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Why American ambulance rides are so expensive

• dostick 3mo ago
  If you remove the $11,000 extortion “fee”, the remaining $1,000 is about the price found in the Western world countries.
• chillingeffect 3mo ago
  This is amazingly coherent and explanatory article! the writer really went into depth about the problem and...surprise...the answer is almost embarrassingly simple. Everyone in the country needs to read this.
• josefritzishere 3mo ago
  TLDR: private equity
  • deleted 3mo ago
    [deleted]
  • jfim 3mo ago
    The article argues the exact opposite: > The standard answer is greed: rapacious ambulance operators, owned by villainous private equity firms, exploit patients at their most helpless. But I don’t think that’s actually what’s going on. Ambulance providers are chronically unprofitable businesses; margins are thin, crews are underpaid, and operators exit the industry every year.
    • deleted 3mo ago
      [deleted]
    • deathanatos 3mo ago
      That paragraph is somewhat incoherent at that point in the article: margins are razor thin — at a price tag of $12,000 per 6 miles or $2,000 per mile. (Yes, there is some other stuff, much, much, much later that maybe cuts into that …)
      • jfim 3mo ago
        The cost isn't about the actual mileage though, it's having two paramedics each earning about 100k/yr per ambulance, while having coverage 24x7x365. So fully loaded, the labor for one ambulance might be in the high six figures to seven figures.
        • jjk166 3mo ago
          Except the paramedics are actually making mcdonalds wages.
        • deathanatos 3mo ago
          Even if we assume we need to cover their downtime between rides, at a conservative estimate of "we're the only call today" that's $2400 of labor at your rate (≈$400/d, 2 paramedics, 3 shifts). TFA suggests they're not paid well.
  • kirrent 3mo ago
    The piece is actually quite concise, but you're right in the other respect. You definitely didn't read it. Private equity as an explanation is explicitly rejected.
• Avicebron 3mo ago
  > The most efficient way to fund ambulance services would simply be to pay for the option the way that options are normally paid for: with a premium, collected from everyone the service stands ready to rescue. That’s how it’s done in the rest of the rich world. Some places, like the United Kingdom or Japan, simply fund ambulance services directly out of taxes; others, like the Australian state of Victoria, sell memberships in “Ambulance Victoria,” with unlimited exercise at the cost of about $70 a year per family. So there is a solution.
  • charcircuit 3mo ago
    >from everyone the service stands ready to rescue So compelled health insurance to use an ambulance? You could just as well make it optional and charge people without the insurance the full price.
    • Avicebron 3mo ago
      So everyone's covered unless you explicitly opt-out?
      • charcircuit 3mo ago
        Everyone is covered and you have the ability to pay someone to take on the risk of having to pay for an ambulance.
        • Avicebron 3mo ago
          what happens to the people who don't pay someone to take that risk when they need an ambulance?
          • charcircuit 3mo ago
            Then they pay for the ambulance.
            • 3mo ago
• arjie 3mo ago
  You don't have to pay them unless they're specific. I got a bill 3 years after being in an accident and I asked them for the documentation they legally have to provide me (itemization, the legal basis, detailed incident record, attempts on their part to contact insurance) of how they arrived at the sum. It's been a year since and they haven't given me anything. Besides this kind of billing is banned in California now https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=202320240AB716 https://leginfo.legislature.ca.gov/faces/billHistoryClient.x... The insurers just pay the in-network fee and you call it a day.
  • Waterluvian 3mo ago
    The last thing I want at that time is to have to reason about any of this. I think I’m realizing that what I cherish about the healthcare system up here is not just that I don’t pay bills, but that I don’t even see a bill. Not that the bankruptcy inducing costs aren’t wretched, but I just cannot even imagine being put into a fucked up bureaucratic hell while my family is in a life altering crisis.
    • ozlikethewizard 3mo ago
      Yea I think this is the bit thats easy to take for granted in nations with rational healthcare systems. Not only do I not get fleeced, but at no point does my healthcare feel like economic activity, a transaction, it feels like healthcare and that the provision of it is being done for the right reasons.
    • alistairSH 3mo ago
      This applies to other things as well - retirement and education come to mind. Anecdote: my uncle and BIL are auto mechanics. One in the US, the other in Scotland. Similar lifestyles - both own homes, have mechanical hobbies (vintage cars for one, Harleys for the other) - typical working class lives. The uncle in the UK just has much less mental overhead when it comes to major life planning.
      • Freedom2 3mo ago
• darth_avocado 3mo ago
  We’re all pretending this is an unsolvable problem when really most of the world has solved it by making ambulance (EMS) funding similar to fire and police departments. Somehow in any emergency I’ve seen, all three show up, often EMS before police or fire dept, and somehow that’s a service that has to be supplemented by insurance billings. The blog mentions it, but it’s one of those obvious things that somehow isn’t solved yet and blows my mind every time it comes up.
  • toomuchtodo 3mo ago
    Very much so. We could fix this. We continue to choose not to, and will for some time into the future. Tangentially (think in systems), much of the US exists off of volunteer emergency services (fire and emt), which is rapidly evaporating. Average age of these volunteers is mid 50s. https://www.nfpa.org/news-blogs-and-articles/nfpa-journal/2026/02/11/volunteer-fire-service-crisis https://www.nfpa.org/news-blogs-and-articles/nfpa-journal/20... > For generations, volunteers have formed the backbone of the nation’s emergency response system. Roughly half of the U.S. population, some 170 million people, live in areas primarily served by volunteer departments. Unpaid firefighters comprise more than 60 percent of all U.S. firefighters, and more than 80 percent of the country’s fire departments are either all or mostly volunteer. https://www.ruralhealthresearch.org/publications/1596 https://www.ruralhealthresearch.org/publications/1596 > 4.5 million people lived in an ambulance desert (AD); 2.3 million (52%) of them in rural counties. Four out of five counties (82%) had at least one AD. Rural counties were more likely to have ADs (84%) than urban counties (77%). Areas with the highest share and number of people living in ADs include the Appalachian region in the South; Western states with difficult mountainous terrain; coastal areas across the U.S.; and the rural mountainous areas of Maine, Vermont, Oregon, and Washington. Eight states had fewer than three ambulances covering every 1,000 square miles of land area (the Western states of Nevada, Wyoming, Montana, Utah, New Mexico, and Idaho; and the Midwestern states of North Dakota and South Dakota).
