Understanding healthcare billing can be daunting, especially when it comes to services like emergency medical response. It can be easy to end up with an out-of-network bill. In fact, nearly 60% of ground ambulance rides were out-of-network in 2022. And with more than 23,000 medical transport providers operating in the United States, and little centralized data about these services, it takes a bit of outreach to discover which providers are considered in-network by your health insurance.
Here’s what you can do to find out:
Define “in-network”
"In-network" refers to healthcare providers or facilities that have a contract with a health insurance plan to provide services at negotiated rates. Providers and facilities include your general practitioner, specialists, medical facilities, and ambulance companies, as well as other individuals and organizations that treat health conditions. Services from in-network providers typically means lower out-of-pocket costs for you. When a medical transportation service is in-network, you benefit from lower cost-sharing, reduced charges, and more predictable out-of-pocket expenses.
Know the limits of your coverage
To help determine what providers and services are in-network before an emergency strikes, take some time to examine your health insurance policy. Review your benefits and look for specifics on emergency services, including ambulance coverage. Some plans may have restrictions or special requirements.
Additionally, health insurers often provide a list of in-network providers, including ambulance services, on their website or through customer service. Familiarizing yourself with the providers in your area can help you know what to expect if you are seeking care during an emergency later. If you often spend time away from home, it’s also a good idea to check the in-network providers in those areas.
Ask your insurance company the right questions
Sometimes getting clarity about your policy means reaching out to your health insurance company for answers. If you're unsure about whether a particular ambulance service is in-network, ask your insurance provider for specifics about your plan. Request details about ambulance providers and confirm if a particular service is covered under your plan.
You'll also want to ask about how your insurer covers emergency services. Some insurance companies may have different policies for emergency services, such as ambulance transportation. Ask how they would handle a situation where you're taken to an out-of-network facility by an out-of-network transport service.
Reach out to your provider
If you are seeking care from a medical transport provider or service for a non-emergent situation — such as paratransit, dialysis transfer, bariatric transport, or other limited mobility transport — you can always ask them in advance if they are in-network with your insurance plan.
Explore government-mandated protections.
The federal government, along with some states, may limit how much you can be billed for out-of-network emergency services. Research your state's specific regulations for any additional protections.
Have an “out-of-network” plan
Avoid the panic and be prepared for the possibility of receiving a bill for out-of-network service. Always carefully review the charges to double-check if the service is listed as out-of-network. If you believe the charges are incorrect or are higher than what you expected, you have the option to appeal the denial with your insurance company. When filing an appeal, provide all relevant documentation and be sure to communicate clearly.
Be prepared for an emergency
Never hesitate to call for emergency services when you need them. In an emergency, you won’t have time to check whether an ambulance service is in-network with your insurance. 911 dispatchers are not trained to provide insurance information or choose services based on your insurance plan — they are focused only on getting you the fastest possible care. Knowing your insurance coverage ahead of time can help you understand which services are in- or out-of-network and what costs you might face if you receive a bill.
At MASA, we believe you shouldn't have to worry about whether your ambulance is in-network when facing an emergency. That’s why we act as a secondary payor, applying your membership benefits after your health insurance pays the ambulance provider. Working directly with all ambulance providers — regardless of health insurance network status — helps us ensure our members are protected from emergency medical transportation costs. If you’re already a MASA member, you can visit the member portal to review the membership benefits available to you and learn more about how to use them. MASA is emergency medical transport cost protection you can rely on.
