Ground ambulance — NSA does NOT cover it

Statute-pinned · primary sources only

Why ground ambulance was excluded

When Congress enacted the No Surprises Act, ground-ambulance services were left out due to lobbying concerns about reimbursement complexity for ground-ambulance operators (many of which are municipal or volunteer-staffed). NSA established an Advisory Committee on Ground Ambulance and Patient Billing to study the issue, but as of writing, no federal balance-billing protection exists for ground ambulance.

Which states have their own law

Approximately 10-15 states have enacted their own ground-ambulance balance-billing protections. Commonly-cited examples include New York, Colorado, Maryland, Maine, and Vermont. Click any state below for its statute citation, effective date, and state DOI consumer-protection entry point.

state law applies (18)partial / verify (2)no state law (25)verification pending (6)

Bucketed state list

NSA does not cover ground-ambulance services. State law controls. Click any state for its ground-ambulance balance-billing posture, the state DOI consumer-protection entry point, and a state-specific statute citation where one is in force.

state law applies — state has own law (e.g., NY, CO, MD)partial / verify — partial coverage / verify scopeno state law — no state ground-ambulance law[VERIFY] — primary-source verification pending

CACaliforniapartial / verify COColoradostate law applies ILIllinoisstate law applies INIndianastate law applies KYKentuckystate law applies LALouisianastate law applies MDMarylandstate law applies MEMainestate law applies MSMississippistate law applies NHNew Hampshirestate law applies NMNew Mexicopartial / verify NYNew Yorkstate law applies OHOhiostate law applies OKOklahomastate law applies OROregonstate law applies UTUtahstate law applies VTVermontstate law applies WAWashingtonstate law applies WVWest Virginiastate law applies ARArkansasstate law applies ALAlabamano state law AZArizonano state law CTConnecticutno state law FLFloridano state law GAGeorgiano state law HIHawaiino state law IAIowano state law IDIdahono state law KSKansasno state law MAMassachusettsno state law MIMichiganno state law MNMinnesotano state law MOMissourino state law NDNorth Dakotano state law MTMontana[VERIFY]NENebraskano state law NVNevadano state law PAPennsylvaniano state law RIRhode Islandno state law SCSouth Carolinano state law SDSouth Dakotano state law TNTennesseeno state law TXTexasno state law VAVirginiano state law WIWisconsinno state law WYWyomingno state law AKAlaska[VERIFY]DEDelaware[VERIFY]DCDistrict of Columbia[VERIFY]NCNorth Carolina[VERIFY]NJNew Jersey[VERIFY]

What it means for ERISA self-funded plans

Even where state law exists, ERISA self-funded plans escape state regulation under federal preemption (29 U.S.C. §1144). If you're on a self-funded employer plan, the state ground- ambulance protection may not reach your bill. Negotiation with the ambulance provider is often the only option for ERISA self-funded plan members.

What patients can do

Look up your state. Click your state above. If state law applies, the state DOI consumer-protection page is the starting point.
Request an itemized bill from the ambulance provider in writing. Many ambulance bills include line items that can be negotiated down.
Ask about hardship discounts. Municipal and non-profit ambulance providers often have hardship discount policies.
If your plan paid an OON rate, request a re-review citing medical necessity. The plan may agree to recompute.

Quick answers

Frequently asked

Why doesn't the No Surprises Act cover ground ambulance?

Ground ambulance was left out of the federal NSA due to reimbursement complexity for ground-ambulance operators (many of which are municipal or volunteer-staffed). The NSA established an Advisory Committee on Ground Ambulance and Patient Billing to study the issue, but no federal balance-billing protection exists for ground ambulance as of now.

Which states have their own ground-ambulance balance-billing laws?

Approximately 10-15 states. Commonly cited: New York, Colorado, Maryland, Maine, Vermont. The 50-state matrix on this site shows each state's posture with a primary-source citation. Even where state law exists, ERISA self-funded plans escape it under federal preemption (29 U.S.C. §1144).

What can I do if my state doesn't have a ground-ambulance law?

Request an itemized bill from the ambulance provider in writing. Ask whether your insurer paid an out-of-network rate — if so, request a re-review for medical necessity. Ask about hardship discounts (many municipal and non-profit ambulance providers have policies). Negotiate directly with the provider.

Related healthcare resources

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Medicare Supplement Open Enrollment Period decoder + 50-state rule grid.

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PetInsuranceDenied

Denial-appeal pattern recognition (consumer health-insurance-adjacent).

Informational, not medical, legal, or insurance advice. Consult a healthcare-billing attorney or patient-advocate before acting on a No Surprises Act dispute. The free CMS NSA complaint pathway is 1-800-985-3059.