    • rconti 3mo ago
      We choose not to, because most consumers of ambulance services don't have to pay for it. So those of us who pay out of pocket for an ambulance, like I did ($1700 to go 3/4 of a mile last year) are a tiny minority.
• gruez 3mo ago
  As much as I like articles that tries to use economics or finance to explain stuff, the "options" analogy is a bit hamfisted. The article starts off by noting about how ambulance is an "option" for a rescue, but even though the analogy might vaguely work, it's not really needed to answer the question. That can be answered far more simply: "medicare and insurance companies pay them too little, so they have to charge everyone else more". Or, from the article: >This meant that the payment structure and the cost structure were increasingly mismatched: and so ambulance services had to pay for their round-the-clock readiness by billing for individual rides. [...] >And notably, the fees that Medicare sets run far below cost. The average ambulance transport costs $2,673 to provide; Medicare pays only about $329 of that. A typical ambulance ride for a Medicare patient, in other words, loses theambulance service thousands of dollars.
  • Noumenon72 3mo ago
    "Medicare pays too little" is based on the "fee for service" model; it only makes sense if you believe the group of people who actually use the ambulance should pay its full cost. The options model matters: if you model an ambulance ride as a roulette wheel, you only expect to pay if you get very unlucky. If you model it as an option, you expect to pay even if you never use it. The former doesn't imply "everyone else should have to pay for my bad luck"; the latter does. It's effective persuasion.
    • gruez 3mo ago
      >The options model matters: if you model an ambulance ride as a roulette wheel, you only expect to pay if you get very unlucky. If you model it as an option, you expect to pay even if you never use it. There are plenty of services that have high fixed costs but low marginal costs, but we don't use the "options" framing. A movie costs tens to hundreds of millions to make, but otherwise costs very little to deliver. Their price are also fixed, rather than dynamically priced. Yet when a movie bombs, nobody is like "wow I guess they shouldn't have been selling an option for 2 hours of entertainment for $20!". It's a price problem, first and foremost, caused by insurance companies and medicare strongarming them.
• comrade1234 3mo ago
  Check your insurance to make sure you have transport. It's the same in Switzerland - it's an extra line on your insurance. My wife and also have Rega. They can't legally call it insurance but if we get injured in, for example, the USA they will send us a private hospital jet to bring us home.
  • standardUser 3mo ago
    And then do what, precisely? Quit your job and find one with better insurance options?
    • Noumenon72 3mo ago
      This comment is confusing because it refers to the first paragraph and also assumes when you checked your insurance you didn't find transport there. Since the parent did have transport and good insurance and a second paragraph, it sounds like you're asking "And then do what after your hospital jet flies you home, quit your job and find better insurance?"
• softdevca 3mo ago
  I don't understand why taxes can be used to save property but not a person.
  • jfengel 3mo ago
    Because we like property.
  • lokar 3mo ago
    Sure you do. Most people don’t own property. Most of the taxes are paid by people who do. And elections are decided by people with property.
    • msftgreed 3mo ago
      You've got it. Who makes the decisions? Primarily the folks with the most property.
  • Noumenon72 3mo ago
    The article explains why; regulators sometimes can't foresee that their decision to consider something fee for service will eventually prevent it from being considered as a communal expense.
    • softdevca 3mo ago
      Fee-for-service doesn't prevent ambulances from being considered a communal expense, it just makes sticky. There is nothing preventing a government from making ambulances equivalent to fire or police except the will. From the article: "The most efficient way to fund ambulance services would simply be to pay for the option the way that options are normally paid for: with a premium, collected from everyone the service stands ready to rescue". In other words, taxation just like anything else we expect to be available to anybody.
      • Noumenon72 3mo ago
        "Sticky" is what I was saying. It currently can't be done because of path dependence from historical regulation to industry structure to attitudes. No broader reason. I felt your post was setting up "If there's no logical reason, it must be because people with property are greedy". Sometimes things are the way they are because they got that way.
• mikeweiss 3mo ago
  Where I live (NJ) you don't pay if your picked up by a town run rescue squad. But you don't always know who's responding... Such a strange system.
• xp84 3mo ago
  I tell this story every time ambulance costs come up because it might be helpful to anyone. I once lived in San Francisco in the mid-2010s. In SF, the SFFD operates the vast majority of ambulances in the city. As in, 80%+. I once had the need to go to the hospital urgently and called 911. The ambulance that showed up was SFFD. They transported me and I recovered safely. I then got a bill from them saying that my insurance had refused to pay for it - apparently that insurance company (they're lucky I've forgotten which one, as naming and shaming health insurance people is one of my favorite hobbies) had refused to contract with SFFD, making them "out of network." Yes, an out of network ambulance. And remember, there's at least an 80% chance that an SFFD ambulance will show up, and I've never heard of them offering a menu of ambulance companies to the caller who's likely having a heart attack, bleeding, etc! So of course, my insurance would only pay some small pittance, if anything, and I was sent a ~$1000 bill. I immediately filed a complaint with the insurance company's California regulator (at the time it was the Dept of Insurance for this one, but it seems most or all now are under the Department of Managed Health Care) since insurance companies are by law obligated to pay at the in-network rate in the case of an emergency (which presumably is why you call an ambulance in the first place). Within 2 weeks I received a letter from the insurance company that all was completely fine and that they'd corrected the situation and paid the bill. So we have an insurance company which surely knows that law, surely knows what an ambulance is for, but has discovered the "life hack" of having an extremely inadequate network, simply refusing nearly every ambulance claim made in the City, and then only paying the small percentage who know the law and know how to file a complaint. And of course, there's no punishment, the punishment is just having to pay the few times they're caught. And insurance companies wonder where all that anger (Delay, Deny, Depose, was it?) comes from. Anyway, practical moral of the story: don't let them get away with doing that if it happens to you or someone you know! Note: My story is obviously kind of tangential to the actual article which explains why the cost is so high due to everyone who's being subsidized by what they're charging privately-insured patients. However, I have but the world's tiniest violin for those extremely profitable insurance companies who would obviously really like one of their costs of doing business to just go away. Yeah, I'd also like it if I could be paid my full salary, even though I refuse any work I find annoying.
