In my case, my recent emergency ambulance trip was paid for by my insurance, but the insurance company sent the check to me and I had to pay the ambulance bill with it. There is a move afoot to change NYS law to compel insurance providers to pay ambulances directly regardless of network status.
Your recent experience brings mine to the conversation. In June I fell and shattered my heel bone. We were camped up in the northern Adirondacks. My wife called 911 less than a minute after the injury. It took 80+ minutes for an ambulance to reach me. The local squad got paged 3 times five minutes apart. Their prime unit was already out on a call. After fifteen minutes, the call went to mutual aid. The next nearest squad was 25 minutes away, and from the front gate of the campground to our camp site is another 10-15 minutes. Luckily, there was a nurse/firefighter/former EMT nearby. She triaged me (after I had already done the same) and sat with me until the ambulance arrived. The ambulance ride to the hospital took another 35-40 minutes.
The bill was $830 for the ambulance plus $439 mileage. Me being over 65, the bill went to Medicare first and then to my insurance carrier. I got an informational copy of the bill only.
The point here is two fold. First, EMS services in rural and mountainous areas are much different from the cities and suburbs. Trained and certified volunteers are not plentiful, and the distances are considerable. That is the reality of things in much of this country. My only problem with this particular situation is the length of time before mutual aid was started. But that is local procedure set by the individual ambulance squads. It's not how I'd do it.
Secondly, EMS ain't cheap. The ambulance crew that transported me was a paid driver and a volunteer paramedic. The cost is typical of this entire region. I live at the southern edge of the Adirondacks, and the squads down here bill about the same amounts.
The town I live in is the only area in this county where the ambulance does not bill for services. We're all volunteer, and we can't always raise a full ALS crew which means we have to pass the call to our backup which is a commercial service. Luckily, they are always dispatched at the same time we are and not cancelled until we know that we have a crew. If we don't have a paramedic, they continue to the scene and it becomes an ALS link-up.
When we move away from the cities and large suburbs, we make trade-offs whether we realize it or not. Small towns don't have paid crews for EMS and fire, and there's rarely anyone sitting in the station waiting for a call so we're pretty much guaranteed to have a longer wait for help to arrive. And it's a longer trip to the hospital, let alone to reach a trauma center or cath lab.
That's about as real as it gets.
