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Why American ambulance rides are so expensive

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Re: Why American ambulance rides are so expensive

#121

Post by the_sleaze_ »

yamillove wrote: post #50
burnhamup wrote: post #15

Earlier quoted context omitted.

Yeah, my family was hit by two ambulance bills in California in 2024, and tried to balance bill us contrary to the law. It was a really frustrating experience trying to get them follow the law. One of the ambulance companies waited an entire year to even file paperwork and still tried to get insurance and me to pay.

[flagged]

Last view of life: slowly bleeding out in the back of a waymo that has gotten trapped in the traffic circle in front of the ER and won't unlock its doors until it reached its destination.

Re: Why American ambulance rides are so expensive

#122

Post by FireBeyond »

khuey wrote: post #111
justonceokay wrote: post #106

Earlier quoted context omitted.

There’s the cost of supplies used during transport. Also the cost of maintaining potential supplies like blood even if they go unused. EMTs may make $23 but they are also getting benefits and have other overhead, making their real hourly cost probably closer to $50/hr minimum. There’s insurance, which I bet is out the wazoo expensive for ambulance. Ambulances have to be maintained and I would guess have much more reg…

I don't disagree with what you're saying but I want to point out that it's rather unusual for (American) ambulances to carry blood, and probably more of them should. https://www.redcross.org/about-us/news-and-events/news/10-wa...

Correct. The only ambulances that typically will stock blood are specialized NICU ambulances and HEMS (helicopter). Although more progressive agencies are looking more and more at part blood products.

Re: Why American ambulance rides are so expensive

#123

Post by joe_the_user »

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.

This thread is filled with strong arguments that ambulence operators do make money with medicare.

But even more, it's completely false that the reason an ongoing, working business charges a huge price to some people is that some other people are taking money from them. A business charge people huge prices when it can. Businesses make as much money as they can.

It is true that what health care providers charge individuals tends to be their "opening offer" to insurance companies so they do make this exact argument "we gotta make all our profits on you 'cause everyone else is denying us" but that doesn't make such arguments any more reasonable.

Re: Why American ambulance rides are so expensive

#124

Post by arjie »

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…

You’re right. The cost of the service not matching the direct cost is something we’re familiar with - that’s just fixed cost and entirely normal (happens with books, movies, etc).

This just happens to be the case where you must transport people but most people are net losses. In this scenario, the only surviving companies would be those who charge the remainder sufficient enough that the blended population of clients causes a net pay-in. Everyone who doesn’t account for that will just go out of business.

Being available constantly could be helped with a retainer, it’s true, but even with that we should expect that some patients pay a lot if they’re rarer than the loss-makers.

Re: Why American ambulance rides are so expensive

#125

Post by FireBeyond »

JumpCrisscross wrote: post #103
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…

> As much as I like articles that tries to use economics or finance to explain stuff, the "options" analogy is a bit hamfisted Idk, my takeaway is ambulances look like a solid market for a subscription model. Ideally, one that taxpayers pay for. But also, potentially, as a private one that you can pay e.g. $50/month to know you won't be billed $12,000 by idiots.

One thing I'd like to point out, many of the Airlift companies, like Airlift Northwest, offer $60/year family insurance for Heli EMS. They'll bill your insurance and accept the insurer's payment as "Paid in full". They also tend to have reciprocal agreements with many other HEMS agencies.

Re: Why American ambulance rides are so expensive

#126

Post by MichaelZuo »

jasonjayr wrote: post #115
justonceokay wrote: post #106

Earlier quoted context omitted.

There’s the cost of supplies used during transport. Also the cost of maintaining potential supplies like blood even if they go unused. EMTs may make $23 but they are also getting benefits and have other overhead, making their real hourly cost probably closer to $50/hr minimum. There’s insurance, which I bet is out the wazoo expensive for ambulance. Ambulances have to be maintained and I would guess have much more reg…

TIL getting an elevator tech to just come out to look at your building's elevator is about $1600. If it's an easy fix, that's all you need to pay. If it's not, it goes up significantly....

