limit surprise out-of-network billing should incorporate protections for patients undergoing ground or air ambulance transportation.

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