When the No Surprises Act was passed in 2022, it banned surprise bills for ER visits and air ambulances. But ground ambulances—the ones 99% of people actually use—were left out. Why?
The "Local Funding" Problem
Almost half of the nation's 911 responses are handled by local fire departments. If the federal government capped what those departments could charge, many towns argued they would have to raise property taxes to keep their ambulances running. Congress blinkled at the political cost of interfering with "local control."
Furthermore, ground ambulance systems are incredibly fragmented. There are over 14,000 different ground ambulance providers in the U.S., ranging from massive private equity-owned corporations to volunteer non-profits. Creating a single federal standard that worked for all of them was deemed "too complex" for the initial 2022 rollout.
The Ground Ambulance Advisory Committee
In response to the public outcry over this exclusion, the federal government formed the GAPB (Ground Ambulance and Patient Billing) Advisory Committee. Their job is to study the issue and provide recommendations for a potential national price cap, though as of 2026, no federal ground protection has yet been signed into law.
Until federal law changes, your ONLY protection against ground ambulance surprise bills comes from specific state-level laws. This is why our tool checks for state mandates in every search.