Don’t they need to sign something legally binding, the moment they adjust even one minor internal part?

Re: Why American ambulance rides are so expensive

#127

Post by delichon »

tbrake wrote: post #119
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…

> This is a short trip in an automobile, essentially a fancy uber ride. We need a regulatory body that can fine people for making analogies this bad

> We need a regulatory body that can fine people for making analogies this bad

We need a communal agreement to apply social opprobrium upon people who reflexively propose to solve trivial problems by imposing their will on other people.

Tsk-tsk.

Re: Why American ambulance rides are so expensive

#128

Post by defrost »

pclowes wrote: post #114
defrost wrote: post #90

Earlier quoted context omitted.

W.Australia has a land area three time that of Texas with the bulk of the 2.9 million in population clustered about the capital city Perth. In the rest of the state there are volunteer Ambulance services subsidised by state and federal government and a fleet of Royal Flying Doctor air ambulances. RFD(WA) comes in at ~ $80 million AUD / annum in state support (for better or worse - https://www.abc.net.au/news/2024-07-…

Australia is also going bankrupt just slightly faster than the United States. Looks like deficit spending and debt levels are only trending the wrong direction there as well. I am all for flight for life as we call it here, but that is different than saying we should have a network of ambulances across massive swabs of mostly empty terrain. I am willing to hazard that the Australian airlift response is slower than yo…

> Australia is also going bankrupt just slightly faster than the United States.

Dunno about that, there be weeds. Not to mention the US clown car demolition derby is still in office.

Still, the coronavirus pandemic and associated policy responses led to the largest deterioration in the Australian Commonwealth Government’s fiscal position since the Second World War. That was 2021.

The forecast national net debt has looked pretty shitty since then, but the arc has been one of improvement - last years 2025-26 National Fiscal Outlook has been claimed to be overly grim by the most recent KPMG assessment of the 2026–27 AU Budget and backs the estimates that the Federal Government net debt servicing will return to pre COVID levels by 2029-30.

Yeah, it's f-obvious it takes longer for a plane to cross 600km than it takes an ambulance to cross a Sydney suburb.

Any other insights?

Re: Why American ambulance rides are so expensive

#129

Post by FireBeyond »

semiquaver wrote: post #47
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…

> discovered the "life hack" of having an extremely inadequate network The article covers this. Ambulance providers are strongly incentivized not to join insurance provider networks, and as a result more than 80% of ambulance rides in the US are “out of network”. So the inadequacy of the network is probably not the insurer’s fault.

As an ex-paramedic and EMT, both with County Fire and private, there are absolutely those. But many-a-time, some of the blame falls on the physician. Medicare has, for one example, a lovely little form to fill out, just a few fields, mostly checks and multiple choice, to explain why the need for a "fully equipped BLS (or ALS) ambulance" was required, versus POV (private owned vehicle) or cabulance.

The number of times we'd have to hang out at the charge nurse's desk because the physician had scrawled a signature at the bottom of the form and nothing else, etc., was ... staggering.

If that doesn't give that reasoning (unable to stand steady, fall hazard, need for continuous O2, etc., etc., etc.) then no pay. And many insurers would use that same paperwork, not just Medicare. Could we fill it out ourselves? No. I'm not risking my EMS career to be at the center of a "ambulance company employees charged with medicare fraud" news story.

Re: Why American ambulance rides are so expensive

#130

Post by ryandrake »

mothballed wrote: post #67
skinfaxi wrote: post #54

Earlier quoted context omitted.

See everyone who decries student loan forgiveness as an example.

Government subsidized sudent loan forgiveness is a regressive tax, though, which makes it quite unpopular in the non educated that on average earn less.

The root cause is still cultural. Nobody wants to pay taxes that are helping someone else. Whether that "other" is in a different economic class, different race, different gender, has different political beliefs, lives in a different state, it's always the same mentality: "I don't want my tax dollars to pay for people I have determined to be 'others' and culturally different from me." Heaven forbid someone who doesn't deserve it or doesn't need it, get help.
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