> ## Content Index > Fetch the complete content index at: https://millionaire-marketing.ghost.io/llms.txt > Use this file to discover other available public pages before exploring further. # The Ride the Surprise Billing Law Left Out - URL: https://millionaire-marketing.ghost.io/the-ride-the-surprise-billing-law-left-out/ - Published: 2026-09-27T10:45:55.000Z - Updated: 2026-09-27T10:45:55.000Z - Author: John Stone The federal surprise billing law that took effect at the start of 2022 covers three things: emergency room care, out-of-network doctors working inside an in-network hospital, and air ambulances. A helicopter is protected. The ambulance that pulls into the driveway is not. Congress left ground ambulance service out and gave three reasons: the services vary too much, states and localities already regulate them, and there was no reliable cost data to build a payment standard on. Instead of a rule, Congress created a committee. It was chartered in late 2021, took until the end of 2022 to seat members, met three times in 2023 and finalized its report in March 2024\. The committee adopted twelve recommendations and warned in its own text that Congress should not pick and choose among them as if they were an a la carte menu. Congress has not picked any of them. --- ***Sponsored by*** ***Omnia Research*** [$95 million when the market crashed. Now this.](https://click.milmkt.com/hhpz/1CL2731?ref=millionaire-marketing.ghost.io) **Editor’s Note:** When the market crashed 37% in 2008, Larry Benedict **made $95 million** for his clients. Now he is sounding the alarm on oil. He warns that high oil prices could strangle the U.S. economy. Yet where others see disaster, Larry sees one of the biggest opportunities in 40 years, and **a way for regular folks to profit without owning a single oil stock.** He lays it all out in a free presentation [**found here.**](https://click.milmkt.com/hhpz/1CL2731?ref=millionaire-marketing.ghost.io) Or continue reading below… --- Dear Reader, Have you seen this guy before? [![](https://storage.ghost.io/c/5b/93/5b931ca3-34c1-4bd0-ba9d-9cc78907a475/content/images/2026/09/image-1.png)](https://click.milmkt.com/hhpz/1CL2731?ref=millionaire-marketing.ghost.io) When the stock market crashed 37%, this man made $95 million for his clients. While everyone else was panicking, he was cashing in. Now he’s turning to oil. And he says it’s one of the biggest opportunities he’s seen in 40 years. [**Click here to see what he’s doing.**](https://click.milmkt.com/hhpz/1CL2731?ref=millionaire-marketing.ghost.io) Lauren Wingfield Managing Editor, The Opportunistic Trader **P.S.** The mainstream financial media won’t tell you about this. [**Click here to see it.**](https://click.milmkt.com/hhpz/1CL2731?ref=millionaire-marketing.ghost.io) --- ### How Often This Actually Happens Two different numbers get quoted here, and the difference matters. One large study of commercial claims found 85 percent of emergency ground transports were out of network, but that 28 percent of emergency trips actually produced a potential surprise bill. A separate analysis of large employer claims estimated that of roughly three million privately insured people taken to an emergency room by ambulance in a year, as many as 1.5 million were at risk of a bill. The amounts are smaller than a hospital bill and large enough to matter on a fixed income. Researchers put the median balance bill at about 450 dollars, and a separate estimate puts the average at 734. ### The Mechanics of a Price Set by City Ordinance Here is why the usual remedy does not fit. Surprise billing rules work by pushing providers and insurers toward a negotiated in-network rate. Ground ambulance service mostly cannot negotiate, because most of it is not a business in the ordinary sense. Local fire departments handle about 37 percent of emergency rides and other government agencies another 25 percent, so roughly five of every eight rides come from a public agency whose charges are set by municipal ordinance rather than by a contract with an insurer. A city council can no more bargain its ambulance rate down for one carrier than it can bargain its parking fines. The economics underneath are unusual too. Roughly three quarters of ground ambulance services bill fewer than three transports a day. Federal analysts reported this year that cost per transport runs about 563 dollars at for-profit operators and 1,626 at government-owned services, and that the lowest-volume quartile costs 2,878 dollars per transport against 918 for the highest. Most of what an ambulance service spends buys the ability to respond at all, not the ride itself, and a service answering two calls a day spreads that cost across two calls. ### What Medicare Does and Does Not Pay For someone on Original Medicare the commercial balance billing problem largely does not apply, because assignment rules cap what the provider may collect. The exposure is different and less discussed. Part B pays 80 percent after the annual deductible, which is 283 dollars this year, leaving 20 percent of an approved amount that can run well over a thousand dollars. Coverage is also conditional in two ways: the ride must be medically necessary, and it must go to the nearest appropriate facility, with mileage past that facility not covered. The denial categories are where the real risk sits. If the trip never qualified as an ambulance benefit at all, because another vehicle would have been safe or because the destination rules were not met, the beneficiary is liable, no advance notice is required, and the federal limitation-on-liability protection does not apply. If the trip did qualify but was judged unreasonable for that patient, an advance beneficiary notice is what shifts liability, and a valid notice cannot be delivered during an emergency. Then there is the call that produces no ride. About 30 percent of emergency calls end in treatment on scene, and Medicare pays for a transport rather than a response, so it pays nothing. ### The Twenty-Two States and the Gap Underneath Them States have moved where Congress has not. Twenty-two now have some form of ground ambulance billing protection: North Dakota caps charges at 250 percent of the Medicare rate, Utah requires insurers to pay a state fee schedule in full, and Washington holds the patient to the in-network amount. *State insurance law cannot reach a self-funded employer plan, which is how two neighbors carried by the same ambulance to the same hospital can receive different bills, with neither able to say in advance which one they are.* Roughly 99.5 million Americans are covered by self-funded plans that state rules cannot touch. Two things are worth knowing before the call is made: whether a household's coverage is fully insured or self-funded, which the benefits summary will answer, and that a Medicare denial for the wrong destination cannot be appealed on affordability grounds. ![](https://storage.ghost.io/c/5b/93/5b931ca3-34c1-4bd0-ba9d-9cc78907a475/content/images/2026/09/paramedics-helping-older-woman-on-front-steps.jpg) --- more interesting content [Robert just asked 443,000 people this question](https://click.milmkt.com/oxuc/1C2732?ref=millionaire-marketing.ghost.io) (Sponsored by Freedom Financial Research) [Why $450M+ in Streaming Revenue Was Only the Beginning for ‘Invincible’ ](https://click.milmkt.com/nunk/1CL3733?ref=millionaire-marketing.ghost.io)(Sponsored by Skybound) [Three Hits In a Row Isn’t An Accident](https://click.milmkt.com/cfrh/1CL6734?ref=millionaire-marketing.ghost.io) (Sponsored by Skybound) [Could This Be the Next $110B Coffee Giant? 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