Why American ambulance rides are so expensive • Hacker News Board

Re: Why American ambulance rides are so expensive

#161

Post by SoftTalker » Fri, Jul 10, 2026, 3:24 AM UTC

Spooky23 wrote: post #149

jjk166 wrote: post #83

Earlier quoted context omitted.

> The average ambulance transport costs $2,673 to provide I think this ignores the 400 pound gorilla in the room. Why does an ambulance transport cost thousands for the operator? This is a short trip in an automobile, essentially a fancy uber ride. At first one might say that's flippant - obviously ambulances are specialized vehicles, and you have paramedics, and they need to get to locations quickly, and so forth, b…

Ambulance crews are almost never 2 paramedics. Most often they transport and do BLS only. If they are it’s because a local government is paying for that service. EMTs make minimum wage. The people who own ambulances typically have a little cartel like business in a region and print money. They refuse to sign insurance contracts so they are almost always out of network and will not accept direct insurance payments. Wh…

Nobody makes (federal) minimum wage these days. McDonalds employees make double that.

Re: Why American ambulance rides are so expensive

#162

Post by stephenbez » Fri, Jul 10, 2026, 3:25 AM UTC

xp84 wrote: post #22

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 insu…

Was this Cigna? Same thing happened to me in SF in the same timeframe.

It took 5 times of me calling and explaining that they can’t charge it as out of network before they adjusted it.

Re: Why American ambulance rides are so expensive

#163

Post by SoftTalker » Fri, Jul 10, 2026, 3:27 AM UTC

tedggh wrote: post #156

“ 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 o…

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).

Re: Why American ambulance rides are so expensive

#164

Post by [deleted] » Fri, Jul 10, 2026, 3:29 AM UTC

gruez wrote: post #87

gerdesj wrote: post #76

Earlier quoted context omitted.

Given you find this is _normal_ for a six mile ambulance ride: "and $11,670 as a “base rate.”" What on earth would you consider normal for a helicopter ride from Exeter to London? That's roughly 150 miles as the crow flies. Pilot, co-pilot and a medic, minimum crew for say 1.5 hours. Each way, so 300 miles of fuel and aircraft lifetime and three hours of crew cost, not to mention ground crew etc. My dad got that on t…

> How can that possibly be justified? They can't make money on some customers (medicare/insurance), so they have to make up the difference however they can. In practice this means screwing over the people who have assets to seize.

[deleted]

Re: Why American ambulance rides are so expensive

#165

Post by jmcgough » Fri, Jul 10, 2026, 3:31 AM UTC

wombat-man wrote: post #159

Spooky23 wrote: post #150

Earlier quoted context omitted.

EMTs are like veterinarians. Lovely people who get ruthlessly exploited. Benefits are garbage unless you’re a unionized public employee.

Yeah, every EMT I know was way underpaid for how crazy stressful it was. Especially considering how expensive the ride was

EMT now is often used as a stepping stone to a career with a liveable wage, like physician.

Re: Why American ambulance rides are so expensive

#166

Post by SoftTalker » Fri, Jul 10, 2026, 3:36 AM UTC

ButlerianJihad wrote: post #44

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 adv…

Yeah I would bet the vast majority of ambulance rides are never paid for. Homeless, street people, the impoverished, the uninsured, the unemployed... none of them will ever pay a dollar much less thousands for an ambulance ride. And in many areas those are the people who disproportionately use ambulance services.

Re: Why American ambulance rides are so expensive

#167

Post by whatever1 » Fri, Jul 10, 2026, 3:39 AM UTC

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.

Re: Why American ambulance rides are so expensive

#168

Post by failbuffer » Fri, Jul 10, 2026, 3:39 AM UTC

indoorfish wrote: post #153

socalgal2 wrote: post #143

Earlier quoted context omitted.

You forgot the cost of insurance when you get sued by the passengers or when you get into an accident since you're racing down the road hoping people are paying attention and get out of the way. No idea what it costs but it's arguably more than an uber driver. 2x? 5x? There are a ton of other costs. You're not paying for one employee. You're paying for many since ambulances run 24/7. They are also driven hard which m…

"My LLM of choice" is like when the news reporter says "confirmed by someone not authorized to speak publicly". It's not a meaningful report.

Your point about LLMs aside, I'd trust the inside source over whatever carefully baked misrepresentation the PR department doles out.

Re: Why American ambulance rides are so expensive

#169

Post by bandrami » Fri, Jul 10, 2026, 3:51 AM UTC

jjk166 wrote: post #83

gruez wrote: post #9

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 e…

> The average ambulance transport costs $2,673 to provide I think this ignores the 400 pound gorilla in the room. Why does an ambulance transport cost thousands for the operator? This is a short trip in an automobile, essentially a fancy uber ride. At first one might say that's flippant - obviously ambulances are specialized vehicles, and you have paramedics, and they need to get to locations quickly, and so forth, b…

We had to move my non-ambulatory[1] father from Mississippi to Virginia a couple of months ago. The vehicle probably didn't have all the staff and equipment of an ambulance but it did have an RN, a crash cart, and some other expensive crap that goes "ping". The cost was $3K for an 800 mile trip (slightly more because I included the "snacks and a DVD player" package).

[1] Oh, holy crap, I just got why ambulances are called that

Re: Why American ambulance rides are so expensive

#170

Post by grogenaut » Fri, Jul 10, 2026, 3:56 AM UTC

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.