EMS leaders explain ambulance billing, say majority of money fails to go to first responders

People are feeling the pain of sticker shock over large ambulance bills. 

Kathleen Knotek lives in Whitehall with her cat, which inadvertently caused an expensive fall. 

"I just sat down on the floor and called the ambulance service, and unfortunately, it wasn't the same group that usually comes here," Knotek said. 

She pays a subscription to Medical Rescue Team South Authority, but Baldwin EMS answered her 911 call that day. 

"When they came in, they asked me a bunch of questions about what happened, took my blood pressure," Knotek said. 

She did not need to race off to the hospital, and first responders got her back on her feet after evaluating her. But the $891 bill shocked her. Her niece, Martha Brahm, called Baldwin EMS and negotiated a discount. Since Knotek pays a yearly subscription to a neighboring ambulance service, Baldwin EMS agreed to honor that. 

"Since the insurance didn't pay anything, then they said the charge would be 50 percent of the $891, so $445," Brahm said. 

KDKA Investigates learned that in Pennsylvania, the average ambulance ride costs $1,442 for basic life support and $1,580 for advanced life support. Some charge a flat $200 fee for what are called "lifts," but not all do that. 

Baldwin EMS Chief Todd Plunkett said, despite his $6.5 million budget, he is still $400,000 to $500,000 in the red every year. 

"Usually, the insurance companies do not pay us the full amount for the care and the transportation to the hospital," the chief said. "On a $1,000 bill, we might get $300. We might get $200."

He said insurance companies Monday-morning quarterback every call after the fact. 

"No other business or profession would come to your home, come to your place of business, provide a service expecting no pay at the end or partial pay or percentage pay without some type of agreement," Plunkett said. 

Because there's no blanket agreement in the industry, every ambulance company is trying different things to stay afloat. 

"A lot of the charges vary from community to community, and it's not very transparent," said Patricia Kelmar, senior director of healthcare campaigns for Public Interest Research Group.

Kelmar said people are now protected from surprise medical bills thanks to Congress' No Surprises Act, but no one is protected from surprise ambulance bills. She said the issue came up, but Congress chose not to include those protections for now, and instead created a committee to look deeper into it. 

"The committee was appointed, and I served as the consumer patient representative on the committee," Kelmar said. "We put together recommendations that were sent to Congress in September of 2024, and we have yet to see action by Congress."

For Kelmar, until Pennsylvania can come up with a consistent pricing system, she suggests reading the language closely before paying for a subscription to any local ambulance fleet. 

 "It's a buyer-beware situation," Kelmar said. "We don't really recommend them because they are so minimally useful."

However, she said subscriptions could help some people looking for regular transportation back and forth to somewhere other than a hospital, like a nursing home. 

Chief Plukett said his ambulance company cannot provide those types of rides, but does cover 100 percent of the bills for subscription members. 

"If you're a subscriber, you're a subscriber," he said. "Our subscription rates sometimes go up to $95, $105 a year. You divide that over 12 months, I think that's a fair amount."

Knotek fears her sticker shock could cause her to hesitate next time she needs help.  

"That's kind of asking a lot from a senior citizen on a fixed income," Knotek said. 

"This is a public health emergency," Kelmar said. "People are making unwise medical decisions because of the cost."

Kelmar says the good news is that there are laws on the books in other states, so Pennsylvania could look at the best laws and implement those.