For many Californians, receiving emergency medical evacuation by ambulance may be financially and emotionally taxing. Health and safety are the most important concerns, but the financial impact can be equally damaging. Surprise billing is a financial shock patients often face when ambulance services are out-of-network. The patient is charged for any balances not covered under their insurance. California lawmakers took steps to address this widespread problem. They passed Assembly Bill AB 716 (AB716) to protect California consumers from unfair and unexpected ambulance fees.
California’s AB 716 protections against surprise ambulance billing, central to this law, provide much-needed oversight to a system that has long left patients with few options. AB 716 was enacted in 2024 and represents a landmark move to reduce the financial burden on patients, particularly those navigating personal injury claims or recovering from emergency medical events.
What Does AB716 Do?
AB 716 forbids ground ambulance providers, even if they are out-of-network, from billing their patients more money than the in-network cost-sharing (such as deductibles or co-payments). It basically caps the amount patients can be billed out-of-pocket to align ambulance billing practices.
Before AB716, patients who needed emergency transport often had no option regarding the ambulance service they would receive. If the responding ambulance service was out of network, patients were often billed for the difference between what their insurance paid and what the EMS company charged. Sometimes, this could amount to thousands. This practice, called a "balance bill," left consumers financially vulnerable in a stressful situation.
To be billed, health plans must treat out-of-network ambulance ground rides like in-network rides. In other words, patients won't have to pay unexpected costs above and beyond their usual in-network co-payments.
What It Means For Personal Injury Claimants
AB 716 is essential to claimants for personal injuries, as they are already dealing with physical and emotional traumas resulting from accidents, which often occur without fault on their part. Personal injury cases frequently involve emergency medical services, which include ambulance transportation. Without AB716, victims in auto accidents, pedestrian injuries, and other emergencies may face exorbitant bills for ambulances, even if part of their medical insurance covers the cost.
By capping out-of-pocket expenses, AB 716 ensures injury claimants can retain more of the potential settlement for ongoing medical care, lost wages, and other needs. This change also reduces administrative costs associated with unexpected bills. Claimants and their legal representatives may then concentrate on other facets of the healing process, such as the legal and medical ones.
Legal And Insurance Issues
AB 716, from a legal perspective, offers clarity and predictability. Attorneys representing personal injury clients can now estimate after-ambulance treatment costs more accurately. In years past, large ambulance bills could complicate settlements. They may create larger-than-expected patient obligations or liens. These could reduce the final recovery amount for claimants.
AB 716 also streamlines insurers' claims processing. Insurers are now required by law to consider ambulance billing as part of their in-network coverage, creating a standardized reimbursement framework and reducing the number of billing disputes. It helps resolve claims quicker and prevents disputes between insurance companies and ambulance providers.
Key Exceptions, Limitations, And Exclusions
AB 716 has some limitations, even though it's a massive step in the right direction. The law only covers ground ambulances, not air ambulances. Patients who travel by air may still be subject to balance billing unless federal regulations protect them.
AB 716 does not apply to self-funded employer plans governed by federal law (ERISA). It might not apply to self-funded employee plans, as they are governed by federal laws (ERISA). However, many large employers offer similar protections in compliance with state legislation to maintain transparency.
Patients still have to pay for cost-sharing, such as copays and deductibles, determined by their insurance plans. AB 716 won't make ambulances free, but it will prevent patients from paying more than the rate negotiated by in-network providers and insurers.
Conclusion
AB 716 represents a significant victory for Californians, as it offers vital protections at a critical time in a person’s life: a health emergency. The law encourages financial equity and protects injury victims by limiting ambulance billing outside the network.
California AB716 protects patients against surprise ambulance bills and signals a shift towards greater predictability, transparency, and fairness in emergency healthcare. California's efforts might help shape a more compassionate and equal healthcare system as other states consider similar legislation.