SACHA PFEIFFER, HOST:
When you call 911 in a medical emergency, you're not necessarily choosing which ambulance responds. The ambulance company may be outside your insurance network, and you may end up with a big bill. Member station GBH's Liz Neisloss has this report. And a heads-up, especially if you're in a car - her story includes the sound of sirens.
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UNIDENTIFIED PHONE OPERATOR: Nine-one-one. This line is recorded.
LIZ NEISLOSS, BYLINE: One October night in 2023, Keith Ventimiglia, a high school math teacher, was home with his family in Brimfield, Massachusetts, when he was suddenly in extreme pain and couldn't move.
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UNIDENTIFIED PERSON: My husband is on the floor. He can't move his...
NEISLOSS: His wife called 911 and an ambulance took him to the nearest hospital, about 16 miles away.
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UNIDENTIFIED PHONE OPERATOR: I'm sending the paramedics to help you now. Stay on the line, and I'll tell you exactly what to do next.
PFEIFFER: When Ventimiglia's wife made that call, a dispatcher sent the nearest ambulance, operated by a private company. It was out of network with his insurance. Not much about an ambulance ride would surprise Ventimiglia. He's a part-time paramedic. But what shocked him was the ambulance bill. It was $6,800.
KEITH VENTIMIGLIA: The single largest by a significant amount of all the other medical expenses.
NEISLOSS: Still, he wasn't worried. He'd fully recovered, and he had insurance. So he sent his bill off, but that one bill would lead to a nearly two-year battle. Ground ambulances were left out of a 2022 law that protects people from surprise emergency medical bills. The result? Those bills can go to debt collection. People get forced into payment plans, summoned up in court.
MAX COLICE: They can't afford to pay these bills. It's just not a possibility for them.
NEISLOSS: Lawyer Max Colice works pro bono, helping those who've been sued over ambulance debt. He says the bills can be a crushing psychological wait for anyone who's just come out of a medical or mental health trauma. In nearly 30 states, ambulance billing is a largely unregulated system that leaves people on the hook for their emergency transport. Roughly half of all ambulance rides are out-of-network because many insurers and ambulance providers don't agree on rates. That could be the case whether your ambulance is from a private company or your municipality.
NEISLOSS: As a paramedic, Keith Ventimiglia understands why ambulances don't come cheap.
VENTIMIGLIA: You got to make sure that truck runs and you have qualified, well-paid people on that truck with good equipment.
NEISLOSS: Still, he thinks people shouldn't be trapped between their insurance company and the ambulance provider, trying to resolve their bill. Insurers and ambulance companies blame each other for the chaos.
LORA PELLEGRINI: We need to rein in ambulance companies.
NEISLOSS: Lora Pellegrini, president of the Massachusetts Association of Health Plans, says some ambulance companies charge exorbitant rates.
PELLEGRINI: We have been seeing, for several years, a failure of many of the ambulance companies to contract with the health plans. I think it's bad actors who can get away with it, so they're trying to.
NEISLOSS: Dennis Cataldo, owner of a Massachusetts ambulance company and a director of the American Ambulance Association, says they're not the villain.
DENNIS CATALDO: More ambulance companies are choosing not to contract with commercial insurance because the rates just don't support the services that are being provided.
NEISLOSS: Patricia Kelmar, a senior director at U.S. Public Interest Research Group, has watched the finger-pointing for years. She thinks regulators need to step in to protect consumers.
PATRICIA KELMAR: We've been waiting for the market - the insurance market, the health care provider market - to solve this, and it hasn't happened. And that's the appropriate time to look for regulation.
NEISLOSS: In the absence of action from Congress, states are stepping in. So far, 22 states have laws that limit patients' responsibility for their bills to what they'd pay in-network.
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UNIDENTIFIED ANNOUNCER: Action Ambulance v. Keith Ventimiglia.
NEISLOSS: Action Ambulance took paramedic Keith Ventimiglia to court over his bill. He countersued, and the case was ultimately dismissed. Now free of his billing nightmare, he echoes the refrain of those swept into ambulance debt.
VENTIMIGLIA: That really makes you pause and go, do I really need this ambulance? Can we just risk taking a car instead?
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NEISLOSS: And with looming federal cuts and changes to Medicaid, millions more will be asking those questions.
For NPR News, I'm Liz Neisloss in Boston. Transcript provided by NPR, Copyright NPR.
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