  • semiquaver 3mo ago
• DoesntMatter22 3mo ago
  I think the answer is very simple. Regulation. If there was no regulation or very little then anyone could open up an ambulance service and the cheapest costs and the best service would win. Unfortunately that’s not the case. It’s like day care. Day care is expensive because the government mandates it to be expensive. Otherwise you’d have grandmas down your street would gladly watch your kid but it’s generally not allowed for more than a couple kids. Same thing with houses. I have half an acre. Could easily put 2 affordable tiny homes on it. Good income for me, cheap rent for someone else, but, unfortunately it’s legally blocked
  • lokar 3mo ago
    I would absolutely not tolerate and unregulated ambulance responding to my emergency.
    • DoesntMatter22 3mo ago
      You don’t have to. You do what you want. I’d prefer to hire a company where the workers make more money. Right now they make a pittance.
      • duskwuff 3mo ago
        Someone who's having a medical emergency is certainly in no position to go comparison shopping for ambulance services.
        • DoesntMatter22 3mo ago
          You would do it before hand of course
          • fragmede 3mo ago
            Let me just schedule in plans for my future heart attack and car accidents.
• Dove 3mo ago
  I think one of the most aggravating things about interacting with the health care system is losing control of cost/risk/reward tradeoffs. The mandatory transfer and ambulance ride in the linked story are an excellent example. I think I'd have walked out against medical advice in that circumstance, but there is the constant danger of being subjected to similar costs, both monetary and physical, when I am less conscious or at a serious informational disadvantage. The need to bring a patient advocate with you to the hospital whose role echoes both doctor and lawyer is becoming quite serious.
• infinite_spin 3mo ago
  In a market where competition isn't relevant, the price of things is whatever you can get someone to pay for it.
  • standardUser 3mo ago
    The genius part is that the negotiations that determine how much they can get away with charging completely excludes the consumer. Two for-profit entities, with no mandate to actually provide care, decide how much they should pay each other.
    • msftgreed 3mo ago
      And they decide that you'll pay a percentage of what they pay each other. Which you also have no say in.
• wewewedxfgdf 3mo ago
  There should be an "Uberlance" - discount emergency pickups by Uber, at Uber prices.
  • paxys 3mo ago
    Uber is already “Uberlance”. Most people take Ubers to the hospital unless they are literally dying (and some even then).
  • mekael 3mo ago
    Years ago i slid down a bannister at a dance club, caught my foot, flipped over backwards, and landed on a barstool. Having grown up poor as dirt, i knew that calling an ambulance would be at least a grand if not double that. I called an uber to take me the 15 blocks to the hospital. Total cost was 70 bucks (10 bucks for the uber, 60 for the er copay). The number of people here in the US who use uber as an ambulance is waaay higher than you would think.
  • jmalicki 3mo ago
    Unlike an ambulance, an uber driver won't be able to keep a hemodynamically unstable patient alive for a 30 minute transport. LAFD has already called Ubers for non-emergency transport to hospitals.
    • jmalicki 3mo ago
      LACFD, and they encouraged the patients to call ubers, didn't call them themselves (I couldn't find the cite). https://www.cbsnews.com/losangeles/news/la-county-changes-ambulance-dispatches-amid-worker-shortage/ https://www.cbsnews.com/losangeles/news/la-county-changes-am...
  • ButlerianJihad 3mo ago
    There is a gigantic business called "NEMT" "Non-Emergency Medical Transport" that has been filled by taxis and rideshares for decades. I first discovered this service when I broke my leg in 2006, and Medicaid was paying for taxi vouchers so that I could travel to far-flung orthopedic appointments over the span of 9 months. Otherwise I'd be on the bus, on crutches: ouch! So NEMT can cover a lot of use cases where people are stable and just going to PCP or specialist visits. Or even behavioral health appointments. There are now dedicated NEMT providers, like Veyo out of San Diego. In fact, when I broke my leg, there was talk of calling an ambulance. But I was only about 3 miles from the destination hospital, and there were many wise people nearby, so several of them suggested I just call a cab and take the cab to the E.D. instead, because that was far more efficient. So that's what we did, because really, I didn't need any life support, or blood transfusion, or rescuscitation on the way there. Since the billing SNAFU last Thanksgiving I also learned about the difference between BLS and ALS. For some reason the ambulance provider billed for ALS even though none of that was necessary. Of course, ALS costs more and bills more and probably profits them more. I should have contested this stupid account trick, but whatever. They haven't even billed me for the "co-pay" yet, so we still need to wait and see how this shakes out.
