North Carolina Bill Looks To Put $100 Cap on Ambulance Rides

A new bill in North Carolina aims to slash patient costs for emergency rides to $100. House Bill 489 passed with strong backing this May, pushing insurance firms to count ground transport as in-network care.

"When you call 911, you don't get to say, 'I want an ambulance in my network,'" said N.C. Rep. Donnie Loftis (R-Gastonia) to WFAE. "There are people who call 911 for transport, and then three or four months later get a $3,000 or $4,000 bill."

The measure fills gaps left by federal rules. While the No Surprises Act blocks unexpected charges for emergency treatment, it skips ground transport services. Most emergency rides, about 60%, fall outside insurance networks across the U.S.

Local costs hit hard. MEDIC bills $1,194 for basic emergency trips in Charlotte, plus $29 per mile. Wake County's rates run from $769 to $1,113, with an extra $13.73 each mile.

The insurance sector warns of rising costs. Under the bill, providers must get paid at least four times the Medicare rate or their standard fee, whichever costs less.

"If the floor is 400%, then what's the ceiling?" said David Smith, who leads the NC chapter of the National Association of Benefits and Insurance Professionals to North Carolina Health News.

Cash flow plagues EMS teams. Last year, MEDIC lost $27 million to unpaid bills, nearly a third of its $90 million budget. Most patients use Medicare or Medicaid, which pay below the service costs.

"When we pick up a Medicare or Medicaid patient, we don't even get enough to pay to have two paramedics on the truck," said Regina Godette-Crawford, speaking for NC EMS administrators.

The rules won't touch federal rates or big company plans. Medicare, Medicaid, and self-funded insurance stay the same.

Other states show mixed results. After New York passed similar laws, more plans added ambulance coverage. Yet prices jumped 13%.

As the bill moves to the NC Senate, patient groups push for federal action. They say state-by-state fixes fall short; only national rules can shield all patients from shock bills.