Why American ambulance rides are so expensive
The unfortunately botched economics of emergency care
In July 2023, a 25-year-old man named Jagdish Whitten was out for a run in San Francisco. As he crossed a busy street, a car hit him; he did, in his words, “a little flip” over the vehicle, landed in the road, and dragged himself to the curb. Those who had seen the accident called an ambulance for him. But Whitten waved them off and called a friend, who drove him to a nearby hospital instead: “I knew that ambulances were expensive,” he said, “and I didn’t think I was going to die.”
Whitten was right on both counts. At the hospital, doctors found that he had a mild concussion, a broken toe, and a few bruises—nothing too serious. But because he’d suffered a traumatic injury, they were obligated to send him to San Francisco General, the city’s only designated trauma center. This time he didn’t have a choice. He was loaded into an ambulance for a six-mile transfer, evaluated without additional treatment, and sent home the same night.
Over the weeks that followed, Whitten got bills from both hospitals. Everything was roughly what he expected, and all of it would be covered by his insurance plan. But a few months later, Whitten got another bill—this time from American Medical Response, the ambulance provider that had transferred him between hospitals. The ambulance ride, he learned, would cost him $12,873 : $737 for the miles traveled, $314 for monitoring his heart on the trip, $151 for infection control, and $11,670 as a “base rate.”
He sent the bill to his insurance provider, which at first denied the claim, saying that AMR was out of network and that the ride hadn’t been pre-authorized. (Whitten, of course, hadn’t chosen the ambulance, or anything else about the trip.) On appeal, his insurance agreed to cover $9,967 of the charge—better than nothing, but it still left him on the hook for about $3,000. After several failed attempts to contest the bill with AMR, and not wanting it sent to collections to hurt his credit score, he paid the remaining $2,900 or so. The brief ambulance ride from one hospital to another had cost him far more than any other part of the experience.
What Whitten had received was a “surprise bill”—a charge that lands on a patient when they’re treated, without knowledge or consent, by a provider outside their insurer’s network. The insurer pays what they consider reasonable; the provider bills the patient for the difference; and the patient, despite having insurance that’s meant to pay for treatment, is left holding the balance. This is a terrible situation to be in.