• ButlerianJihad 3mo ago
  I had an ambulance ride on Thanksgiving Day last year. And the punchline was that with my ACA insurance, the "ambulance run" co-pay was $1,200. (Of course my total ambulance bill was around $1,310.) There was a long period of back-and-forth with calls and website visits, where they were insistently billing the wrong insurance, and so forth. But I'm grateful that I used the ambulance at that point in time. The key advantage to an ambulance ride is bypassing the Triage Nurse. If you're going to an E.D. and you take a ride-share or a friend drives you, then you'll go to the registration desk and then meet the triage nurse. And the Triage window is pretty good at conserving hospital resources, and de-prioritizing you if your issue could be handled by Urgent Care or your PCP on a weekday. But if the ambulance gets called to your home, it's a foregone conclusion that you really, really want to go to the E.D. and the ambulance crew will Keystone Kops their way to a successful hospital drop-off. They'll take some vitals and ensure that you're stable, because if you're not, they can save lives, and keep you alive during transport. But if you're conscious then they ask that $64,000 question: "do you want to go to the hospital?" Once a few years ago, a nurse in a clinic had called 9-1-1 on my behalf and it was actually difficult to refuse a hospital transport. The EMS crew put me on the phone with a hospital attending physician and I had to emphatically refuse transport several times, after being advised of all the risks. (My only issue was elevated blood pressure. C'mon, guys.) One of the troubles with ambulances is that they are really overkill for many calls. If some homeless dude goes unconscious on the curb, they get called. Some neighbor was going to call 9-1-1 because I laid down briefly near the pool. The ambulance and its crew is highly equipped to save lives and respond to the worst trauma cases: multi-GSW, car accidents at 70mph, etc. But I called them because I had a bad headache. And that's why they got to bill so much: they cost a lot! And I bet that a lot of uninsured deadbeats default on their ambulance bills, and the City gets to eat all those costs. But the times I've transported myself to the hospital, I kinda got blocked by Triage, and it was for my own good. This last time over Thanksgiving, I had a lot of issues, and isn't it always the way that they hit at the beginning of a holiday weekend? So, it was good I went to the hospital. But I was flabbergasted that my "co-pay" was 92% of the ambulance bill. I don't know why, but that plan has terminated anyway, so there's no arguing about it. At least, my actual hospital bills were well-covered by that plan.
  • SoftTalker 3mo ago
• paytonjjones 3mo ago
  I've treated people with panic disorder who, if there were no cost involved, would probably have called an ambulance monthly for suspected heart attacks. I wonder how countries with universal healthcare coverage deal with the lack of a (dis)incentive here. Maybe they just eat the cost?
  • weezing 3mo ago
    They eat the cost, at least in my country.
• abeppu 3mo ago
  Aside from the funding mechanism being a premium that everyone pays, the other part of the motivating story here that seems downright silly is: - the patient was _forced_ to take an ambulance to another hospital, but not to be treated for anything in particular. - the post goes into how the EMS system is expensive b/c you need trained paramedics and expensive medical equipment and such -- but sometimes they really do just need to move a patient, not treat anyone in the field or en route. Saying that you pay for the paramedics even when you're effectively just being moved between facilities _also_ seems wasteful. Yes, we should share the cost. But once we all share the cost, maybe we should try to spend the public dollars effectively by only using ambulances when they're needed, and distinguishing between "transport patient who can't sit upright and buckle a seatbelt" and "try to stop their arterial bleeding as you speed towards the hospital".
  • contubernio 3mo ago
    Sharing costs generates institutional incentives to keep costs down. Individualizing costs generates institutional incentives to charge more. Perverse incentives are the essence of what is wrong with US medical systems.
• js2 3mo ago
  > There are parts of the U.S. that do this already. Ambulance rides are already subsidized by taxpayers in most places, thanks to public funding for fire departments; and a growing number of places have taken this further. Indeed, in my county that's the case along with a $60/year subscription program to indemnify yourself against further costs: https://www.wake.gov/departments-government/emergency-medical-services-ems https://www.wake.gov/departments-government/emergency-medica...
  • dqv 3mo ago
    Finding out about this program was such a relief. I haven't worried about the prospect of having to call 911 since signing up.
• yanhangyhy 3mo ago
  i think i read many warnings or jokes about this: when go to usa, dont call an ambulance because it's so fucking expensive..to compare, in china, it usally cost less than 100USD.
• msla 3mo ago
  > In 2020, Congress passed the No Surprises Act, which banned surprise balance bills for most parts of emergency care. But by necessity, it exempted ground ambulances from the law: actually restricting the practice would have rendered much of the EMS industry insolvent. Right, but air ambulances are subject to the No Surprises Act, and we somehow still have those. Also, ERs are subject to the No Surprises Act, and they do some pretty damned expensive things. Plus, if you're seen by an out-of-network practitioner in an in-network hospital or ER, no you weren't: No Surprises Act forces them to accept QPA and not balance bill. Somehow all of those out-of-network anesthetists and radiologists are still in business. Here's a PDF about the No Surprises Act: https://www.cms.gov/files/document/a274577-1a-training-1-balancing-billingfinal508.pdf https://www.cms.gov/files/document/a274577-1a-training-1-bal...
• dodger-dog 3mo ago
  "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." Tell the insurance company to wait to release the funds until you talk to the ambulance company or to release the funds directly to you. Tell the ambulance company they can take the $9,967 or get zero.
  • msftgreed 3mo ago
    This isn't sustainable. You really want every person who is dealing with this bureaucracy to manage negotiating between their insurance and their EMS? After they've just had a significant accident/health issue? That seems needlessly cruel to do to people.
• tedggh 3mo ago
  “ 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.” This is weird, why didn’t he have a choice? I have literally walked out of a hospital with IVs still attached to my arms when I disagreed on course of treatment that included hospitalization for a case of white coat syndrome. They also wanted me to wait one hour to sign a waiver, which I unkindly refused.
  • SoftTalker 3mo ago
    Yeah you're always free to decline medical services. Nobody can make you go to the hospital (unless you're unconscious or in delirious but then you aren't deciding anything).
