Beginning in 2022, if you end up in an emergency room, and find out later that someone on the medical team was not in your insurer’s approved network, you won’t be stuck holding the bill for getting health care. But you could be on the hook for the ride to the emergency room.

Congress has outlawed “surprise” billing that has left patients with higher costs when they didn’t have the foresight to figure out in the middle of an emergency if everyone working on their case was in their insurance network. The No Surprises Act also prohibits those out-of-network emergency health care providers from going after patients for the difference between what an insurer paid them and what they actually billed. That all too common practice is known as balance billing.

But there’s one big honkin’ caveat to this good news: The federal law does not cover ambulance rides to the hospital, except for air-ambulance transport.

An expensive ride

New research from Health System Tracker, a joint project of the Peterson Center on Healthcare and the Kaiser Family Foundation, found that more than half of all emergency ambulance rides in 2018 ended up being out-of-network. Separate academic research published last year estimated that the median cost of surprise bills for out-of-network emergency ambulance rides is $450. In high-cost areas such as New York City, it can be at least double that amount. Often, much more.

While 51% of all ambulance rides in 2018 triggered an out-of-network charge, your odds of having financial insult added to injury are far higher in many states.

Peterson-KFF had data for 32 states. At least 70% of emergency ground ambulance rides in California, Colorado, Florida, Texas and Washington triggered an out-of-network bill. In Illinois and Wisconsin, 69% of emergency ambulance transports triggered a surprise out-of-network bill. Six in 10 ground ambulance rides in Oregon, Virginia, Kansas, New Jersey, New York, Arizona and Pennsylvania resulted in the patient being hit with a surprise bill.

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Why didn’t Congress protect ambulance rides? It’s complicated.

There doesn’t seem to be a big powerful ambulance lobby behind the exclusion of ground ambulance rides in the new legislation. Rather, Congress got all twisted in knots trying to understand each state’s ambulance system and regulations.

The Peterson-KFF report notes that nearly two-thirds of emergency ambulance rides were provided by a government entity, such as a fire department. Throttling a government service from collecting ambulance fees would likely require a municipality to raise other resident user fees, or taxes. That’s not something many elected officials are eager to pursue. Thus, Congress opted to punt, saying it will study the ground ambulance ecosystem before considering any regulation of its surprise billing practices.

How to (maybe) navigate around out-of-network charges

To state the obvious: In a searing emergency situation, the reality is that you are in no position to advance shop for in-network transport. About all you can do is pressure your congressional reps to focus on that promised study of the problem.

That said, keep in mind that if you find yourself needing nonemergency ambulance transport, you have more control. For instance, if you are being transported from one facility to another, say from a hospital to rehab, you might have the time — if not the energy — to contact your health insurer and ask what in-network options you have for your ambulance ride.

Yet, the reality is that this is just reason 4,285 why having a bulked-up emergency savings fund can be so important for your financial health.

It’s not just the deductibles and copays on doctor bills, tests and treatment that can add up. Merely trying to get to a hospital in an emergency can drive you into debt if you don’t have the cash ready to pay for the ambulance ride.