Jagdish Whitten 因车祸被转运了 6 英里，收到了 American Medical Response 公司开出的$12,873账单，最终自付约$2,900[1]。每年约有 300万拥有私人保险的美国人乘坐急救车，其中约一半收到网络外账单 [1]。
文章指出，美国救护车服务费用高昂且不可预测的核心原因在于支付模式与行业成本结构的严重错配 [1]。自 1965年 Medicare将救护车视为单次医疗服务而非保险选项进行付费以来，这种机制导致了长期的财务失衡 [1]。Medicare设定的平均运输成本为$2,673，而实际仅支付约$329[1]。
为了弥补向 Medicare、Medicaid及无保险患者提供的低于成本的运输损失，私营救护车公司必须从能支付的私人保险公司身上收回全部成本 [1]。由于该行业具有高固定成本（待命状态）和低边际成本的特点，现行按次付费模式迫使公司采取上述策略[1]。尽管 2020年美国国会通过《无意外法案》禁止大多数紧急护理的意外账单，但地面救护车被明确排除在该法规之外 [1]。
Jagdish Whitten received a bill of $12,873 from American Medical Response after being transported six miles following a car accident, ultimately paying approximately $2,900 out-of-pocket [1]. This case illustrates the high and unpredictable costs associated with emergency medical transport in the United States. Approximately 3 million Americans with private insurance ride ambulances annually, about half of whom receive out-of-network bills [1].
The root cause lies in a payment structure mismatch established when Medicare began reimbursing ambulance services as single episodes of care rather than an insurable option in 1965 [1]. Under this model, the average cost per transport is roughly $2,673, yet Medicare pays only about $329 [1]. To offset these losses on payments to Medicare, Medicaid, and uninsured patients, private ambulance companies must charge high fees to private insurers capable of paying full rates [1].
Although Congress passed the No Surprises Act in 2020 to ban most surprise bills for emergency care, ground ambulances were explicitly excluded from this protection [1]. The industry operates with high fixed costs while on standby and low marginal costs; consequently, current per-episode payment models force companies to recoup all expenses from a small number of privately insured patients who can afford the charges [1].