• whatever1 3mo ago
  Taxi / shuttle service also needs trained professionals, high fixed cost investment on specialized equipment, 24/7 availability. I am shuttled to the airport at 4 am and paid $30. It did not cost 20k per ride. So ambulance providers charge that much because they can. There is no real competition.
• grogenaut 3mo ago
  He refused to go in an ambulance the first time. He could have refused the second ride. You can refuse transport or medical care at any time as long as you are able to make rational decisions. As an EMT if you're A&Ox4, alert to time, place, person and event, you make the choices. You do sign a release so we have proof we didn't abandon you, but you make the choice. If we move you without your approval, it's kidnapping or entrapment (not hit me up law arguers). To do that we either need implied consent (minor no parent, not A&Ox4, or Law Enforcement). My department, a small rural one with a small tax base which happens to cover a lot of injuries because we have 20 miles of dangerous mountain pass freeway and a ski and mountain bike area, only charge for calls if we transport. I think a transport is around $900. Our minimum transport is 37 miles. We scale it down depending on income and type of event. We're not massive sticklers about it. We're just trying to cover wear and tear on big expensive vehicles for all the non-transports, winter driving, equipment, uniforms, training, etc. Most of our "business" comes from "transients" eg folks who don't live there, eg those skiing, hiking, biking, or driving over the pass. This is also very much not the norm. But should explain a bit about those who do pay are covering those who don't. We don't want a chilling effect on calling 911 for precautionary stuff. We'd rather show up 99 times and check people out and let them go than miss the impending cardiac event. And we get those. It's very interesting just how much going over a 4k foot pass stresses people on the edge. Many of our medica calls are people driving to seattle for deeper care and things exacerbating when they get to 4k feet.
  • onion2k 3mo ago
    I don't think the question is "Should ambulances be a thing?" though. It's a question of "Should someone in a situation where they need an ambulance have to balance the potentially life-threatening impact of saying no versus the potentially financially ruinous impact of saying yes?" The (fairly obvious) answer to that no one should be in that situation. It's horrible. Society should find a better way to pay for ambulances. Most of the world has accepted that some system to spread the cost among everyone is better than putting people in that situation.
    • grogenaut 3mo ago
      Is this the common cost or is this an outlier blog story that hit it off. Talk real data to me. I don't get excited about any individual anecdote (unless it's me personally of course). No people shouldn't be bankrupted for a short cab ride that's not needed. I'm not arguing that.
• uwagar 3mo ago
  its horrible to think when u are caught up in something serious that calling an ambulance could ruin your life later. better to live in uk where nhs takes care of all this compassionately for free.
• rado 3mo ago
  Cost in Bulgaria: $0
  • weezing 3mo ago
    Same in Poland. Even uninsured junkies get a free ride.
• siliconc0w 3mo ago
  Seems like rationalization - PE firms establish regional monopolies and jack up rates. They do it with every type of service. Just accept that we're all serfs under the billionaires who extract rents over every aspect of our lives.
• miramba 3mo ago
  Same from Argentina to Canada? Wow
• mdavid626 3mo ago
  Anywhere else in the world it’s possible to do this orders of magnitude cheaper. But yes, it’s because of “options” and not because of greed. Some group of people tries to extract as much money as possible. You can call this capitalism. I think it’s a big scam.
• Lio 3mo ago
  > a car hit him; he did, in his words, “a little flip” over the vehicle, landed in the road He was lucky he was hit by a car. A slab fronted SUV or pickup would have dragged him underneath and so it goes.
  • Lio 3mo ago
    OK for those that seem to dislike the suggestion that pickup trucks and SUVs kill more than cars do here's a study from the BMJ. Specifically, with regard to the shape of the front of the vehicle: > A large recent study in the USA found that, as compared with the low and sloping front end of a traditional passenger car, the odds of pedestrian fatality increased by 45% if the striking vehicle had a tall and sloped front end; increased by 44% if the striking vehicle had a tall and blunt front end; and increased by 26% if the striking vehicle had a medium-height and blunt front end. https://injuryprevention.bmj.com/content/32/1/16 https://injuryprevention.bmj.com/content/32/1/16
• lordkrandel 3mo ago
  This is the best article of HN ever, so detailed and explaining, and engaging. I have a message for all US readers, this is simply nonsense. Putting blame on the hurt in the moment of need, discussing money over his own health, is something demons do. I hope you will realize someday
• ReptileMan 3mo ago
  Because America healthcare is stuck in the middle - it is semi socialized. You get both the negatives of socialized and free market ones. Either make it full socialized or remove all state money (this includes tax breaks and incentives) and allow competition.
• chmod775 3mo ago
  > The standard answer is greed: rapacious ambulance operators, owned by villainous private equity firms, exploit patients at their most helpless. But I don’t think that’s actually what’s going on. Ambulance providers are chronically unprofitable businesses; margins are thin, crews are underpaid, and operators exit the industry every year. The author does not understand how private equity extracts money. The high-liability and heavily scrutinized business is intentionally left with little profit: the actual profits are funneled up the supply chain. This is why private equity buys "nonprofit" hospitals - they can now control who that nonprofit buys services and equipment from.
  • IG_Semmelweiss 3mo ago
    [flagged]
    • chmod775 3mo ago
      Let's ask the thing whose mistakes I iron out all day to think for me.
  • hnmullany 3mo ago
    I worked in private equity as an analyst in the 90's - we looked at an ambulance service that was up for sale - the underlying operating margins (before you load on debt) were pretty reasonable, although I don't remember the details.
  • veunes 3mo ago
    Thin operating margins don't really settle the greed question when the ownership structure is complicated
  • deleted 3mo ago
    [deleted]
• NSUserDefaults 3mo ago
  Uber for ambulances, got it. Claude, get to work. We will submit for Apple app review at EOD.
