Ambulance services play an essential, life-saving role in the health care system but can also be a source of surprise bills to patients and unexpected high out-of-pocket costs. This HCCI data brief and downloadable data explores the 10-year trends in ambulance prices, utilization, spending, and the frequency of out-of-network billing for the commercially insured – people who get their health insurance through their employer.
Ambulance services can be described in two categories: ground and air. Ground ambulances are the most common type of ambulance trip, representing over 98% of trips. Air ambulances are either fixed wing (airplane) or rotary wing (helicopter) aircraft used to transport people in often time-sensitive medical situations. Using HCCI data, we examined ground, airplane, and helicopter ambulance trends from 2012 to 2021. The accompanying downloadable datasets also include state and procedure code (CPT) level trends.
Utilization
- Utilization of ambulance services remained relatively unchanged between 2012 and 2021, although we observe a dip in utilization in 2020 related to the COVID-19 pandemic.
- The average price of a ground ambulance trip increased 33% from $820 in 2012 to $1,093 in 2021 (Figure 1).
- The average out-of-pocket cost for a ground ambulance trip increased 64% from $140 in 2012 to $229 in 2021.
- The average price of a helicopter ambulance trip increased 84% from $16,385 in 2012 to $30,151 in 2021.
- The average price of an airplane ambulance trip increased 75% from $21,736 in 2012 to $37,944 in 2021.
- The variation in the price of an ambulance trip increased since 2012, with a widening gap in the cost of the lower and higher price trips– the 90th percentile price increased faster than the 10th percentile price.
Figure 1: Variation in Price for All Ambulance Trips, 2012-2021
Out-of-network Billing
- 35% of ground ambulance trips were out-of-network in 2021, down from 43% out-of-network in 2012. Most of the decline occurred between 2020 and 2021 (Figure 2).
- 23% of helicopter ambulance trips were out-of-network in 2021.
- 26% of airplane ambulance trips were out-of-network in 2021.
Figure 2: Share of Ground Ambulance Trips Billed Out-of-Network, 2012-2021
Methods
Ambulance trips were identified in the HCCI dataset using Current Procedural Terminology (CPT) codes. Trips were classified as fixed-wing or rotary air ambulance if they included the following CPT codes: A0430 (plane/fixed-wing air ambulance base rate), A0431 (helicopter/rotary air ambulance base rate), A0435 (plane/fixed-wing air ambulance mileage), and A0436 (helicopter/rotary air ambulance mileage). All other ambulance trips were classified as ground. An ambulance trip was defined as all ambulance services of the same type of transport – ground, plane, or helicopter – for a patient on the same date. A trip was considered out-of-network if any of the ambulance services were billed out-of-network. Our 10-year (2012-2021) sample included 8.5 million ground and 175,000 air ambulance trips, in the employer sponsored insured population under the age of 65. Trips with allowed amounts of $0 or less were excluded from the analysis.