This Ohio toddler’s 40-minute ground ambulance ride came with a shocking $9,250 bill. How an exception to surprise billing rules hurts Americans

In August, 15-month-old Darragh appeared to have a common viral infection, but his condition worsened, with blisters and skin peeling off his face. Yoder took her son to the emergency room at Mercy Health hospital in nearby Urbana, where she was advised he would have to be transferred to a nearby children’s hospital by a private company’s ambulance.

Though the 40-minute trip seemed “fairly straightforward” to Yoder, the cost of the ambulance ride included a base rate charge of $6,600, a mileage fee of $2,340, $250 for use of an intravenous infusion pump and $60 for monitoring Darragh’s blood oxygen levels. By contrast, the children’s hospital charged only about $3,000 more for the toddler’s three-day stay.

The family is uninsured, relying instead on a Christian health care sharing ministry. Their income is slightly too high for them to qualify for Medicaid, and so the family had little recourse for dealing with the massive ambulance bill.

Here’s what you should know about the risks of opting out of traditional health insurance, plus tips on how you can avoid getting hit with surprise medical bills.

Legal loopholes for ground ambulances

Christian health care sharing ministries do not offer members negotiated rates with ambulance companies or other medical providers, unlike a traditional insurer. In Ohio, where the Yoders live, there are no state or federal billing protections for uninsured patients to deal with a ground ambulance bill. Even the federal No Surprises Act, which protects the insured from large bills for out of network air ambulance transportation, doesn’t cover ground ambulance services.

Patricia Kelmar, the senior director of health care campaigns for PIRG, a national advocacy group, said in her interview with The Washington Post that patients are rarely told what an ambulance ride will cost before receiving the bill.

“Shouldn’t the hospital know that?” she said. “I don’t think it’s that heavy of a lift.”

Kelmar said she has seen per-mile charges ranging from less than $30 to more than $80 and wildly different base rates.

“Studies show about half of emergency ambulance patients with insurance are at risk of receiving a surprise medical bill which is an out-of-network charge for those transportation services. Those balance bills carry a median out-of-pocket charge of $450 but in some states, the average is more than $1000,” wrote Kelmar in a 2022 U.S. PIRG report (2).

Yoder attempted to negotiate with the ambulance company representatives and was told they could reduce the bill to $5,600 if the family paid in a lump sum. She opened a new credit card with a 17-month no-interest deal to fund the bill. After charity discounts, the hospital bills were dropped to $6,800.

The family expects that their sharing ministry will reimburse them for about 75% of the total cost of their payments to the hospital and ambulance service.

Yoder told The Washington Post she wishes that she had driven her son straight to the children’s hospital.

How to plan for medical expenses

This cautionary tale points to how important it is for families to have proper health insurance coverage, and to be ready to self-advocate in the event of medical expenses. You should know that the No Surprises Act protects you from unexpected out-of-network bills if you have health insurance through an employer, a federal or state-based marketplace, or other individual market coverage, but doesn’t help those who have no insurance coverage.