California ground ambulance billing protections come from Assembly Bill 716, which took effect January 1, 2024. If you have a California-regulated health plan, an out-of-network ground ambulance can only charge you your in-network cost-sharing amount, and the provider cannot balance bill you for the difference. If you are uninsured or self-pay, your bill is capped at the greater of the Medicare or Medi-Cal fee-for-service rate. The law covers both emergency and non-emergency ground transport, whether the ambulance is run by a private company, a municipal fire department, or another public agency.1California Legislative Information. AB 716 Ground Medical Transportation
What You Owe If You Have Insurance
When an out-of-network ground ambulance responds to your call, the provider can only charge you the same copayment or coinsurance you would owe an in-network ambulance under your plan. Nothing more. The ambulance company cannot send you a separate bill for the gap between its sticker price and what your insurer paid.2California Legislative Information. California Health and Safety Code 1371.56
What you do pay counts. Your cost-sharing on a ground ambulance ride applies to your in-network deductible and your annual out-of-pocket maximum, just as if you had used a contracted provider. Before AB 716, an out-of-network ambulance payment might not have counted toward your deductible at all, which meant you were effectively paying twice.2California Legislative Information. California Health and Safety Code 1371.56
Your health plan is required to tell both you and the ambulance provider the exact in-network cost-sharing amount you owe when it pays the provider. If the plan and the ambulance company disagree about the underlying reimbursement, they can fight it out through an independent dispute resolution process. You are kept out of that entirely, and your obligation does not change based on the outcome.
What You Owe If You Are Uninsured or Self-Pay
With no insurance, or a plan that does not cover ambulance services, the provider cannot charge you more than the greater of the Medi-Cal or Medicare fee-for-service rate for the services you received.1California Legislative Information. AB 716 Ground Medical Transportation The cap is automatic. You do not have to apply for it, prove hardship, or negotiate. If the ambulance company’s usual charge is $3,000 but Medicare would pay $800 for the same service, your bill cannot exceed $800.
Those government rates are updated periodically, so the cap moves with reimbursement policy rather than sitting at a fixed number. The point is to anchor pricing to something predictable instead of leaving individual patients exposed to whatever charge a provider chooses to set.
Collections, Credit Reporting, Wages, and Home Liens
AB 716 goes further than most surprise billing laws by restricting what happens if you do not pay right away. Only the protected amount can ever be sent to collections — the in-network cost-sharing figure for insured patients, or the Medicare/Medi-Cal rate for uninsured patients. The full sticker price is off the table permanently.1California Legislative Information. AB 716 Ground Medical Transportation
For 12 months after the initial bill is sent, the ambulance provider and anyone acting on its behalf, including debt buyers and collection agencies that purchased the debt, cannot report adverse information to a credit bureau or sue you to collect. This cooling-off period applies whether you are insured or uninsured.2California Legislative Information. California Health and Safety Code 1371.56
Two protections have no expiration. A ground ambulance provider or its debt collector can never garnish your wages or place a lien on your primary residence to collect an ambulance bill covered by this law, no matter how long the balance has been outstanding.2California Legislative Information. California Health and Safety Code 1371.56
The statute does not require providers to offer payment plans, despite what some summaries of the bill suggest. The collection restrictions give you time, but contacting the ambulance company to arrange installments is still worth doing before the 12-month window closes.
When AB 716 Does Not Apply
The biggest gap catches Californians whose employers self-fund their health benefits rather than buying a policy from an insurance company. These plans are governed by the federal Employee Retirement Income Security Act, and states generally cannot impose billing rules on them.3Congressional Research Service. Surprise Billing in Private Health Insurance Overview of Federal Consumer Protections and Payment for Out-of-Network Providers If your employer’s plan is self-funded, AB 716’s balance billing ban may not reach your ambulance ride. Your plan documents or HR department can confirm whether your coverage is fully insured (state-regulated) or self-funded (federally regulated).
The federal No Surprises Act, which has protected patients from balance billing for emergency room visits and air ambulance services since 2022, specifically excluded ground ambulances.4The Commonwealth Fund. Expanding the No Surprises Act to Protect Consumers from Surprise Ambulance Bills Map of State Laws If you are on a self-insured plan and receive a bill that seems unreasonable, your options include requesting an itemized bill, comparing the charges against Medicare rates, negotiating directly with the provider, and filing a complaint with CMS if you believe broader federal billing rules were violated.
Medi-Cal managed care enrollees are outside AB 716, but existing California law already bars ambulance providers from balance billing Medi-Cal beneficiaries and generally eliminates cost sharing for those services.5Department of Managed Health Care. APL 24-010 Coverage of Ground Ambulance Services Provided by a Noncontracted Provider Medicare Advantage products and specialized health care service plans are similarly excluded from the state’s implementation guidance, though Medicare Advantage enrollees have their own federal protections through Medicare.
How to Push Back on an Illegal Bill
If a ground ambulance provider balance bills you in violation of AB 716, start by filing a grievance with your health plan. If the plan does not resolve it within 30 days, escalate to the Department of Managed Health Care Help Center at dmhc.ca.gov or 1-888-466-2219.6Department of Managed Health Care. Surprise Medical Bills Fact Sheet If your coverage is a traditional policy regulated by the California Department of Insurance instead of a DMHC-regulated plan, file with CDI.
Uninsured patients who receive a bill exceeding the Medicare or Medi-Cal rate should write to the ambulance provider, cite Health and Safety Code Section 1797.233, and request a corrected bill. Keep a copy of the original bill and any correspondence in case you need to escalate.