  • a3w 3mo ago
    "Honest EMT — not just rides, but better"
• ornornor 3mo ago
  I had to call an ambulance in Switzerland where ambulance prices are freely set by the operator (except in a few cantons which are enforcing reasonable flat rates) A 5 minutes ride cost 1500.- (more or less the same in USD) Because I had used a good broker to pick my insurance plan, I was left with “only” 500.- to pay out of pocket for the ride. In Quebec, as a resident, going 3 blocks in the ambulance cost us about 500 CAD if I remember correctly.
  • mc3301 3mo ago
    Yeah, I had a Canadian friend who was in a motorcycle accident. He could see the hospital from where he crashed. He begged the paramedics to let him walk, but they judged he should not. He was billed 600$. The paramedics' judgment as to whether he should or shouldn't have isn't the debate here. They likely made the safe call.
  • vinay427 3mo ago
    Similar story here in Switzerland, with a 0 minute ride (they decided I didn’t need to be transported) that resulted in a bill of about 600-800 CHF.
    • ornornor 3mo ago
      Oh wow. They were cool with me they said if we transport you it’ll be expensive. I didn’t have a car, I was living pretty high up a hill, it was midnight, and I had lost quite a bit of blood already so I thought “fuck it I’ll find out how expensive it is once I’m fixed”. But they wouldn’t have charged me if they hadn’t transported me (at least that’s what it sounded like) I guess I made the right call because I fainted in the ER later from blood loss.
    • ornornor 3mo ago
      To add, Switzerland is a little weird with accident vs disease. If it’s an accident (ie sudden, unavoidable, unpredictable, more or less) it’s great because you have nothing to pay, you don’t even need to worry about the bill and there is no deductible and everything is covered no questions asked. If it’s a disease, then it’s the regular insurance rules which can be quite arcane and you’re never sure what’s going to be covered and how much. My transport was from adverse consequences of a surgery and so they deemed it not an accident, and that’s why I had to pay.
• conductr 3mo ago
  I spent a lot of time in healthcare finance and across most medical service industries the Medicare rate is actually not a loss. It’s a common thing said as it’s not super profitable, but it’s usually not a huge loss. It’s pretty close to what the cost of care should be. It just doesn’t give the extra padding for extremely fancy clinics, hospitals, admin and executive compensation, and often PE investor margin expectations. It’s usually slightly positive on contribution margin and given the volume of Medicare in the mix there’s enough flow through to cover reasonable overhead and perhaps slim margins. But, whenever I see a claim that the true cost of service is 10x over the Medicare rate, it’s a huge red flag there’s some financial shenanigans at play. Saying that Medicare is a loss, leaves the impression that it leaves a huge hole to fill so other payers need to pick up the bag in a huge way. This kind of lazy analysis blindly perpetuates this misconception. If they wanted to add value here, they should have performed a “what should an ambulance ride cost?” type analysis. You have to really strip out costs that are unneeded, excessive, and account for profit margin similarly. There’s no way $13k makes any sense for the service described. We need sensible cost controls in this industry. The industry hands these people blank checks when they can hide behind out of network, etc. It’s still captive price gouging.
  • Esophagus4 3mo ago
    [if the article’s analysis is true] cost controls would reduce the supply of ambulances, since the article claims Medicare actually is a loss. You have claimed it isn’t, but you haven’t really provided much evidence other than “there’s no way that’s true, trust me, I used to work somewhere in healthcare finance”
    • conductr 3mo ago
      Thats fine, I'm a passerby making a comment on their work on a platform that they may not even be aware of. If you look closer I’ve done more than they have by simply raising the concern and I’m not authoring an article attempting to educate people on the industry. I think it’s perfectly fine to question someone’s assertion based on experience alone. Basically you’ll have to do more to convince me what you’re saying is true is what I’m saying. That’s the same feedback a teacher would give a student on their homework. It takes data that I don’t have to do the analysis which is probably also why they didn’t do it. But I don’t think it’s completely off the mark to mention that I’ve been an insider at multiple healthcare service companies that like to claim they lose money on Medicare yet they opt to accept Medicare patients. When we consider denying Medicare we realize they are such a large part of the mix that they allow us to be as profitable as we are. It’s almost always a misconception of what “losing money” means. Price gouging the few patients that can afford it, is only profitable if all your expenses are already covered and economies of scale are at play, which is what Medicare is good for.
• altern8 3mo ago
  I live in Poland and despite being Europe from what I understand they don't have socialized healthcare. You need to buy insurance from the government, or private (I have both). If you don't have it, you don't have a right to healthcare. Then, if you go to public doctors or hospital you still have to wait months for an exam or years for surgery. BUT, I've never heard of anyone going bankrupt from getting sick, or being scammed by their insurance not covering costs. From what people make it sound, in the US you don't have socialized healthcare, getting doctors and exams is quick, but you also get scammed by insurance companies who will try their best to get out of paying, and I've definitely heard about people going bankrupt because they got sick.
  • mgol94 3mo ago
    that's not true, access to the emergency medicine (and transport) is a constitutional right in Poland, you don't need NFZ coverage for that.
    • altern8 3mo ago
      Same as in the USA. They are legally required to treat you in emergency situations there, too. BUT, they will charge you for their services afterwards--both in the USA and in Poland. Although I suspect that the bill from the American hospital will be A LOT more...
