Summary of State Patient Protection – Balance Billing Laws
Across the United States, the issue of patient financial protection, particularly related to ambulance balance billing, has rapidly evolved into one of the most complex and consequential policy challenges facing the EMS profession.
While the federal No Surprises Act established important consumer protections for many healthcare services, ground ambulance services were notably excluded, leaving states to develop a patchwork of laws and regulations addressing balance billing and reimbursement methodologies.
As a result, EMS agencies now operate within a highly fragmented regulatory environment, where payment standards, patient protections, and payer obligations vary significantly by state.
The purpose of this document is to provide the EMS profession with a clear, concise, and actionable summary of state-level balance billing protections and associated reimbursement frameworks for ground ambulance services.
By organizing this information into a single, accessible resource, PWW Advisory Group aims to equip EMS leaders, policymakers, and stakeholders with a foundational understanding of how different states are approaching this critical issue.
This document provides the EMS community with a clear, concise, and actionable summary of state-level balance billing protections and associated reimbursement frameworks for ground ambulance services.
This is a summary, not a complete statement of these laws, and users should consult with legal counsel on the impact of these laws on your EMS agency.
We hope this resource will assist the profession in several key ways:
- Inform Advocacy Efforts: Support national, state, and local advocacy by identifying trends, gaps, and best practices in existing laws.
- Guide Strategic Decision-Making: Help EMS agencies assess financial risk, payer strategy, and operational impacts within their respective regulatory environments.
- Promote Policy Alignment: Encourage the development of more consistent, sustainable reimbursement models that balance patient protections with the true cost of EMS delivery.
- Advance EMS System Sustainability: Provide a data-driven foundation for discussions around reimbursement reform, including future federal considerations and potential expansion of patient protections to ambulance services.
Ultimately, this document is intended to serve as both a reference tool and a catalyst for meaningful dialogue.
We believe that by bringing clarity to the current landscape, the EMS profession can more effectively advocate for policies that protect patients while ensuring the long-term sustainability and advancement of mobile healthcare.
Sources:
National Conference of State Legislatures – Emergency Medical Services Legislation Database
https://www.ncsl.org/health/emergency-medical-services-legislation-database
Commonwealth Fund Report: Expanding the No Surprises Act to Protect Consumers from Surprise Ambulance Bills