  • orwin 3mo ago
    I dislike sentences like 'you still have to wait months for an exam or years for surgery'. Depends on the exam or surgery. - Blood test: wait time (after your 12 hour fast) is likely 15-30minutes in most of Europe (even eastern Europe. I should know, I do one every 3 month). - pet-scan/x-ray: at most a few hours if your area is truly underserved, in my experience, less than an hour (but I needed it 4 times, so it might be small sample size). Specialists will make you wait for sure if it doesn't sound life-threatening for deeper exams, and especially exams that requires surgery, but the only example I have on hand is my mother's boyfriend who got his in less than two weeks, and his cancer removal surgery was planned within 3 months after the tumor biopsy (you need to change your diet at least a month before surgery to prevent complications and improve healing, so the true delay caused by wait time is ~2 month). They also explicitly said that if his cancer was more aggressive they would have given him a month to prepare according to my mom. But yes, in Europe especially, convenience surgery can take a year (my intern lips and teeth took 17 months) (and you pay a bit out of pocket), when in the US you can be done within days.
• King-Aaron 3mo ago
  Here in Australia, you can be 2,000km in the bush and an ambulance will fly out to you and fly you back to the city for free. That being said, we also have private ambulance companies here that will sting you for a huge bill if you don't have private ambulance cover.
  • RowanH 3mo ago
    We're getting taken to the cleaners in NZ!! I think it's $50 for a westpac chopper ride...
  • sevenseacat 3mo ago
    Yay for the RFDS. If only ground ambulances were as universally awesome
• orthoxerox 3mo ago
  Why won't EMS providers strip down their services to the level where Medicare/Medicaid rates completely cover their costs?
• crnkofe 3mo ago
  I don't get this US medical system. And the more I get to read about it the less informed I feel. Sounds like every involved medical service out there is just to rip the patient off.
• djantje 3mo ago
  Its a collective emergency service, which can save lives. If by law this service is required and you bill only the rides, you get this, high bills per ride. It would be nice to see a chart of countries with cost of ambulance rides, cost for the patient and average response times.
• jzer0cool 3mo ago
  So what is the practical advice to avoid high costs? Also for foreigners, long ago had a friend visit from Asia and wave away ambulance after a potential serious injury (waiver not to be transported) knowing of the high medical costs.
• magic_hamster 3mo ago
  This was a fun read, however, I feel that the actual essence is quite thin. It can be summarized in a short sentence: The cost comes from being always prepared with teams and equipment, and few privately insured riders subsidizes everyone else, getting very high surprise bills - this can and should be a shared community tax which would effectively allow free ambulance rides to almost everybody. It's an excellently written post though. I suspect people read this author for the experience, more so than actual information. I just wonder if they should just do prose and go wild with their skill instead of coating a few predictable facts with so many layers of color.
• winrid 3mo ago
  My fun ancedotal story about US healthcare: Kaiser transported me 4hrs in a ambulance to get surgery and I think I just paid the $200 ER fee But then they would never cover an MRI for an issue with the same leg. It's like we're almost done with this project guys, come on.
• dark-star 3mo ago
  Wait, being transported in an ambulance costs money? Man, every day I learn new things about how shitty the US health system is, and I'm more and more happy to not have to worry about deciding if I'd rather die or be broke in an emergency
• Planktonne 3mo ago
  > The standard answer is greed The article is interesting, but it doesn't actually sufficiently dismiss this; it's the route cause of it all.
• IG_Semmelweiss 3mo ago
  Great article. One item that it avoids touching even though it clearly insinuates it - the solutions. And among the solutions, there's one that is briefly alluded to, but skipped around like a hot potato. What if EMS were to refuse services for those who don't pay for the option on a monthly basis? And for the rest, if they choose to pay "on the spot" they can be OON like everyone is now? Why give out a free (or subsidized) option out, at all ? After all, I dont think it is illegal to turn away Medicare & Medicaid patients if you are not in-network with them. We pay for other types of insurance. EMS insurance seems like a natural fit for a family.
• secult 3mo ago
  Usually, when some system is getting outdated, the system gets replaced or updated to fit the needs. Does this system work for the majority of USA, or not? Do I read it correctly, that the poor people have medicare/medicaid and therefore it's fine for them, the average person has some health insurance and don't mind spending a few thousands of dollars once in a while when his life is in stake?
• mstaoru 3mo ago
  Just a personal anecdote. I was living in China, my father was visiting and fell ill (anemia). We needed to go to the hospital and decided to call an ambulance vs. calling a car because it could enter the gated compound. For a 3 km ride the price difference wasn't even a concern. A car would cost ~$3 and an ambulance ended up about $30. PS: An average net salary in that city was about $1700/month at the time.
• pshirshov 3mo ago
  I worked at a company which was doing medical billing for ambulances among other things. Essentially, the bills are always inflated so when the settlement comes the providers get 20..50%. The crucial procedure is so called "medical coding" where medical notes (sometimes - scrawled on paper with a pencil) are being turned into bills - and that's where additional codes are getting added and more expensive codes are selected. There are books and guidelines on how to do the coding and some automated logic which "fixes" filled forms to bump the amounts a bit. If the insurance (less frequently - the patient) pays more - that's just a bonus. Billing itself gets a small fraction of the bill usually amounting to $20..50, they don't profit from inflated bills directly but the clients would select you on the basis of average settlements. Dispatchers also get little fractions. Things are very different when it comes to helicopter ambulances, where the bill could easily get to hundreds of thousands and everyone involved gets a lot. In fact, all the operators prefer to work with helicopters because of that, everyone involved references ground operations as "crap" or so. Can't say for whole industry but that's what I've seen at one particular place working with several providers/dispatcher companies. From what I can remember about the ground reality, a $12K bill would mean that they expected to actually get $3..4K. A typical ground bill for some particular region the company operated at was settled at $500..$2K while an average helicopter bill was smth around $200K if I remember correctly, with spikes up to $500K.
  • Ntrails 3mo ago
    > an average helicopter bill was smth around $200K if I remember correctly, with spikes up to $500K. Those numbers made me blanch somewhat! Having been in a helicopter (aka Air Ambulance) in the UK, all of which operate as charities iirc, I was curious about their costs. > The average cost of a helicopter mission is £4,748* and the average cost of a critical care car or rapid response vehicle mission is £2,054*[1]. https://www.airambulancesuk.org/about-us/facts/ https://www.airambulancesuk.org/about-us/facts/ eesh
    • gosub100 3mo ago
      There are stories where the air ambulance sues patients who are still in ICU because getting paid depends on being first in line to file the lawsuit.
• anovikov 3mo ago
  This problem just doesn't exist anywhere else in the world. Ambulance is just another truck. There are some fees involved with having priority on the road and some regulations, but it's just another truck. It won't cost (to anyone - i mean OF COURSE it is free for the actual patient) over a hundred euros or so to do a simple across-city ambulance ride anywhere in EU, maybe 2x the price of a cab. That's corruption and nothing more. End it and imprison everyone who ever had a tangential relationship to this system, for life - to ensure no one will try to pull this sort of "regulatory capture" again.
  • anticensor 3mo ago
    To be precise, a minibus.
• hnmullany 3mo ago
  I worked in private equity in the 90's and looked at one of the big regional ambulance service companies that was up for auction. The underlying operating margins were fairly reasonable - the private equity owned companies only have issues because of their debt load.
• ciclotrone 3mo ago
  Last year I had appendicitis in Italy, where I live. I called a cab to reach the nearest hospital, since I didn't feel so bad as warranting an ambulance. I got accepted, visited, transferred to the larger nearby hospital by ambulance, appendectomy, 4 nights stay, and I was provided with the drugs for the convalescence. When I was dismissed I took another cab back. Total expense: ~25€ for the two taxi rides. Very happy to pay my taxes, and very happy that when I don't need it myself, they go into financing the healthcare services for others that may or may not be able to pay out of pocket.
  • anonym29 3mo ago
    This sounds like a great deal if your annual taxes are less than your annual unsubsidized medical expenses, and a terrible deal if your annual taxes stretch into the six figure range as a young healthy person.
    • Avicebron 3mo ago
      Doesn't this young person theoretically become older and less healthy as time passes? How many young people have six figures in taxes and not understand reciprocity?
      • anonym29 3mo ago
        Reciprocity is great when all parties contribute equal amounts, all parties receive an equal share of the benefit, and the arrangement is strictly voluntary. Think toll roads where everyone pays the same price, only the people using the road pay for it, and everyone using it benefits from it. It's less great when some parties are expected to give more than they receive in return (in order to provide for those who give less than they receive in return), without their consent, enforced by the state's monopoly on lawful violence, and are demonized for so little as daring to express dissatisfaction with the involuntary arrangement.
    • pjc50 3mo ago
      > annual taxes stretch into the six figure range as a young healthy person At that point you're in the, what, top 2% of salaries? Especially for your age band.
• rpunkfu 3mo ago
  tldr: greed
• panny 3mo ago
  His mistake was going to an American hospital at all. For what he paid, he could get a round trip ticket to literally anywhere in the world, then just get realistically priced medical care. The entire American medical establishment needs to end. It's cancer. I won't go. Not even if the alternative is my death. I just won't go. I should probably get some kind of dogtag to wear that explicitly states this if I'm ever knocked unconscious. Just leave me in the ditch man, American medical care is a fate worse than death.
• veunes 3mo ago
  Yet "the payment model is broken" and "some prices are absurd" can both be true
• quentindanjou 3mo ago
  If there is no emergency way to contact an ambulance in network then there should be no in- or out-of-network. Calling 911 does not give you an in-network and there no way to know in advance unless calling your insurance (in business hours, giving that you are not dying... which you probably are)
• JKCalhoun 3mo ago
  I was handling my moms bills when, at an independent living home, she was sent twice by ambulance for minor falls. As the article says, thousands of dollars for these 5 minute drives. (Fuck "credit score") I sent a check for $20 for each of the two bills. And I then did the same the next month when the bills came again. I repeated this $20-a-month routine for a few years before, in both cases, they ended up closing the accounts-billing after perhaps $500 or so was paid.
• everdrive 3mo ago
  Can anyone explain why coverage networks even exist? What exactly makes it so expensive for an insurance provider to deal with an out-of-network health care provider? That same health care provider would not be expensive for an in-network insurance provider. I have no sense whatsoever for why the same health care provider would be expensive in one case and inexpensive in another case.
• memcg 3mo ago
  I called 911 last year when my wife was unresponsive in Maryland. At least 10 vehicles arrived in under 10 minutes. EMTs worked to revive her for 30 minutes doing what they described as the same care she would have received at the emergency room. She was transported to the hospital because she had a slight heart beat. Had she been declared dead at home, police and other staff would have helped process the death report and application for death certificate. I did not receive a bill or provide insurance information.
• tsoukase 3mo ago
  It's simple. Ambs in the US are all private companies. Everywhere in the world private ambs are also extremely expensive and public ones free of charge. There is no truly public amb ride in the US.
  • Henchman21 3mo ago
    We don't even have public toilets. We do have laws criminalizing homelessness though!
• moribunda 3mo ago
  3rd world country.
• Henchman21 3mo ago
  Why? Because fuck you, that's why. Welcome to America. It's a business. Gimme my money.
• deleted 3mo ago
  [deleted]
• summarybot 3mo ago
  What are the margins on an ambulance ride?
• weezing 3mo ago
  You guys pay for an ambulance ride?
• deleted 3mo ago
  [deleted]
• ronn00 3mo ago
  [flagged]
• lofaszvanitt 3mo ago
  What a selfish society the US have. 900 bucks for a fn ambulance. I enjoyed my stay when I was there, but living there.... seems to be a fucked up, soulless, dog eat dog, sell your own mother for 3 pennies kinda devil ridden place.
• doby111 3mo ago
  In India, there's a quick commerce company (Blinkit) which offers free ambulance service, under 8 minutes TAT. Just broken systems, I guess.